The county supervisors respond

As the governing body of King/Drew hospital, the Board of Supervisors is ultimately responsible for reforms there. The following are excerpts from interviews conducted by Times staff writer Mitchell Landsberg:

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The question: Has the board taken adequate steps to fix the hospital’s problems? If not, what more should be done?

Michael Antonovich: Well, the board has given full authority to the director of health and the CEO to remove incompetent or negligent staff and to report Civil Service obstacles that hinder this effort. The Navigant [consulting] contract and the closure of the trauma center will allow us to focus on the core medical services and place King/Drew on the right track.

Yvonne Brathwaite Burke: I’m very optimistic about Navigant and their responsibilities, where they’re going and the assessment that they’re doing. I’m confident that they know what they’re doing, that they’ve experienced these things before and that they will come up with the necessary steps to correct those problems that the hospital has experienced

Don Knabe: I guess my feeling is that at this point we’ve taken the adequate steps necessary to at least get a handle on the problem. As far as what more needs to be done, I guess we’ll have to wait and see what Navigant recommends. We’ve done the adequate steps to try to get our arms around the problem, instead of continuously fixing it with Band-Aids.

Gloria Molina: You know, we keep assuming we are taking the appropriate and adequate steps necessary to do the final fixes, and yet at the same time, it doesn’t seem to fix itself. Other than myself going in there with a whip, I don’t know how else you can bring any order. We’re hoping that Navigant is going to be our answer. We don’t know that Navigant is going to be successful.

Zev Yaroslavsky: Well, I think the board has taken important and unprecedented steps to fix the hospital, and there’s a lot more to be done. We’ve made a long-overdue decision to take ownership of the problems at MLK, and to treat the hospital as a countywide asset rather than a district facility. This is just a beginning. Hopefully, it’s the end of a shameful and painful history at this hospital.

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The question: Is it time to consider an independent hospital authority to run the county hospitals?

Michael Antonovich: No, funding another layer of bureaucracy does not improve efficiency and quality. Historically, the effectiveness of authorities of this nature has been dismal.

Yvonne Brathwaite Burke: I’m still open to consider an authority. I recognize that it’s a long process. I am more than willing to continue to listen to exactly how it would be implemented.

Don Knabe: I think it’s always time to look at that issue. I’ve not necessarily been a strong advocate for it. The only thing I’ve ever had a concern about is how is it structured.

Gloria Molina: I don’t know. We looked at this and it’s not such a terribly bad idea ... but I don’ t know that that’s going to dismiss me from accountability. I don’t know that that’s going to create the fix.

Zev Yaroslavsky: I have long advocated a health authority for the county health system. But it’s not a silver bullet. It does not in and of itself create excellence, and it does not in and of itself rid an organization of incompetence or failure.

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The question: Should Civil Service rules be changed to make it easier to fire incompetent workers?

Michael Antonovich: Yes, yes, yes. Where public safety is concerned, we cannot tolerate a Civil Service system that protects incompetence and life-threatening negligence.

Yvonne Brathwaite Burke: Civil Service rules, if carried out properly, make it possible to fire incompetents. Now, in order for Civil Service rules to work, you have to have the evaluations and you have to be willing to make decisions that those employees will be terminated.

Don Knabe: Absolutely. And you know, nobody’s trying to weaken the Civil Service system, or at least that’s not my perspective. But certainly when there’s wrongdoing, there has to be an immediate process of some sort to remove them from the system.

Gloria Molina: The problem is management isn’t handling Civil Service well. Our own lawyers aren’t even prepared on some of the cases when they go before the Civil Service Commission. So I’m not willing to say, at this point in time, the only way to do it is to get rid of Civil Service.

Zev Yaroslavsky: Look, Civil Service rules can be a barrier to swift and decisive action in any governmental organization, and they’re often used as an excuse. But the problems at MLK cannot be laid at the doorstep of the Civil Service system.

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The question: There’s a risk that the hospital could lose both its accreditation and its federal funding within a year. Under what circumstances would the county close it?

Michael Antonovich: There ought not to be any surprises when accreditation is lost in January. That’s a given. Any delay in applying the life-saving measures risks the loss of all federal and private funding, thereby closing the hospital. And it’s better to save the hospital by changing staff and personnel than to close the facility.

