Massive overhaul of ailing hospital urged

"If they don't delegate the responsibility and step aside, it's going to be a nightmare," said Dr. Ron Anderson, chief executive of the Parkland Health and Hospital System in Dallas.

Handing over control to an independent board or healthcare professional would be the best way to ensure that good medicine takes precedence over King/Drew's polarizing politics, said many of those consulted.

The Times talked with leaders of the nation's largest public hospital systems, national accreditors, and experts in hospital management, human resources, patient safety and nursing. In addition, the paper interviewed elected officials and others familiar with King/Drew's politics.

They were asked to suggest remedies for problems detailed in a five-part series, "The Troubles at King/Drew," published by The Times two weeks ago.

A yearlong investigation by a team of reporters determined that errors and neglect at the 32-year-old facility in Willowbrook, south of Watts, had repeatedly harmed or killed patients. Entire departments at the hospital, founded with high hopes after the 1965 Watts riots, were found to be rife with incompetence, infighting and, sometimes, criminality.

The failings cannot be ascribed to sparse funding, as the hospital's supporters often have done. The Times found that by the standards of most public hospitals in California, King/Drew is well-funded. The money, however, is often wasted.

The hospital's governing body, the five county supervisors, has been told of the problems repeatedly. But for years it has backed away from decisive action when faced with activists' anger and accusations of racism. So the problems at King/Drew, most of whose patients are impoverished African Americans or Latinos, have become entrenched.

There are no pain-free cures, the experts told The Times. All potential remedies face barriers, even active resistance. But they are worth trying, on their own or in combination, they said.

"I see this as kind of like a person who has a very bad — but curable — illness," said Dr. Donald Berwick, president of the Boston-based Institute for Healthcare Improvement.

Dr. Robert Wachter, chief of the medical service at UC San Francisco Medical Center and co-author of a book on medical errors, was equally pragmatic.

"Nobody's aspiring to turn this into the Mayo Clinic," he said, referring to the renowned facility in Minnesota. "That ain't going to happen. Everyone should try to turn this into a place where you wouldn't panic if you're told that's where the ambulance is taking you."

Successful reform depends heavily on the commitment and good will of the people involved, from the county supervisors to low-level hospital technicians, the experts cautioned. It almost certainly would require changes in staffing, policy and, perhaps, law.

The supervisors say they already have taken a dramatic step. In October, at a cost of $13.2 million, they hired Navigant Consulting to identify and begin making changes over the next year. The hospital turnaround firm's blueprint for action is due Jan. 3.

But many of those interviewed said bringing in consultants was the easy part.

"They're not the ones that are going to stay there and fix the place in the long term," said Dr. Kenneth Kizer, California's former health director and now chief executive of the National Quality Forum, a patient-safety group in Washington, D.C.

For fixes to last, said Los Angeles civil rights attorney Connie Rice, they need to be farsighted, even drastic.

"Don't bring in this consultant to do tooth whitening and flossing," she said. "We need root canals and dental implants."

Create new oversight