County Launches Hospital Overhaul

Los Angeles County supervisors moved quickly Tuesday to begin a sweeping evaluation and reorganization of Martin Luther King Jr./Drew Medical Center after disclosures about myriad problems at the county-run hospital and trauma center.

While leaving many of the specific management changes for incoming Health Services Director Mark Finucane, the supervisors approved the creation of both a Crisis Management Task Force and a special advisory “oversight” commission to investigate conditions at the beleaguered hospital near Watts.

Those two groups will investigate all aspects of King/Drew’s operations, to see if any problems possibly caused by everyone from front-line nurses and doctors to top administrators are compromising the quality of medical care that patients receive.

The supervisors approved the reorganization proposal unanimously and with little discussion, though some said the action is overdue. Board Chairman Mike Antonovich praised Supervisor Yvonne Brathwaite Burke for “biting the bullet on this very difficult situation” and bringing the proposal to the board.

“It is critical that the board take this step . . . in trying to address the problems not only of confidence but whatever the problems really are, and rectifying them,” said Supervisor Zev Yaroslavsky. “This is a major step, it’s a beginning at MLK.”

Burke called for the reorganization two weeks ago in the wake of a series of Times articles on problems at the hospital. On Tuesday, she said “swift and decisive” action was needed not only to protect patients but to “establish a level of operational stability” and bring the hospital into compliance with health and safety laws it has violated in the past.

Burke said a “top to bottom” shake-up was needed to restore the community’s confidence in a medical staff and management buffeted by damaging disclosures. Those problems include troubles at the hospital’s blood bank that led to a woman receiving HIV-tainted blood and contracting AIDS in 1994, and doctors remaining in administrative positions despite being convicted of Medi-Cal fraud. Other doctors are alleged to have moonlighted excessively, abused overtime policies and diverted patients to their private practices at county expense.

“We should have . . . strong action [taken] and most of the changes in place within six months,” Burke said. The Crisis Management Task Force will include health officials, auditors and a host of other county officials, while the advisory oversight team will bring in community members and medical experts, Burke said.

No one has yet been selected for either group, but Burke and health officials said they want to move as quickly as possible.

Finucane, who is set to take the helm of the troubled health agency Jan. 17, could not be reached for comment Tuesday, and King/Drew officials have deferred comment on the issue to Burke, who represents the district that includes the medical center.

Burke said, however, that county health officials have been in close contact with Finucane, and that he supports the proposed restructuring “and said we should move forward immediately on it.”

Although no major decisions will be made until Finucane has a chance to visit the hospital, county officials said Tuesday that they want an experienced hospital administrator to come in on a strictly temporary basis so they can make politically unpopular decisions and then hand over management responsibilities to someone else. Both Burke and Walter Gray, assistant county health director in charge of hospitals, said Melvin Fleming, a former top health official and King/Drew administrator, may come out of retirement to lead the hospital for six months to a year.

Fleming retired in 1986 after heading the hospital’s management team and holding administrative roles with the county health department, according to personnel records. He could not be reached for comment Tuesday.

Burke also said another change in the works could be privatizing the hospital’s emergency room, which she said urgently needs board-certified specialists in emergency medicine but can’t hire them under current county hiring guidelines. “I believe we have to do it,” said Burke. “A few years ago it might have been considered unusual, but at this time it does not appear to be unusual.”

Although she asserted that overall quality of care at the hospital is good, Burke said she was concerned about a number of issues raised in the Times articles. For instance, she said, she wants an aggressive investigation into allegations of moonlighting by doctors because postgraduate medical students told her that senior attending physicians at times were not present to provide them with training and oversight as they operated on patients.

Gray said the performance of everyone--from top administrators to nurses, doctors and even orderlies--will be thoroughly examined to ensure that they are up to par. “No one should feel that they have a safe job,” he said in an interview. Already there are at least seven key management vacancies at King/Drew, including that of the hospital’s top administrator.

Burke said she also was concerned about issues of medical malpractice at the hospital, including a June 1994 incident in which a mother of three was given a unit of blood that had been determined to be tainted with the virus that causes AIDS. The board was about to settle a claim filed by the woman, Aleta Clemons, but has postponed that decision.

In recent months, The Times has reported that many of King/Drew’s problems have existed for years, often despite knowledge by top officials at the hospital, in the health department and even on Burke’s staff--which traditionally keeps close tabs on the major link in the county’s trauma network and central facet of the safety net for the poor in her district.