Yvonne Brathwaite Burke: First of all, I don’t believe that we will lose the accreditation and the federal funding. If I believed that, I wouldn’t have spent the $13 million for Navigant. I feel very confident that the problems that are there will be solved, that it will be restored to its accreditation. Closing King is not really a viable alternative. Our responsibility is to fix it.

Don Knabe: I think the question sort of answers the question. I mean, obviously, losing [Joint Commission on Accreditation of Healthcare Organizations] accreditation and the centers for Medicaid and Medicare -- you know, federal funding -- that would be a huge hit for that hospital. And obviously the potential for closing would be greater than it is right now.

Gloria Molina: We’re in jeopardy right now of losing our federal funding. The reality is, we’re facing an unbelievable financial risk of losing all our hospitals. So if you now have a hospital that loses half of its budget through loss of accreditation it would be very, very tough to keep that hospital open.

Zev Yaroslavsky: If MLK loses its federal funding, it’s hard to imagine how it could stay open. I don’t anticipate that MLK will lose its funding. I do anticipate that MLK will lose its accreditation early next year. And while it’s certainly a setback for the hospital to lose its accreditation, it needn’t result in the close of the hospital.

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The question: The county has demanded changes at Drew University, and the university says it is carrying them out. Are you confident that it can become a strong and reliable partner for King/Drew Medical Center? Or should the county sever its ties with Drew?

Michael Antonovich: I have little faith that Drew University can continue to function independently, and I would urge the health department to aggressively pursue an agreement with one of the three medical schools -- USC, UCLA or Loma Linda -- to provide the hospital with a competent, structured, quality teaching facility.

Yvonne Brathwaite Burke: Dr. Michael Drake, who heads up all the hospitals for the University of California, heads up a group that has been working with Drew. This is a very strong group. I have every reason to believe that they have the capacity to provide the necessary backup and recommendations for change.

Don Knabe: From my perspective, I am not totally convinced yet that the university can become a strong and reliable partner. I think the university has to earn that trust over a period of time. I will say that at least all indications at this point are that the recent changes they’ve made are very positive.

Gloria Molina: Yes, it could become a strong partner -- but then there’s the ‘if.’ The reality is, we’ve done everything on our end to try to create that partnership. But [I] wonder about whether Drew is as serious as it should be about maintaining its affiliation with us.

Zev Yaroslavsky: You can’t talk about solving MLK’s problems without talking about the problems at Drew University. It’s a school that’s in a world of hurt, and the direct answer to your question is that it’s too early to say whether the relationship between Drew University and the county can be savd.

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The question: Has the Board of Supervisors been complacent? If yes, will that change?

Michael Antonovich: The board has failed by not having three votes to enact the necessary reforms and to remove the previous health directors when they failed to do what they were responsible for. Today, everybody is on the same page, and that is moving forward to implement the reforms of Navigant, the recommendations of [regulators], and the plan of action by Dr. [Thomas] Garthwaite [head of the county health department].

Yvonne Brathwaite Burke: I can only say to you that I have spent a tremendous amount of time in working with King/Drew. I have been faced with all kinds of problems, but I believe that we have addressed each problem as it comes along, and I feel very comfortable with the fact that I have not been complacent. I have been spending an inordinate amount of my time since I came onto this Board of Supervisors on King/Drew hospital, as have my staff.

Don Knabe: I strongly feel that we have not been complacent. You know, we tried to do different things over the years, and put Band-Aids on it, tried to respond to the community’s outcry every time we tried to touch the hospital. And it was never enough. But I certainly wouldn’t consider it complacent. Should we have been more aggressive earlier? Absolutely. I mean, we should have just buckled up and taken the heat.

Gloria Molina: I know I haven’t been complacent. That’s all I can say. I think we’ve done so very, very much other than walking in there and cracking the whip on everybody. We’re supposed to have people who are trained, who are professionals. And we’ve put management in place that’s supposed to monitor the quality of that professionalism. So I can’t accept that we’ve been complacent.

Zev Yaroslavsky: Look, this and the previous boards of supervisors could and should have done more. And this board has owned up to its responsibility in that regard. There is no question that this board is committed to doing whatever it takes to fix MLK hospital, and make it a facility of which the county and the community that it serves can be proud. Our challenge is to sustain this intensity of purpose until this job is done.