King/Drew May Lose All Training

A national accrediting group has taken the first step toward shutting down all physician training programs at Martin Luther King Jr./Drew Medical Center, finding that the hospital’s oversight is substandard.

King/Drew has several months to contest the “unfavorable” assessment, which could lead to the elimination of the hospital’s 18 doctor-training programs, including emergency medicine and pediatrics. Such a sweeping closure at a teaching hospital would be unprecedented.

The negative rating is a distinction shared by only 13 of the 374 institutions nationwide with more than one residency program. The hospital received the same evaluation the last time it was reviewed, in 2000.

“This is horrifying,” said an emotional Dr. Roberta Bruni, a neonatologist at King/Drew who learned of the proposed rating Wednesday. She and others had been optimistic that the hospital would be judged favorably after a reviewer visited the hospital last month.

“We thought the review went well,” Bruni said. “The system has been overhauled so dramatically.”

The hospital in Willowbrook, just south of Watts, relies on physician trainees, or residents, to provide the core of its care to its mostly impoverished and minority patients. Their loss at a public hospital would be “absolutely devastating,” said Dr. David Altman, chief medical officer at Los Angeles County-USC Medical Center, which like King/Drew is owned by the county.

“I can’t envision it,” Altman said. “You can’t function at the same level. You’d clearly have to shrink.”

The proposed action by the Accreditation Council for Graduate Medical Education is the harshest blow yet to King/Drew. It learned earlier this month that, because of deficiencies, its surgery training program would have to close next June. Its troubled radiology program was ordered to close in June, and four other residencies have been placed on probation or received warnings.

The council’s proposal suggests that it has rejected the hospital’s assertions that it had cleaned up problems in overall oversight of its 330 residents, who are typically recent medical graduates being trained in a specialty field.

Hospital officials will receive a letter outlining detailed problems within weeks. In 2000, the council cited King/Drew for lack of commitment, insufficient supervision of residents, overworking residents and using them for inappropriate chores.

Some critics said the county needs to take immediate corrective action.

“There’s a great deal of incompetence and mismanagement at the hospital, and it has to be corrected by the county,” said state Assemblyman Mervyn Dymally (D-Compton), who heads a special legislative panel on King/Drew. “Some heads have to roll.”

Dr. Thomas Garthwaite, director of the Los Angeles County Department of Health Services, said the hospital is now in a “very precarious” position. “We need to change the direction things are headed.”

News of the accrediting council’s proposed action also intensified calls for UCLA to step in and help run the beleaguered training programs before they are lost.

“They just have to quickly determine that things have reached a level of crisis that warrant extraordinary intervention,” said Assemblyman Mark Ridley-Thomas (D-Los Angeles), a member of the legislative panel on King/Drew. “UCLA needs to take a more active role.”

A spokesman at Charles R. Drew University of Medicine and Science, which runs the hospital’s training programs, would not comment in detail, saying that no final action has been taken and that it has not yet received a written report from the accrediting council.

The most immediate effect of the council’s proposed “unfavorable” rating is that the hospital won’t be able to apply to begin new radiology and surgery training programs. An institution must have a favorable rating to open new programs.

That means that about 45 surgical and radiology residents will have to find jobs at other hospitals by next summer. “This is it for us,” said Dr. Anthony Charles, a surgical resident. “This news is obviously quite sad to us.”

The accreditation council has never before closed all of the training programs at an institution, spokeswoman Julie Jacob said, but the group changed its rules last year to crack down on bad programs. Now, it is possible to strip an institution of all training programs after two unfavorable ratings. In the past, it took three.

After a review committee upholds a hospital’s second unfavorable rating, it “will propose administrative withdrawal of accreditation of the institution’s programs,” which may lead to their closure.

Los Angeles County Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, said the county needs to move quickly to install a permanent administrator and medical director at King/Drew. Both jobs have been without permanent leaders for at least a year.

The county’s $13.8-million contract with Drew medical school allows the county to sever its ties if the hospital is forced to close two training programs, as is now the case. But Burke said the hospital should be given more time to fix its problems.

Still, the supervisor said, she is worried that infighting at the school over its leadership is hindering its ability to fix problems.

“I know there are people at this moment demanding that there be a change in terms of the president of the medical school,” Burke said. Although she said the county should do everything it can to help save Drew, “we can’t let the hospital go down” in the meantime.

Garthwaite said the Drew school board needs to be transformed from one made up of community representatives to one familiar with running a top-notch school.

He said he is awaiting the recommendations of a task force led by former Surgeon General David Satcher on how to restructure the training programs at King/Drew. The panel will visit the hospital next month.

Dr. M. Alfred Haynes, chairman of the Drew board until earlier this month, acknowledged that the school may not have done enough to address the accrediting council’s concerns. But he added that many people don’t recognize the difficulty of running a teaching program to serve an indigent community and train minority doctors. “Rather than criticizing for the failures, one has to realize that they undertake a big job,” he said.