Hospital Wards Escape Closure

Los Angeles County health officials Friday abandoned their proposal to close the obstetric, pediatric and neonatal wards at Martin Luther King Jr./Drew Medical Center after belatedly discovering that the move would have cost them $29 million in government aid.

The county Department of Health Services made the announcement just three days after releasing plans for an Oct. 18 public hearing on the controversial recommendations -- the final step in a two-month process. The Board of Supervisors is expected to cancel that hearing Tuesday.

“I’m very disturbed and disappointed that this information has come to us at the 11th hour,” said Supervisor Zev Yaroslavsky. “The county looks like the gang that can’t shoot straight on Martin Luther King hospital, and people would be justified in concluding that.”

The county announced its plans for shrinking the troubled public hospital without first checking with state officials to make sure that the proposal would meet legal requirements for certain critical funding. Officials did not ask the state about the legal consequences until Sept. 15, more than a month after county health director Dr. Thomas Garthwaite recommended closing the units.

The proposed downsizing triggered fierce opposition from community groups, politicians and even the supervisors’ own advisory board on King/Drew, some still angry over the closure of the hospital’s treasured trauma unit in March. These critics argued that obstetrics and pediatrics were vital to the largely poor and minority community served by King/Drew, and that the hospital’s problems would not be fixed by eliminating wards.

“We went through all of this for nothing,” said Jim Lott, executive vice president of the Hospital Assn. of Southern California and vice chairman of the King/Drew advisory board. “It was unnecessarily painful for a lot of people, and it bolsters the naysayers, who believe that some of the [health] department’s leadership is on a mission to shut the hospital down. And that’s unfortunate.”

Friday’s about-face marks the latest embarrassing disclosure about the county’s bungled management of King/Drew. A series of articles in The Times last year detailed how the county’s Board of Supervisors and health officials allowed deadly problems to fester for more than a decade.

The hospital south of Watts lost its national accreditation earlier this year and has been threatened with the loss of federal funding because of a series of patient care lapses, some of them lethal. For now, the hospital is being run by Navigant Consulting Inc., a turnaround firm being paid $15 million for a one-year contract, which expires at the end of the month.

Los Angeles Councilwoman Janice Hahn, who opposed the downsizing proposal, said it actually had exacerbated the hospital’s problems by scaring away patients who thought the services had already been cut and potential employees who questioned the hospital’s future.

“I think this is an answer to prayer,” she said of the county’s retreat. “I wish they would have listened to reasonable voices from the beginning.”

In announcing his plans in August, Garthwaite said the county needed to reduce the range of services provided at King/Drew so it could focus on the problem areas. In addition, he said, pediatrics and obstetrics were, relatively speaking, little used.

Last year, King/Drew delivered about 600 babies, compared with about 4,000 a decade earlier. Most obstetrical patients and children have private insurance or coverage through Medi-Cal, the state’s insurance program for the poor, and can choose private hospitals for their care, he said.

In a memo to the Board of Supervisors sent late Friday, Garthwaite explained the county’s current predicament.

He said county officials had asked the state Department of Health Services on Sept. 15 whether their proposal would jeopardize funding under a crucial state and federal program. The program, which pays extra money to hospitals that serve a large number of Medi-Cal and uninsured patients, netted King/Drew $29 million last year.

One requirement of the program is that each eligible hospital have at least two obstetricians on staff who can provide care for pregnant Medi-Cal patients.

The county had assumed that the cuts would not affect its eligibility, because it would still have obstetricians on staff, although they would be offering gynecological services. But Friday, state health officials concluded otherwise.

If the hospital had to keep obstetrics, Garthwaite said in his memo, it needed to keep its neonatal intensive care unit too, for the sickest babies. He also withdrew his plan to close down inpatient pediatrics and the pediatric intensive care unit “because of the limited benefit of these reductions in isolation of the other planned service changes,” according to the memo.

Garthwaite said county lawyers had reviewed his initial recommendations and had not raised any legal objections.

Officials decided to ask the state to review the matter, he said, after learning that attorneys for the Alameda County public hospital had determined that closing obstetric services could lead to a loss of funding. But even after conversations with the state last month, Garthwaite said county lawyers expected a favorable decision.

“Our attorneys were in all the meetings leading up to the August announcements and were looking at the legal ramifications of our proposals,” he said. “I was relying on our attorneys.”

County supervisors expressed anger that Garthwaite had not told them of the potential problem. They also complained about overall delays in reforming King/Drew. The health department told supervisors Friday that the hospital would not be ready to reapply for national accreditation until March, not December as previously pledged.

“There’s no excuse for Dr. Garthwaite to have withheld this information from the Board of Supervisors,” said Supervisor Mike Antonovich. He said the board should continue with plans for the Oct. 18 hearing, a view his colleagues didn’t share.

Supervisor Gloria Molina, who had opposed the downsizing measure, welcomed its demise but voiced exasperation at the lack of progress in reforming the hospital.

“There is a leadership problem, a credibility problem, an accountability problem, and more than anything else, the people who are suffering is every patient in this service area,” she said.

“This is their emergency room. This is their hospital. They need to go there, and unfortunately, we’re not providing them the services they need,” she said.

Molina and Supervisor Yvonne Brathwaite Burke, who also opposed the downsizing and whose district includes King/Drew, said Friday’s developments created an unnecessary rift with hospital supporters.

“Getting the people all riled up over this was very unfortunate,” Burke said. “It would have been better to have everybody working in the same direction to fix things.”

Lark Galloway-Gilliam, a leader of the Coalition for Health and Justice, said the proposed cuts were a “complete distraction.”

“We just need some assurance that we can move forward with the task at hand,” she said, referring to improving the hospital. “We’ve spent a lot of time and energy on this, but I’m glad it’s been stopped.”