Key Program at King Hospital May Be Shut

The Martin Luther King Jr./Drew Medical Center, a linchpin in Los Angeles County’s emergency services network, is threatened with the loss of its training program for young resident doctors, who provide the bulk of patient care in the hospital’s emergency department.

To help avert loss of accreditation, officials at the Drew Medical School on Friday removed the chairman of the emergency department, Dr. William Shoemaker, and the county pledged to hire more supervising physicians.

The national accrediting agency has notified King officials that the accreditation of the training program may be revoked in February because the hospital has failed to correct substandard conditions during the past four years. County officials are appealing.

“They are pretty much at the end of their rope,” said Dr. John Gienapp, executive director of the Accreditation Council for Graduate Medical Education in Chicago.

“It’s up or out,” he said, adding that King’s program must fully comply with all standards or lose accreditation.

The agency, which certifies all medical specialty programs for doctors in teaching hospitals across the nation, concluded in a confidential report last month that emergency facilities and the supervision of patient care at King are inadequate.

The report, obtained by The Times, said emergency patients are treated by 42 young resident doctors who often are poorly supervised by senior physicians. It noted that less than half of the 13 supervising doctors are certified as emergency medicine specialists, and that three of the certified doctors only work one shift per week supervising patient care.

The report singled out Shoemaker, 70, saying the emergency department chairman is an excellent surgeon but has “limited experience” in emergency medicine. The report noted that he was not a board-certified emergency specialist and that he devoted only 12 hours a week of his duties at the hospital to supervising residents in the emergency room.

Shoemaker, chairman since 1991, could not be reached for comment. The director of the residents training program, Dr. Eugene Hardin, declined to discuss the accreditation report.

Many of the program deficiencies were pointed out in previous evaluation reports. Improvements have not been made, according to the accreditation council, even though the annual load of patient visits at King has dropped during the last two years from 86,000 to 65,000.

County officials said they are preparing an appeal and are confident they will prevail when the accrediting agency takes a final vote on the matter in February.

Dr. Reed Tuckson, president of Drew University, said the county has authorized the hiring of additional supervising physicians for the emergency department and that he is beginning a national search for a new chairman to replace Shoemaker, who was removed Friday from his $164,000-a-year post.

Supervisor Yvonne Brathwaite Burke, whose district includes the hospital in South-Central Los Angeles, said she believes the program will have “no problem” meeting standards. She pointed out that the county is building a new trauma center at King and has made improvements in emergency room facilities.

The emergency department is the hub of King. It is the point of entry for about 78% of all patients who are admitted, compared to a statewide hospital average of about 20%.

Since February, 1990, the emergency medicine training program has been on probation--a status that is not permitted to continue for more than four years.

Withdrawal of the program’s accreditation would not take effect for about 18 months, giving the hospital time to wind down the program and allow some of the current enrollees to graduate, Gienapp said. New residents would be virtually impossible to attract.

Each year the council makes about 2,000 decisions on various medical programs and revokes between 40 and 50 accreditations, or about 2%, Gienapp said. The emergency medicine training programs at the county’s other three teaching hospitals--County-USC, Harbor-UCLA and Olive View medical centers--are all fully accredited.

Losing accreditation at King would be a blow to the prestige of the hospital, where administrators say great improvements have been made since 1989, when federal authorities threatened to cut off millions of health care dollars because of poor patient care.

The loss of interns and residents would also be costly for the county, which would have to hire more-expensive private physicians to replace the low-wage residents who work long hours for top pay of about $30,000. Most of their salary is paid with state and federal health care funds.

In its report, the accreditation council concluded:

* A shortage of critical care beds forces severely ill patients to wait two or three days in the emergency department for a bed. Patients with routine problems wait six to eight hours to be seen. Adult patients spill over into the pediatrics area.

* Oversight of residents is inadequate, with only one senior physician on weekend and night duties. Two senior physicians work day shifts. Resident physicians said they consult the supervising physician on only a couple of cases each shift. “In a facility with 65,000 visits, this is inadequate supervision,” the report said.

* Only five of the 13 senior supervising doctors are board-certified emergency medicine specialists, and three of these devote just 12 hours a week to supervising the care that residents give patients. Three of the physicians do not list any professional activities in emergency medicine and three do no patient care in the emergency department.

Walter Gray, who oversees hospitals for the Los Angeles County Department of Health Services, said hospital and university officials are reviewing the workload, credentials and schedule of every senior emergency physician to determine whether changes should be made.

They also are looking into new policies to keep better track of the hours that doctors work at King.

In October, six of the senior emergency physicians, including Shoemaker and program director Hardin, were accused by a caller to a county fraud hot line of cheating on their time cards by collecting full pay while actually working only half time, according to a county audit summary.

The auditors found no evidence to substantiate the allegations but noted, as previous audits have, that the hospital has lax controls over hours worked by emergency physicians.

Full-time county doctors are permitted to engage in private practice as long as they disclose their outside employment and it consumes no more than 24 hours a week.

Auditor Fred Leaf concluded that four physicians had private practices that did not interfere with their work at King. He said Hardin told auditors he had no private practice.

But Hardin’s private practice is listed in the phone book in Carson. In an interview, Donna Garnier said she works there as his physician assistant, seeing patients in his internal medicine practice. “He has varied schedules,” she said.

Asked whether he has a private practice, Hardin said, “I don’t want to comment on that at all.”

After the audit, Hardin and Shoemaker announced a new policy in the emergency room requiring doctors to sign in and out of the hospital.

It was an effort, according to administrator Edward Renford, “to monitor and balance physician commitment to the hospital along with any outside commitments.”

Seven of the senior emergency physicians responded by hiring attorney Rees Lloyd. He filed a complaint Nov. 4 with hospital and county health officials alleging that the new policy violated the Fair Labor Standards Act on the grounds that doctors are “exempt” employees ineligible for overtime.

Later, the hospital withdrew the sign-in policy. Officials said they are looking at other ways to monitor physicians.