Hospital Faces Loss of Funding

Federal health officials said Wednesday that they would cut off money to Martin Luther King Jr./Drew Medical Center as of Feb. 18 unless the hospital passed an inspection before then.

Without the $200 million a year in payments from the Medicare and Medi-Cal public health insurance programs, King/Drew could be forced to close. That would imperil the largely low-income African American and Latino population served by the Los Angeles County-owned hospital in Willowbrook, south of Watts.

The U.S. Centers for Medicare and Medicaid Services has cut off funds involuntarily to only six American hospitals in the last three years, said Jeff Flick, the agency’s regional administrator.

The agency’s threat came one day after a national hospital accrediting group revoked its seal of approval for King/Drew because the medical center did not meet quality standards.

County officials expressed optimism, however, that the hospital would pass its next inspection, which will be narrowly focused on the treatment of psychiatric patients.

Regulators have reported that hospital staff relied too heavily on county police to shoot aggressive mental patients with Taser stun guns instead of trying less extreme methods first. (The officers work for the county Office of Public Safety but are stationed at the hospital.)

Although King/Drew failed an inspection on that issue in December, managers have since repeatedly drilled employees on the proper handling of such patients.

County Supervisor Zev Yaroslavsky would not predict how King/Drew would perform when it was inspected again, but he said, “This is not rocket science.”

“It’s just about how you respond to a psych ward incident without using a Taser gun,” he said. “There is a way to do it. They’ve been trained how to do it. They’ve been practicing. I’d be very surprised and disappointed if they weren’t able to pass muster this time.”

Federal inspectors have cited King/Drew twice in the last year for failing to properly handle aggressive mental patients, including inappropriate use of restraints and Tasers.

Until those problems are corrected, the inspectors have said, patients at the facility are in jeopardy.

Hospital officials had promised to minimize the role of police on teams that responded to psychiatric patients and, ultimately, to replace them with trained mental health workers.

The officials had also said they would retrain employees on how to handle aggressive psychiatric patients without resorting to stun guns or restraints.

But during their examination of the hospital in late December, inspectors found that workers were still unable to follow proper procedures. The reviewers conducted three drills, in which doctors and other staff members were asked how they would respond to aggressive mental patients.

In all three, hospital employees were not able to “clearly describe and demonstrate their roles in managing assaultive patients,” the county Department of Health Services acknowledged at the time.

After additional training and testing, employees now know what they are doing, county officials say.

“I’m much more confident this time than I was last time,” said Kae Robertson of Navigant Consulting Inc., which has been responsible for day-to-day operations at King/Drew since November.

“Always, your success is dependent upon each person,” Robertson said. “Surprise always makes people more nervous than just a drill.”

Federal inspectors said they had spent a great deal of time dealing with King/Drew. In a letter Wednesday, the Medicare agency said it had conducted eight surveys at the hospital in the last 14 months and offered to help fix problems.

“Unfortunately, despite our productive working relationship, the hospital’s performance on the most recent survey” was inadequate, said a letter from Steven Chickering, a regional official with the Medicare agency.

The agency said that in addition to the problems with mental patients, the hospital failed to meet standards in nursing, pharmacy and quality assessment.

Even if federal funding is cut off Feb. 18, King/Drew will still be eligible for some money to cover the cost of emergency medical care.

Supervisors, however, have said the loss of the $200 million would make it extremely difficult to keep the hospital open.

Supervisor Don Knabe said the government warning underscored something he had said repeatedly as supporters of the hospital accused the supervisors of trying to close King/Drew: The greatest threat to the hospital’s continued existence comes from outside regulators who continue to find problems.

“It’s not the Board of Supervisors that the hospital and the community have to worry about,” he said. “It’s the federal regulators -- and here it comes.... We need to do everything we can to save the hospital.”

Other supervisors said they thought the hospital was rebounding.

“We’re really struggling to make sure that we’re putting in place a real fix-it plan,” Supervisor Gloria Molina said. “We’ve had these assurances in the past, as you know.”

In the event that King/Drew fails again, federal officials are taking legally required steps toward cutting off funds. On Friday, they will publish a notice of their decision in the Long Beach Press-Telegram.

Dr. Thomas Garthwaite, director of the county health department, said the notification sent Wednesday was expected and wouldn’t affect services available at the hospital.

“There’s really nothing new today,” he said. “This is just the process that must be followed according to their regulations.”

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Chronology of lapses

Martin Luther King Jr./Drew Medical Center has repeatedly been criticized and threatened by federal health regulators for its care

of patients. Below are some key events:

January 2004: The U.S. Centers for Medicare and Medicaid Services determines that King/Drew is out of compliance with federal standards in nursing services, quality assessment and performance improvement.

February 2004: King/Drew submits an acceptable plan to correct the problems.

March 2004: The Medicare agency says patients are in immediate jeopardy because of lapses in medication delivery. It sets March 26 as the cutoff date for federal funds, but later rescinds the termination date.

June 2004: The Medicare agency says patients are in immediate jeopardy because of inappropriate use of Taser stun guns on psychiatric patients. It sets June 26 as the cutoff date for federal funds, but later rescinds the termination.

July 2004: The Medicare agency finds major problems in nursing services, patients’ rights and the physical environment. They have not yet been corrected to inspectors’ satisfaction.

December 2004: The Medicare agency again declares that patients are in immediate jeopardy because of inappropriate use of Taser stun guns. A review later in the month finds that the problem has not been corrected.

Feb. 2, 2005: The Medicare agency sets Feb. 18 as the date to cut off federal funding to the hospital. King/Drew has one final inspection to show that it has corrected the problem.

Source: Times research. Graphics reporting by Charles Ornstein