A Hospital Escapes the Critical List

A disastrous breakdown in the Los Angeles County health care system has been averted by the decision of federal officials to continue funding Medicare and Medi-Cal programs at Martin Luther King Jr./Drew Medical Center. But the basic problem of under-financing has not been resolved, and, as a result, most of the urban county hospitals in the state still run the risk of collapse.

Officials of the U.S. Health Care Finance Administration found a “dramatic turnaround” in patient care at King. That may be an excessively generous judgment given the numerous continuing problems identified by federal and state officials. But the reforms at least justified a continued flow of federal funds. Without this money, the hospital would have been forced to close. That would have left a giant hole in the county system, since the 480-bed hospital averages more than 30,000 in-patient admissions and 211,000 out-patient visits a year.

The hospital has relied heavily on stopgap measures to correct some of its more conspicuous problems, in effect postponing necessary steps for permanent solutions. There has been, for example, reliance on increased hiring of part-time workers, a poor substitute for permanent staff. And there have been arbitrary cuts in patient population at a time when every effort is needed to increase, not diminish, services. The shortage of nurses, which has complicated the situation at King, is affecting many hospitals, but recruitment is made no easier at King by working conditions exacerbated by heavy caseloads.

The Los Angeles County Department of Health Services has been candid in acknowledging that each of its four medical centers, not just King, is beleaguered. The story is repeated elsewhere, including the UC (Irvine) Medical Center, which serves as the major public hospital for Orange County. State funding simply is inadequate, both in its Medi-Cal contracts with the hospitals and in the state funding to counties for medically indigent adults. King has earned praise for its effort to correct some of its problems. But none of the state’s public hospitals will have much to celebrate until Sacramento accepts its responsibility for adequate funding of health care.