King/Drew Plight Is Detailed

The former head of surgery at Martin Luther King Jr./Drew Medical Center disobeyed repeated demands from his colleagues and an outside accrediting body to cease training more aspiring surgeons than he was allowed, according to the president of the medical school affiliated with the hospital.

As a direct result, the Accreditation Council for Graduate Medical Education withdrew its approval for the surgical training program this month, forcing the Willowbrook hospital to shut it down, said Dr. Charles Francis, president of Charles R. Drew University of Medicine and Science. The university runs the 18 physician training programs at the hospital.

Francis’ remarks Tuesday provide the first detailed explanation of how King/Drew antagonized the accrediting council to such a degree that the panel exercised its toughest sanction against the surgery program, forcing the hospital to find new placements at other institutions for two dozen trainees.

At their regular meeting Tuesday, Los Angeles County supervisors expressed alarm at King/Drew’s predicament and openly worried that it might lose approval for all of its training programs.

These are “life and death issues for many of the patients.... I want to just raise the level of emergency,” said Supervisor Zev Yaroslavsky.

Accreditation of the radiology training program was revoked last year, and four other residency programs are either on probation or have received warnings. An overall review of King/ Drew’s programs by the accrediting council begins Sept. 9.

Like the supervisors, Francis said he was concerned about how the surgery decision would affect the accrediting council’s overall review.

“It certainly will not help,” he said in an interview. “This is another nail. We already have a number of programs that are in trouble. That fact that this is a proposed withdrawal is not good.”

Francis said King/Drew’s former surgery chairman, Dr. Arthur Fleming, was warned three times by the accrediting council -- in October 2001, April 2002 and December 2002 -- not to train any more than the 38 residents. The hospital’s own graduate medical education committee made the same demand.

Fleming, who was stripped of his administrative responsibilities last week, erred by accepting a full incoming class of residents even though he held back two upper-level residents who had academic problems, Francis said.

The accrediting body took unusually extreme action because the program already had been on probation for providing inadequate training.

“There were at least two or three times ... when it was conveyed to him either orally or in writing that his requests to temporarily increase the number of residents in the program was denied,” said Francis, who is the highest-ranking official at the medical school.

Fleming would not discuss the situation, scolding a reporter who paged him Tuesday afternoon. “It is most inappropriate to page me while I’m in seeing a patient,” he said before hanging up. He did not return repeated telephone calls afterward.

Dr. Thomas Garthwaite, director of the county Department of Health Services, said he had not heard Fleming’s side of the story but felt that the information available to him was “pretty damning” and enough to strip Fleming of his administrative duties.

Earlier, at the supervisors’ meeting, Garthwaite said the chances of keeping the overall training program after next month’s review were “better than 50/50, but I’m no expert.”

Yaroslavsky replied, “When I go into surgery and I ask the doctor, ‘What are my chances of survival?’ and he says, ‘They’re slightly better than 50/50,’ that doesn’t give me a warm and fuzzy feeling.”

The supervisor also questioned whether King/Drew could hook up with another teaching hospital such as those of UCLA or USC to help run its programs for the “short term or long term or both.”

Garthwaite said the county plans to bring in outside leadership to assess the quality of the surgery department and perhaps consider a countywide training program that would include other medical schools.

During the supervisors’ meeting, two King/Drew residents gave impassioned pleas for the supervisors to do what they could to save the program -- for themselves and the community.

“Most of the trauma that we receive and the emergency services, the patients are in critical condition and are not able to make it to the nearest hospital,” said Dr. Marian Safaoui, who is in the final year of the five-year surgical residency program.

“We implore you to help us find a solution for this, because it’s not only our lives and careers that have been affected, but also the people that we have dedicated our lives to serve.”

Dr. Almaas Shaikh, a third-year resident, said she chose to attend USC’s medical school and complete her residency program at King/Drew specifically to work with underserved populations.

“Who is going to take care of the patients who come through there?” Shaikh asked. “If you do not have a surgical residency in that hospital, you will be shutting down a very large portion of that hospital, and, unfortunately, a lot of people will suffer the impact of that decision.”

Francis said the medical school would work hard to find new placements for residents when the training program was shut down. And officials plan to ask the accrediting council for a last-minute reprieve, although chances for success are considered slim.

Francis said it was an unfortunate ending to a program that “has successfully trained a generation of surgeons and provided trauma services for this community for many years.”

Fleming “deserves some credit for that,” Francis said.