King/Drew Loses Its Right to Train Surgeons
Martin Luther King Jr./Drew Medical Center has been stripped of its accreditation to teach general surgeons, jeopardizing its entire physician training program and potentially impairing the hospital’s ability to operate on patients.
The rare move this month by the Accreditation Council for Graduate Medical Education, which cannot be appealed, is a devastating loss for the Compton-area public hospital, which relies heavily on medical residents to care for its mostly poor and uninsured patients.
For the record:
12:00 AM, Sep. 27, 2003 For The Record
Los Angeles Times Saturday September 27, 2003 Home Edition Main News Part A Page 2 National Desk 2 inches; 93 words Type of Material: Correction
King/Drew -- Stories that ran on Aug. 23, Aug. 27 and Sept. 17 quoted officials from Los Angeles County or Charles R. Drew University of Medicine and Science as saying that the surgery-training program at Martin Luther King Jr./Drew Medical Center enrolled two more residents than the 38 allowed overall by an accrediting council. County health department officials said this week that they erred in making that statement. In fact, the program was cited for having two more residents in its graduating class than the six it was allowed, the county now says.
The hospital was created in 1972 in response to concerns that the community, then mostly African American, did not have access to adequate medical care.
The decision comes as several of the hospital’s major teaching programs are imperiled. Less than a year ago, the council revoked King/Drew’s right to train diagnostic radiology residents, which takes effect next June.
In addition, four more of King/Drew’s 18 training programs are on shaky ground with the accrediting body. The hospital’s anesthesiology, family medicine, internal medicine and neonatal-perinatal programs have been placed on probation or have received warnings in the last two years.
The surgery program sanction, known as “summary withdrawal,” is given only under extreme circumstances -- two other times nationwide this year and never in the previous two.
The decision, which takes effect immediately, means that King/Drew must now find surgical training programs at other universities for two dozen residents, including six who just began their training this summer. Residents slated to complete the five-year program by next June can stay.
In general, residents are new doctors being trained in a specialty; to be certified in that field, they must complete an accredited program.
The accrediting council revoked the surgery program’s accreditation because it had two more residents than the 38 it was allowed, county officials said. The program was placed on probation last year because residents were not provided with enough surgical experience, faculty research was inadequate and curriculum did not follow recommended guidelines.
Officials at Charles R. Drew University of Medicine and Science, the historically black college that runs the hospital’s training programs, said they understand their punishment because they broke the rules.
“The rules are the rules,” said Dr. M. Alfred Haynes, chairman of Drew’s board of directors. Still, he said, “This is a severe blow.”
The accrediting council plans to visit King/Drew for a review of its overall physician training programs Sept. 9. The institution received an unfavorable rating overall during its last review, in 2000. If it receives another unfavorable rating, the council could pull its right to train residents at all.
News of the medical center’s loss came as a shock to former surgical residents. Officials at Drew broke the news to faculty and residents at an evening meeting Friday.
“It’s going to be devastating not only to the hospital, but to the community, because the residents do all the work there,” said Dr. Romeo Massoud, a trauma surgeon in Georgia who completed King/Drew’s general surgery residency in 2001. “Where will the people go? Where will they go? There’s just going to be too much work.”
As surgical residents left the meeting announcing the program’s shutdown, some looked as if they had been crying; others appeared angry and were unwilling to answer questions.
“It’s an outstanding program,” said Dr. Michael Sedrak, a resident. “This is an unfortunate decision.”
King/Drew is one of 13 centers in Los Angeles County certified to handle trauma, including gunshot wounds and car-accident injuries.
The loss of the residency program will force the county to downgrade the hospital’s official status, but the facility will still be certified to treat the same kind of patients. The problem, however, could be staffing the trauma center, where residents play a key role.
Combined, the loss of the surgery and radiology programs allows Los Angeles County, which owns the hospital, to terminate its $13.8-million agreement with Drew. As part of that contract, the loss of two programs “shall constitute a breach by [the] university and an event of immediate termination of the agreement.”
