King/Drew Facing a Major Overhaul

Los Angeles County health officials said Tuesday that they plan sweeping management changes at Martin Luther King Jr./Drew Medical Center, which one county supervisor described as “going to hell in a handbasket.”

Members of the Board of Supervisors called for a more complete overhaul of the troubled hospital, and cast doubt on the future of the county’s relationship with the private medical school that collects $13.8 million a year to run physician training at the hospital.

The county’s five supervisors were responding to the preliminary findings of a surprise inspection last week that was ordered by the federal government. The inspectors faulted county officials for their poor oversight of a hospital where nurses neglect basic patient care and doctors fail to address known problems.

For nearly two hours and in unusually blunt language, the supervisors by turns grilled administrators from the county health department, vowed to take a stronger hand in the hospital’s management, and lamented what they said were political obstacles to effecting change at King/Drew.

In response, county health department chief operating officer Fred Leaf indicated that changes in top leadership are imminent.

“I would say within this week and the next couple of weeks, there will be a number of very, very significant actions taken in terms of the structure of the hospital, the services they provide and the management,” Leaf told the supervisors.

Although King/Drew is in Supervisor Yvonne Brathwaite Burke’s district, the territorial deference and cautious approach that normally defines board meetings was cast aside as one supervisor after another questioned the county’s stewardship of King/Drew or lambasted the hospital. The hospital in Willowbrook, just south of Watts, serves a mostly minority clientele.

Burke called for weekly progress reports, but other supervisors displayed more anger.

“They come in on a moment’s notice and do a little investigation,” said Supervisor Zev Yaroslavsky, referring to outside health inspectors. “They make these ... findings that the place is going to hell in a handbasket. Why did they know that and we didn’t?”

Several of the supervisors complained about the “political” sensitivities surrounding the hospital, apparently referring as much to race as to traditional political rivalries.

“I’ve never seen such hostility,” said Supervisor Gloria Molina, the lone Latina representative on the board, referring to the hospital’s defenders. She said that when she first tried to get involved at King/Drew, where leaders are primarily African American, “I was accused of trying to take over the hospital and change it to Benito Juarez Hospital.”

“There is a political bubble that exists there that needs to be busted,” Molina continued. “This is a top priority. This is a hospital that is quickly sinking.”

In recent months, King/Drew has been buffeted by a steady stream of criticism and sanctions. The latest inspection was prompted by the deaths of two patients last summer who deteriorated undetected even though they were hooked up to heart monitors.

In addition, a national accrediting body has stripped the hospital of its ability to train aspiring surgeons and radiologists. The group also recommended closing the hospital’s neonatology training program.

Those and other problems have prompted the county’s health department to pursue a series of changes at the hospital, including placing managers from other county hospitals in charge of King/Drew’s day-to-day operations. The department has also said it is close to hiring a new permanent medical director.

In addition, the county has appointed a national task force led by former U.S. Surgeon General Dr. David Satcher that is expected to issue recommendations in the coming weeks about how to shore up the hospital’s teaching programs.

Health department Director Dr. Thomas Garthwaite told supervisors that he is relying on Satcher’s task force -- of which he is a member -- to recommend changes. Garthwaite said it is likely that the hospital will have to significantly pare back the number of residency programs it offers.

The supervisors expressed frustration with the slow pace of reform. “We don’t need much more reports,” said Supervisor Don Knabe. “We’re getting them daily in the paper.”

Supervisors and health department officials also had harsh words for the nonprofit Charles R. Drew University of Medicine and Science, which contracts with the county to run the doctor-training programs at King/Drew.

Leaf, the health department’s chief operating officer, told supervisors that the department’s relationship with Drew “stinks.”

“The school continually refuses to comply with the contract,” Leaf said. “It is appalling, the lack of respect and cooperation.”

In a written statement, Drew President Dr. Charles Francis defended his university. “While it is true that challenges exist with several -- four or five -- of the residency programs, the overwhelming majority of these programs are in very good shape and indeed are running well,” he said. “Our commitment is to excellence, accountability and taking action to correct any program deficiencies.”

Yaroslavsky said the county may have to form a coalition of medical groups to pressure USC and UCLA into helping manage the teaching programs at King/Drew because they so far have been unwilling to play a large role there.

Officials at USC said they are busy enough managing medical affairs at the larger County-USC Medical Center to take on the problems at King/Drew. UCLA officials said they have not been asked to step in.

At the hospital itself, Garthwaite and other county officials suggested it may be a difficult and costly process to remove top managers because of civil service protections.

Molina said previous efforts to discipline or remove management personnel at King/Drew have failed because “these people are all connected. The minute anybody gets any kind of discipline they run to the congressional office, to the legislative office, and they start in.”