County Closes Medical Center Ward

Los Angeles County health officials closed a patient-care ward this week at the embattled Martin Luther King Jr./Drew Medical Center, where three patients have died under questionable circumstances since July.

The county health department, which owns the King/Drew hospital in Willowbrook just south of Watts, also has suspended two nurses who were involved in the care of the patient who died most recently, Dec. 14, officials said.

State investigators who visited the hospital this week told the county that nurses had failed to respond promptly when monitors showed that the patient’s vital signs were declining. State inspectors made similar findings in the previous two deaths.

Fred Leaf, chief operating officer of the county Department of Health Services, said he had decided a week ago to close the 22-bed monitoring unit and transfer patients to other units and hospitals.

He said he was concerned that King/Drew did not have enough nurses trained to read the sophisticated monitors in that unit.

“I couldn’t guarantee that we had dedicated nursing staff that would be consistently assigned to, and work in, that unit day to day,” said Leaf, who is heading his agency’s crisis response team at King/Drew. “That was the problem.”

The ward closing was completed Wednesday. Leaf said he would not reopen the unit until it could be staffed by qualified nurses for at least two months without interruption.

Nurses at other hospitals said that nurses on such wards usually receive several weeks of on-the-job training to be qualified to read bedside monitors and respond appropriately.

King/Drew, which serves an overwhelmingly impoverished and minority community, has been at the center of an avalanche of criticism in recent months about patient care, training of aspiring physicians and financial inefficiencies.

County health officials, trying to keep the hospital from closing, have essentially taken over the day-to-day operations.

The health department has installed a new team of managers, suspended the director of nursing and hired a private firm to run nursing services.

Concerns about the now-closed monitoring ward arose last summer with the deaths of two women patients.

In one of those cases, inspectors from the California Department of Health Services found that a patient’s heart had slowed and stopped over a 45-minute period before nurses responded; she died soon afterward, despite resuscitation attempts.

A physician discovered that the other woman had stopped breathing; she was revived but died four days later.

Inspectors determined that nurses had failed to examine both patients adequately and that some apparently had never been taught to use new bedside monitors.

In addition, one nurse lied about performing crucial tests ordered by a doctor, the report said.

In both women’s cases, a technician assigned to watch a central monitor displaying patients’ vital signs was also given other duties.

Initially, the county’s investigation focused largely on potential problems with the new bedside monitoring system installed in late June. To calm nurses’ jitters, hospital officials disconnected the $411,000 system in September and reinstalled the 7-year-old monitors that had been in use previously.

County officials also changed the rules so that monitor technicians should do nothing but watch the monitors at a central station for the ward. They also gave nurses additional training.

The Dec. 14 death has prompted additional state and county investigations and discussions about what other steps might be taken to improve care.

Leaf said his agency was examining whether the licensed vocational nurse on duty at the time had properly watched the central monitors and whether the registered nurse assigned to the patient had performed her duties properly. Both have been suspended without pay until the inquiry is completed.

Some doctors at King/Drew said the patient, who had end-stage liver or kidney disease, would have died anyway.

In other actions, Leaf said Friday that his crisis response team has:

* Taken King/Drew off the county’s list of hospitals that can receive trauma patients by helicopter. King/Drew had received five or six trauma patients each month by helicopter, all from the east San Gabriel Valley. The move was intended to reduce pressure on the hospital.

* Increased monitoring of employees to reduce chronic absenteeism.

* Consolidated the neurosurgical and trauma intensive care units to better utilize staff.

* Ordered the hospital to keep social workers on call after hours to ensure that patients are discharged from the hospital properly.