Even Worse Than We Knew

Once again, the substandard and often dangerous conditions at Martin Luther King Jr./Drew Medical Center and the failure of the Los Angeles County Board of Supervisors to provide appropriate supervision have been documented, this time in an investigation by the California Department of Health Services. Federal and state funding and the state license for hospital operation are in peril.

This new report, following shocking disclosures in articles in The Times last week, gives new urgency to reforms and reinforces concern about the quality of the entire county hospital system, as well as other public hospitals in the state.

Officials at the hospital had responded to The Times articles by acknowledging the problems but insisting that corrections had long since been made and reorganization was proving effective. This is placed in question in the state report, however, because it identifies serious problems observed as recently as June, long after the hospital ostensibly had made basic corrections.

The lengthy report, drafted by a team of medical professionals, is a catalogue of appalling violations of basic sanitation, medical, nutritional and staffing rules that clearly place patients at risk.

Many of the problems stem from inadequate funding and staffing, including the use of under-trained aides to do the work of professionals, and the difficulty in recruiting persons to work at relatively low wages in the difficult situation at King. But the susceptibility of many of the problems to quick correction was manifest in elements of the state report that found serious defects remedied between an initial inspection on a Thursday in June and a return inspection the following week.

Dereliction of legal responsibility at the highest levels, including the county Board of Supervisors, is manifest in the findings. “There is no evidence within the minutes of the proceedings of the governing body (L.A. County Board of Supervisors) from May 31, 1988, to June 9, 1989, that the governing body was ever apprised concerning medical staff evaluation of patient-care services provided by the institution, or that the medical staff was held accountable for the quality of care provided to patients,” the inspectors reported. But that is not all. “Further, there is no evidence that the quality assurance plan was ever approved by the governing board or that the quality assurance program is reviewed on a periodic basis by the governing board.” And, finally: “Due to the amount and seriousness of the deficiencies cited in this survey, the governing body is not effectively insuring the facility’s compliance with licensing requirements and regulations, safety procedures and federal standards for hospitals.”

That is a serious indictment of the county Board of Supervisors. It calls for a response more profound and serious than its proposal of one more investigation. It demands establishment, at the very least, of a respected professional oversight commission to see that the problems are corrected, that the hospital is appropriately funded, that both the county supervisors, the county Department of Health Services and the hospital administration are conforming to their responsibilities under the law before more lives are imperiled.