The Martin Luther King Jr./Drew Medical Center, a national resource for the black community, has been critically wounded in recent months by hospital accrediting agencies, the local press and members of its own staff.
It matters little whether the agency reports are scientifically valid or if the media blitz is fair. Permanent injuries have been inflicted, crippling the center's ability to recruit scarce manpower, raise philanthropic funds and maintain the confidence of the people it serves. Hence, reforms are inevitable in governance, administration and professional services.
Our concern is not so much for the viability of Drew Medical Center as it is for the impact of forthcoming changes in the community for which the center was designed. South-Central Los Angeles must have a hospital in order to respond to the need for services and the demands of public health. It is essential that it meet the larger need of our black and Latino populations for access to economic resources as well as the services of the health-care field.
The stakes are high. Health care is the second-largest industry in the U.S. economy. It provides more than 15 million jobs--more than the automobile and utility industries combined. Along with the natural sciences, it is the most rapidly growing occupational sector. Many of the more than 1,000 health-care occupations are among the most prestigious and secure.
A new academic medical center is a powerhouse that can turn around a failing community. Teaching programs generate a new private-practice resource for the surrounding region. Medical centers are magnets for high-technology industries in the electronic, data processing, pharmaceutical and nutrition fields.
Whatever its failings, the King/Drew Medical Center is meeting some of these goals. More than 80% of the graduates of its resident physician programs settle in under-served regions. These are areas that have been unsuccessful in recruiting graduates from other programs.
It has launched an ambitious human resources development effort that includes model programs such as the Tillman Child Care Center, Weinstein State Preschool, the Medical Magnet High School, undergraduate college science instruction projects and the Drew/UCLA Medical Student Education Program. The medical center's community partnership programs help people and agencies develop child-care, education and guidance programs, while they in turn aid the center in carrying out health services.
At present, two other approaches are being tried to improve health care for the poor: health insurance and "privatization." Providing health insurance to the more than 31 million Americans who are unable to afford it would allow them to purchase services from private vendors. Privatization by Los Angeles County government has started with contracts for some hospital administrative and technical services. But neither insurance nor privatization respond to the important social and economic benefits needed by the poor.
Reform, not replacement, is the right course for obtaining these benefits. The county Board of Supervisors itself serves as the board for each of its public hospitals. Like community and university hospitals, ours should have its own board of directors. At other hospitals, distinguished citizens accept fiduciary responsibility. They advocate, raise funds, guide, discipline and plan for their hospitals. They select the chief executive officer. Accountability is local and in the hands of individuals who have no need to exploit the institution for political or fiscal gain. The proposed board could tailor obligations to available funds.
At present, our public hospitals, particularly King/Drew, are crushed by an avalanche of trauma and other serious illnesses that result from the new social pathology. Capital is expended on immediate demands while our physical facilities deteriorate, our clinical units become more understaffed, pay for our professionals lags, and our equipment becomes increasingly obsolescent or defective.
In community and university hospitals, administrators support their professional staffs so that they can carry out clinical services. However, in ours, the administrator answers to the Board of Supervisors and the public administrators who supervise him. With a new board, the administration could be reoriented to the needs of patients.
The professional staffs of Los Angeles County hospitals are faculty members recruited by affiliated universities. However, UCLA and USC are governed by independent boards concerned solely with the good of their institutions. From its inception, the Drew board has consisted of representatives from the Drew Medical Society, the local community, USC, UCLA and Harbor/UCLA Medical Center.
Drew should move toward establishing an independent board, rather than one representing a variety of vested interests. When academic or fiscal irregularities are reported to the board, there should be no suspicion that members might be motivated by personal alliances with individuals on the faculty or staff, or by the interests of other institutions.
New federal safeguards are needed to protect King/Drew and other scarce inner-city health-care resources. The medical schools at UCLA and USC possess strong academic-service bases in affluent communities. These bases insulate them from inadequate federal and state reimbursement rates for services and from the effects of county politics.
Throughout the nation, academic medical centers have been withdrawing from the inner cities to the suburbs. They have taken with them the hospitals of the Veterans Administration and of many metropolitan governments. Drew was founded to swim against that current, concentrating on academic services for the inner city through its own programs and those of its affiliated public hospital.
The high-risk services provided by public hospitals in the inner cities should be reimbursed at higher rates by both federal and state governments. Comparisons between such facilities and other hospitals should be based on scientifically valid analyses of morbidity and mortality, rather than the current misleading data released by federal and state governments. A new system of grants-in-aid should be created and linked to organizational improvements required to meet stringent new standards.
The worst scenario that could result from the current crisis would be for King/Drew to be left hanging on the ropes, a spent fighter absorbing blow after blow from accrediting agencies and the press. It is essential for the center to make a new beginning with the necessary systems of governance and funding in place to assure quality work.