More Fuel on the Fire

The Los Angeles County Board of Supervisors set off a hurricane of protests last week when it unexpectedly announced plans to shut down the trauma unit at Martin Luther King Jr./Drew Medical Center near Watts. The King/Drew trauma center sees more gunshot victims than any other in the county, so it’s hard to imagine a bigger loss -- except, that is, for the entire hospital to shut down.

What got lost in the uproar last week is that closing the trauma unit is a last-ditch effort to keep the rest of the hospital, including its even more heavily used emergency room, open. It is a lesser-of-two evils fix for a pattern of medical errors that is threatening King/Drew’s very survival.

Trauma centers demand a tremendous amount of personnel, time and money. That’s why fewer than 450 of the nation’s 6,000 hospitals have one. It requires one nurse for every patient, for example, compared with one for each four patients in the ER. It also requires a stable of specialists to be on duty or on call at all times.

Closing the labor-intensive trauma unit would free King/Drew to redirect employees (particularly scarce nurses), shore up basic services and keep the rest of the hospital from collapsing. This would preserve the hospital’s emergency room, which is separate from the trauma center and which sees about 45,000 patients a year for everything, including serious injuries, flu and heart attacks. The trauma unit treats about 2,000 patients a year -- the most severely injured victims of car crashes, shootings and the like.

The supervisors’ announcement came as a shock in part because they have done such a good job convincing county residents of the importance of maintaining the county’s 13 public and private trauma centers, even to the point of winning a rare property tax hike two years ago to keep the system from going under.

Injuries are the leading cause of death for people between the ages of 1 and 44. Trauma care -- developed during the Vietnam War -- saves lives by delivering speedy, specialized treatment in the crucial “golden hour” after injury.

King/Drew has the second-busiest trauma unit in the network after County-USC, which is another reason the decision came as a surprise. But South Los Angeles also suffers the county’s highest death rates for diabetes, heart disease and lung cancer. More mothers go without prenatal care. More adults have no regular doctor. Fully one-third lack medical insurance. They are among the tens of thousands who depend on King/Drew’s emergency room. The stark reality is that the hospital and its ER are on the brink of collapse.

Federal inspectors, county auditors and Times reporters over the last year have documented a pattern of patient deaths and errors. The federal government, which provides half the hospital’s operating budget, is threatening to cut off funding. An accrediting agency suspended three of the doctor-training programs run by the private and equally problem-plagued Charles R. Drew University of Medicine and Science.

Experts on turning around deeply troubled hospitals say that when the problems become this extreme, it’s often better just to shut down -- as long as another hospital can absorb the patients. County officials looked at the 45,000 patients treated at King/Drew’s ER and saw no way other hospitals could take on that load. But the private, nonprofit St. Francis Medical Center, about two miles from King/Drew, and the county-run Harbor/UCLA Medical Center in Torrance operate trauma centers that, with county help, can absorb some of King/Drew’s 2,000 trauma patients. County officials are also trying to persuade another, more stable hospital in the area to open a trauma center.

A handful of political leaders and healthcare experts -- Assemblyman Mark Ridley-Thomas (D-Los Angeles) and Jim Lott, executive vice president of the Hospital Assn. of Southern California, among them -- applauded the supervisors’ tough, unpopular call as a means to save the rest of the hospital. They have been all but drowned out by others, including Los Angeles City Councilwoman Janice Hahn and Rep. Juanita Millender-McDonald (D-Carson), who are shamelessly accusing the county of dismantling King/Drew “brick by brick” while denying the real harm already occurring from unsupervised nurses and botched care. On Wednesday, the very day yet another panel threatened to yank the hospital’s accreditation, the L.A. City Council voted to oppose closing the trauma center.

Such objections to any reform, large and small, from the area’s politicians have helped bring King/Drew to the miserable place it is in today. King/Drew cannot keep all of its parts running. The trauma center inordinately pulls nursing and other skills from the rest of the hospital.

If there are honest alternatives to closing it, political and community leaders should offer them and spare the rancor. Pouring gasoline on the fire, exploiting emotions for cheap political points, isn’t going to fix King/Drew.