King Hospital Faces Loss of Federal Funds

Federal officials notified Martin Luther King Jr./ Drew Medical Center Monday of plans to cut off millions of public health care dollars to King on Dec. 21--effectively closing down the hospital--unless scores of serious patient-care deficiencies are corrected immediately.

The action by the U.S. Health Care Financing Administration threatens about $60 million in annual funds received by the hospital from the Medicare and Medi-Cal programs that pay the health care bills of the elderly and poor.

Closure of the hospital would cause chaos in the county’s health care network, as hundreds of thousands of people would be forced to seek care elsewhere. King is the only county-operated hospital in South-Central Los Angeles, shouldering an enormous patient load, including about 1,200 emergency ambulance runs a month. About 70% of the time, the hospital’s resources are stretched so thin that the emergency room has to be closed to all but walk-in patients.

In threatening to terminate funding, federal officials cited major break-downs in six fundamental areas of care that “seriously limit the facility’s capacity to furnish an adequate level or quality of care,” according to the letter delivered to King on Monday. Hospital and county health officials were not available for comment.

“The federal government is not in the business of terminating hospitals,” said Gerald Moskowitz, regional administrator at the Health Care Financing Administration in San Francisco, “but we do expect the quality of care to be at an adequate level, and at King, it’s not.”

Meanwhile, officials at the state Board of Medical Quality Assurance said they have opened an investigation of doctors at King who provided questionable medical care to patients whose cases were detailed in a series of articles published in The Times earlier this month.

And officials at the Chicago-based Joint Commission on Accreditation of Healthcare Organizations, which accredits more than 5,000 hospitals nationwide, said that they, too, will investigate charges of poor health care at the 430-bed, county-owned hospital in Watts. The commission has accredited King in the past, but federal officials said Monday that regardless of the commission’s action, they will disregard the past accreditation and no longer rely upon the commission’s inspections. Instead, federal officials will do their own investigations of the hospital.

Two reports prepared by state health officials earlier this month have cited King for massive, wide-ranging health care deficiencies in six areas: quality assurance, infection controls, nursing, dietary services, administrative leadership and physical environment.

The inspectors cited instances in which patients at King languished for hours in the emergency room without care. Others, believed to have infectious diseases, were not properly isolated, it was reported.

Equipment had fallen into disrepair and one piece in the pediatrics unit was so filthy that the odor alerted investigators. There were cases in which drugs were left unattended, patient records were misfiled and inexperienced nursing students were called upon to care for acutely ill patients, according to the report.

The reports by the state Department of Health Services were prompted by a national study released in January that analyzed death rates of elderly Medicare patients nationwide and ranked King among the bottom 50 of 5,577 hospitals surveyed.

Moskowitz said that teams of state health inspectors were dispatched to write reports on the 11 worst-ranking hospitals in California. King is the only one that has been hit, as a result, with the threat of losing its funding because “the problems at King were in a variety of different areas,” Moskowitz said. “They’re systemic and more serious than the ones we found at other hospitals.”

He added, however, that he hopes King officials will be able to prove to his satisfaction that the hospital has made necessary corrections by the December deadline.

Moskowitz noted that the Los Angeles County Board of Supervisors, which is faulted in the state reports for its lack of leadership and oversight of the hospital, has scheduled a private meeting for today to discuss personnel and management changes at King.

“One would hope that the necessary actions to bring the facility into compliance would be taken,” Moskowitz said.

Supervisor Pete Schabarum requested the meeting, according to his senior deputy, Judy Hammond, because county officials “have known for a long time that there are operational problems at King--that it’s not just a funding problem, but that there’s a need for a shift and change in management.”

After reports of fiscal mismanagement at King last year, the health department attempted to rotate King’s veteran hospital administrator, William Delgardo, to another county post, according to county officials. But Hammond said that two supervisors, whom she would not name, blocked the move after protests in the community to keep Delgardo at King.

The supervisors have asked the health department to investigate “serious charges of substandard health care” at King raised by articles in The Times.

But Dist. Atty. Ira Reiner said in an interview Monday that he will urge the supervisors to expand the investigative team to include medical and health care experts outside the county health department.

“I don’t think they should rely on the hospital, the health department or the state Board of Medical Quality Assurance to rectify the problem. At stake is whether the community is receiving substandard care,” he said.

Reiner’s office reviewed 31 cases of questionable medical care at King two years ago, according to Deputy Dist. Atty. Ed Feldman, but there was not enough evidence to bring criminal charges against any particular physician.

However, he said, “there is support for the view that there are too many instances of poor care, inadequate care and failures in care.”

In instances where the deaths were “particularly tragic and questionable,” he said, there was often a problem with incomplete and missing medical records.