A Stone of Hope

Martin Luther King Jr./Drew Medical Center is terribly sick, the victim of more than a decade of incompetence, interference and political negligence. As readers of the recent Times series well know, the hospital near Watts is troubled -- so troubled that it calls to mind words spoken in a different context by its namesake:

Is it possible to hew out of this mountain of despair a stone of hope?

Yes, it is possible to fix King/Drew, but only if some difficult choices are made and only if public outrage forces public officials to remain focused on King/Drew’s failings until they are remedied. Keeping the medical center open in its present condition serves no one’s purpose.

Some of the needed remedies are clear, if not politically easy.

County Health Authority

The Los Angeles County Board of Supervisors, which bears primary responsibility for the hospital, has taken the first steps. In November, the board agreed to hire an outside management firm to run King/Drew for at least a year. More important, the five supervisors stopped averting their eyes from poor management and botched care.

Now comes an even greater test of the supervisors’ commitment. As most of the two dozen experts consulted by The Times in Thursday’s article concurred, the board needs to remove itself from the day-to-day governance of the entire county healthcare system, not just of King/Drew.

This isn’t new advice. The supervisors oversee more than 30 other departments. Separate task forces have twice urged them to establish a specialized county health authority whose single purpose would be to run hospitals and clinics. This editorial page has long championed such a move.

“It makes no sense,” says Dr. Lester Breslow, a former director of the state health department and chairman of the 2002 task force, “for five people who have such broad responsibilities to act as the decision-making board that has to approve contracts and key personnel decisions and every major policy affecting healthcare services.”

The supervisors argue that state law holds them accountable for indigent healthcare, and that a new authority would just add another layer of bureaucracy. But if a dedicated authority would not entirely get the politics out of healthcare, it would at least provide an arm’s length of distance. And by giving the health department autonomy to be more responsive to a rapidly changing medical environment, it would actually eliminate a good deal of bureaucracy. An authority also could relieve hospitals of civil service protections that have made it easier for people who do no work to stay on the King/Drew payroll. Constrained by these protections afforded county employees, hospital managers now find it hard to reassign staff members as needed, and sometimes years are required to dismiss those who are incompetent.

Most people would be staggered by the county bureaucracy. The health department does not have its own lawyers. It can’t directly negotiate a union contract with its nurses. It does not have its own human resources department. Health officials can barely get a meeting with the county HR staff. It took a year for Dr. Thomas Garthwaite, the department’s director, just to hire a chief of staff.

A county health authority alone is not a miraculous cure-all, as supervisors have pointed out. But the reason that 60% of public hospitals nationwide are no longer directly operated by state or local governments is that politicians don’t make the best hospital managers.

What is distinctly not a good idea is to create separate authorities for each of the county’s five hospitals. The hospitals need to be managed as a single system, with more coordination and less duplication. The worst possible scenario would be to hand King/Drew off to an autonomous board, as the trustees of the private Charles R. Drew University of Medicine and Science suggest.

Bring In UCLA

This brings up another tough decision: What should Drew’s future role be at the hospital?

Preferably none, if UCLA could be drafted to take over. The county now pays Drew $13 million a year to run a physician training program that is rated among the worst in the country. In the last two years, a national accrediting agency has ordered the surgery, radiology and neonatology programs shut down and has given the overall program two consecutive unfavorable reviews.

Drew’s trustees blame the county, which certainly bears its share of responsibility. But most directors of teaching hospitals agree that the academic program drives the quality of the institution -- in this case down. Drew is so much a part of the problem that it’s hard to imagine it being part of any solution.

Because UCLA is a public institution, a proper mix of inducements should be used to get it to take on the challenge. Realistically, though, UCLA might get involved only as a partner with Drew in a drastically downsized training program, as recommended last fall by Dr. David Satcher, the former U.S. surgeon general.

Drew’s track record is so bad that if UCLA cannot be persuaded to play any part, the best alternative may be for the medical center to abandon its role as a teaching hospital altogether. King/Drew could be turned into a smaller community hospital that concentrates on patient care rather than on teaching and research.

Does Race Matter?

Satcher also recommended that King/Drew remake itself as a “center of excellence in multicultural health.” By that, he does not mean swapping a predominately African American symbol for a Latino one. He means tackling the disparities in health among all ethnic groups.

King/Drew should focus on the surrounding residents, who suffer disproportionately from such treatable illnesses as diabetes, asthma, hypertension and congestive heart failure. The solution need not include a teaching and research institute.

Los Angeles County’s poorest neighborhoods need access to basic health services, competently delivered. That’s what they were promised 40 years ago. Surely it is not too much to hope for today.