King-Drew Hospital Programs in Trouble

Medical regulators are withdrawing their accreditation from a key training program at Martin Luther King Jr.-Drew Medical Center and have found problems that could hamper the hospital’s ability to serve patients, officials said Monday.

The move raises “significant questions” about the county’s affiliation agreement with Charles R. Drew University of Medicine and Science, which manages medical care at the hospital, Dr. Thomas Garthwaite, director of health services for Los Angeles County, said in a memo to the Board of Supervisors.

The Accreditation Council for Graduate Medical Education has revoked the accreditation of King-Drew’s diagnostic radiology program and found “significant deficiencies” in the office that handles all medical training at the facility, Garthwaite said.

The hospital’s internal medicine training program has been put on probation, and its general surgery program has been proposed for probation.

A survey by a separate accrediting body, the American College of Surgeons, found so many problems at the institution that it may restrict the level of trauma care the hospital can provide. The hospital’s trauma designation has not been changed.

King-Drew officials are appealing the decision to withdraw accreditation from the radiology program, which takes effect in June 2004. But the hospital has stopped accepting new radiology residents for the time being.

“We are really revamping everything,” said Marcelle Willock, dean of the College of Medicine at the historically black Drew University. “A lot of it boils down to dollars, of course.”

In an interview, Garthwaite said patients are not at risk at King-Drew, the sole major hospital for one of the poorest, sickest and most densely populated stretches of Los Angeles County.

“I don’t think they’re in any more danger at King-Drew than they are at any other hospital,” he said. “It’s an accredited hospital.”

County Supervisor Yvonne Brathwaite Burke said that if King-Drew loses some of its graduate programs, the effect would be “devastating, absolutely devastating.”

“Everybody has to get on the ball and come up with some answers,” she said.

In withdrawing its approval of the radiology program, the accreditation board found that medical residents do not receive enough supervision while working in the emergency room. In addition, only 15.4% of residents from 1997 to 2001 passed their oral exam for board certification on their first attempt.

The radiology program has 12 current residents, according to a county spokesman.

“The program has been cited repeatedly for poor board scores for the last eight years,” wrote Judith Armbruster, executive director of the radiology residency review committee in an Oct. 22 letter.

Responding to the group’s concerns, Drew officials said that their board pass rates are improving, and that problems with supervision in the emergency room have been rectified. Willock said some of the citations arose because the county has not provided enough support staff, so physicians must fill in.

Burke said she will formally ask the medical center and university for corrective action plans at today’s Board of Supervisors meeting.

The big test for King-Drew will come in April, when the accrediting group reviews its overall graduate medical education office. If it receives an unfavorable rating, the impact would be “significant” on all training programs there, Garthwaite said.

“We need to get everyone to take it extremely seriously,” he said.

Willock said that the school is doing so, and that it and the county must continue to push each other to ensure they improve. “Unfortunately, a lot of things don’t happen until there’s a crisis,” she said.

Garthwaite said the previous clinical leadership at the hospital should have pushed harder to address problems. The hospital has a new interim executive director and medical director, and Drew University has a new medical school dean, Willock -- all of whom Garthwaite said are committed to fixing the problems.

Drew’s greatest challenge now, he said, is attracting teachers and researchers without the resources of some other big universities.

Because of the medical needs in South Los Angeles, Garthwaite proposed to keep King-Drew open despite the county’s projected multimillion-dollar budget deficit. If other hospitals were required to close, he proposed Harbor-UCLA and Olive-View UCLA medical centers as more appropriate targets.

But Garthwaite said King-Drew could become more efficient because its costs outpace those of other county hospitals. The health services department hired a consulting firm, Renoir Corp., to look for ways to cut 16% of the hospital’s budget. The group has presented its findings about ways to better use operating rooms and better deploy emergency room staff.

“I want them to succeed,” he said. “What I’m trying to do is find the right mixture of forces to get them to continue to change in the right direction. I don’t think the current management has been given a chance to show what it can do.”

Because of the county budget cuts, Garthwaite also is looking to revamp the health department’s overall affiliations with medical schools. He has considered eliminating the links between individual hospitals and schools, in favor of a broader tie between medical schools and the entire health system.