But Dr. Thomas Garthwaite, director of the county Department of Health Services, said he doesn’t intend to end the relationship immediately, because the new leadership at Drew has been working hard to improve the residency programs. Garthwaite and the medical school dean, Dr. Marcelle Willock, have been in their positions for less than two years.
“We fully recognize that there are several programs down there that have been on the margins, but we’ve taken fairly decisive action” to make changes, Garthwaite said. “It’s still too early to tell whether the efforts of the new leadership at Drew and the Department of Health Services can be successful or not.”
Garthwaite said he had already relieved Dr. Arthur Fleming, chairman of the general surgery department, of his administrative responsibilities and would conduct a national search for a new chairman from outside King/Drew. Fleming will remain on staff as a physician.
The county health department would not release correspondence from the accrediting council outlining the penalty, citing the need to keep such information confidential.
Drew board Chairman Haynes said Fleming’s efforts to help out some struggling doctors by allowing them to stay in the program an extra year may have gotten King/Drew in trouble.
“I do know that Dr. Fleming is a very compassionate individual and he may have been trying to bend over backward.”
Haynes conceded that the surgery program is “not as good as it can be.” The program’s pass rates for the surgery board exams were brought down recently after two surgeons who were clearly unprepared took the boards and failed, he said.
In 2002, only one of the four residents who took the written test passed. The pass rate was much higher -- above 80% -- the previous four years.
King/Drew can apply immediately to start a new surgical program, but the institution would have to prove that all of its problems had been resolved, and approval is not guaranteed.
“I can’t imagine that we would not eventually reapply,” said Dr. Charles Francis, president of Drew, who did not specify when. “Surgery is a major program and one which we obviously want to have as strong here as possible.”
Haynes said it could be difficult to attract residents to a new surgery program because the reputation of the institution has been damaged.
Officials at other public hospitals around the country said the loss of accreditation for a surgery training program would have serious consequences.
“It would be extremely difficult and extremely expensive” to continue operating without a surgery residency program, said Michael Korpiel, senior vice president for surgery and trauma at Parkland Health and Hospital System in Dallas. “That would be pretty devastating. We wouldn’t be able to do it. We wouldn’t be able to survive. I don’t know how they’re going to do it.”
Without residents, a hospital would have to hire staff surgeons who would have to be paid substantially more than trainees.
Former residents agreed.
“I don’t how they will substitute for the absence of the residents,” said Dr. Gabriel Carabello, who completed his surgical residency at the hospital and later served on staff. “There is a high volume of patients there and the residents are key to delivering patient care.”
Carabello, who is now a vascular surgeon in Glendale, said King/Drew’s surgical training program is excellent.
If necessary, Francis said, his surgical faculty would step up and fill the void left by the departing residents.
“Most people agree that there is going to have to be some adjustment, but I don’t know that we’ve had enough time to quantify that right now.”
County Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, called the violation by the surgery program “unthinkable” and said she has summoned the president of Drew, the dean of its medical school, the director of the county health department and members of the Drew board to her office Monday to discuss the situation.
“It seems to me the board of that school should have known about it and they should not have allowed this to happen,” Burke said. “The only way my trust will be restored in the institution is when I see that they are getting the proper accreditations.”
Drew board member Marvin Jubas, a lawyer, said that because the hospital has been underfunded, negative repercussions can be expected.
“It’s pretty easy for somebody to sit back and say, ‘This is outrageous. It shouldn’t happen,’ and then look for the fall guy -- who should take the blame for what took place. If politicians want to try to look for blame, there’s plenty of blame on their doorstep. You can do just so much when you are significantly underfunded.”
Outside audits and the county’s own statistics indicate that King/Drew spends more per patient than the county’s three other full-service hospitals.
Jubas said the loss of accreditation was a huge blow, and the consequences could be tragic.
“The threat to the university is enormous,” he said. “Not only do you have the concomitant loss of credibility that goes with it, [but] it’s very easy to say, ‘They’re not doing a good job. Screw it, let’s kill the program.’ ”
Times staff writer Monte Morin contributed to this report.