King/Drew Gets Mixed Review

The mortality rate at Martin Luther King Jr./Drew Medical Center has fallen in the last six months as officials closed the hospital’s trauma center and worked to correct pervasive quality problems, a new report shows.

But other key measures of care, including basic treatments for common conditions, suggest the hospital still needs improvement, according to the report released this week by the Los Angeles County Department of Health Services.

The hospital’s inpatient mortality rate dropped from 3.2% in January to 1.6% in June, from 26 to 15 deaths, the report said. The trauma center’s closure in March helped by reducing the number of critically ill patients taken to the hospital.

The death rate at King/Drew, a public hospital in Willowbrook, south of Watts, is now in line with national averages, the report shows. Emergency room patients are spending far less time waiting to be seen, treated and released. Critically ill patients on ventilators are suffering fewer infections. And doctors are doing a better job of supervising physician trainees.

“The facility is showing signs of moving in the right direction,” said Dr. Bruce Chernof, the health department’s senior medical director.

On the other hand, King/Drew’s nurses are not assessing patients’ conditions as well as they did earlier this year, according to the report. In May, staffers notified doctors only 58% of the time when patients’ vital signs were abnormal, down from 75% in January.

In addition, King/Drew continues to perform worse than other county hospitals in following some national standards for treating heart attacks, congestive heart failure and pneumonia.

The hospital also has increased its reliance on traveling nurses, who now account for more than half of all nursing hours. The lack of permanent staff is probably hindering the pace of change, experts have said.

“I don’t see any change of any substantial nature ... that’s anchored to any sense of permanency,” said Jim Lott, executive vice president of the Hospital Assn. of Southern California and a member of King/Drew’s hospital advisory board. “It’s not as good as I think we would have expected it to be by this point in time.”

The health department released the report to help the county Board of Supervisors measure the hospital’s progress under Navigant Consulting Inc., a turnaround firm that took over the hospital’s operations in November. Under a one-year contract, the firm is being paid $15 million.

Under Navigant’s watch, regulators have continued to cite the hospital for medical errors and misconduct, including a pattern of medication mistakes and deaths after nurses failed to respond to vital-sign alarms.

Separately, county auditors have found repeated examples of King/Drew doctors whose billings could not be accounted for or who moonlighted at other medical facilities on county time. Since January 2004, the hospital has taken disciplinary action against 242 employees, of whom 128 resigned under pressure or were fired.

Hank Wells, a Navigant consultant serving as King/Drew’s acting chief executive, said his team had worked aggressively to fix the hospital, especially to reduce mortality. The consultants created rapid response teams to quickly mobilize when a patient’s vital signs plummet. And Navigant now has nurses patrolling the units, scouting out trouble spots.

“Are there things that still need to be done? Absolutely,” Wells said. “Are we satisfied with the level of progress? I don’t think we’ll be totally satisfied until we’re out of the limelight. I think the answer is mixed, but I believe positive.”

Regulators and accreditors, who have been sharply critical of King/Drew over the last two years, will soon weigh whether the hospital has improved enough to regain its good standing.

Later this year, the hospital plans to reapply for its seal of approval from the Joint Commission on Accreditation of Healthcare Organizations, which pulled its endorsement in February.

In addition, King/Drew must convince the U.S. Centers for Medicare and Medicaid Services that it has fixed numerous patient-care lapses and, as a result, should not lose $200 million in federal funding as has been threatened.

Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, said the new report suggested to her that the board should rethink its negative opinion of the hospital.

“Apparently from what this report says, Martin Luther King hospital does not have any more fatalities and compares favorably with other hospitals on a national level,” she said. “It’s a very positive message.”

But Supervisor Mike Antonovich said the report is deceptive.

“It misleads the public by painting a picture that King/Drew is comparable to hospitals on a national level,” he said. “King/Drew lost their accreditation, whereas the other hospitals are performing properly and meeting their standard of care.”

Supervisor Gloria Molina said that the outside inspectors’ findings would carry more weight for her than the data compiled by the health department.

“I’d like to applaud this as much as possible,” she said. “It’s just hard for me to just stand up ... and say we’re on our way to everything being fixed. I’m not totally convinced of that as yet. I’d like to be proven wrong.”

Dr. Hector Flores, chairman of King/Drew’s advisory board, said the continued focus on the hospital by the news media, politicians and regulators appeared to be paying off.

“Everybody got the wake-up call,” he said. “If nothing else, people realize they’re under the magnifying glass and are minding their Ps and Qs better than they were before.”