Two Crisis Teams to Oversee Hospital

Spurred by the latest death of a patient under questionable circumstances, Los Angeles County health officials announced plans Friday to immediately send a top-level “crisis response team” to oversee management of the troubled Martin Luther King Jr./Drew Medical Center.

The officials also said they had hired a private “turnaround team” to take over management of the nursing staff, which has been at the center of many of the hospital’s problems.

Both the nursing and crisis response teams are expected to begin work this morning.

The decision to send in the outside managers was made after the death of a patient Sunday, the third in recent months in which medical staff members apparently failed to intervene promptly as patients attached to cardiac monitors deteriorated, officials said.

The county’s top two health officials, Dr. Thomas L. Garthwaite and Fred Leaf, said in an interview that they were concerned not only by the death of the patient -- who, they said, was terminally ill and would probably have died at the hospital anyway -- but by the failure of King/Drew officials to report the incident to county health officials until Tuesday.

“That was completely inappropriate,” Leaf said.

As a result, one job of the crisis response team will be to monitor, every four hours, what Leaf described as “all activities occurring in the hospital, including any incidents that require immediate attention in terms of staff or corrective action.”

Leaf, chief operating officer of the county Department of Health Services and second in command, will personally head the crisis team, which will include three or four other health officials.

Establishing the crisis team and hiring the nursing management contractor are among the most dramatic reforms of late at King/Drew, which has been a source of serious concern to county health officials for more than a decade.

The hospital, established in Willowbrook as a response to the 1965 Watts riots, is the only public hospital in the South Los Angeles area and serves a vital need in the community. Public confidence has been shaken by a series of widely publicized incidents involving allegedly inadequate or incompetent care.

County Supervisors Gloria Molina and Yvonne Brathwaite Burke, whose district includes the hospital, expressed frustration Friday over the circumstances surrounding the latest patient death. Molina said she had called Garthwaite and Leaf, urging them to “get on the ball” and establish a “command post” at the hospital.

“I’m at a point where I’m saying, ‘Should we shut this hospital down?’ ” Molina said. She added that she did not consider that a realistic or desirable option, given the need for medical care in the surrounding community.

However, she said the Board of Supervisors needs to know that the hospital has “a very solid plan in place, a plan with real accountability, a plan that provides assurances to all of us that this is a functional hospital. And if they can’t do that, then I think we have to find a way to minimize the patient care there. That is, maybe transferring emergencies and canceling elective surgeries or elective hospitalizations of some type.”

Burke called the death of the patient Sunday “tragic” and “horrible,” and said that if it was caused by a nurse’s failure, “that person should be fired.”

However, she expressed optimism that the changes in nursing management would ensure that such incidents did not recur.

Health officials have not identified the patient or discussed the case in any detail.

Burke said she knew little about the death. Health officials have said the patient was terminally ill with kidney or liver disease, and had deteriorated while nurses apparently failed to keep watch on a cardiac monitor. The patient was resuscitated, but died about 90 minutes later, the officials said.

Burke said the patient’s family was present, and had noticed the decline in vital signs. It was a family member who notified nurses that the patient was failing, she said.

Burke added that she was particularly concerned by the hospital’s failure to promptly report the death to county or state officials. She said she didn’t find out until Wednesday. Health officials sent a memo to all five county supervisors late Thursday.

Molina said she missed that memo, which was sent after regular business hours, and learned of the incident in Friday’s newspaper. “When I read that headline, my jaw dropped,” she said. “I just couldn’t believe it.”

Garthwaite and Leaf said the crisis team being sent in today will not assume management of the hospital, but rather will monitor and advise existing management, which already includes some recently installed health department officials.

“We really want to establish accountability for performance and

The new nursing team, however, will take immediate charge of all nursing operations at King/Drew.

In a memo to the Board of Supervisors on Friday, Garthwaite and Leaf said they had contracted with the Camden Group, a consulting and management company, to provide the nursing leadership and to assess nursing operations at the hospital.

They said the team would be headed by Barbara Patton, a registered nurse whom they described as “a turnaround specialist,” and Larry Kidd, a registered nurse who was formerly chief nursing executive with the Alameda County Medical Center in the Bay Area.

Former King/Drew Nursing Director Rosemary Haggins was suspended earlier this week after a government inspection found systemic problems with nursing care at the hospital, including a failure to attend to patients who were in pain.

The problems at King/Drew prompted the formation of a task force headed by Dr. David Satcher, former surgeon general of the United States, to advise the county on reforms to its doctor-training programs. Satcher is expected to release a report as early as Monday detailing his panel’s proposals for reforming the hospital.

While declining to describe what the report might contain, Burke, who sat in on a task force meeting this week, said, “I can say to you that they are suggesting some very drastic action.”

She said it would be consistent with calls by Garthwaite and others for consolidating a number of specialized services at all county hospitals, which would probably mean the elimination of certain subspecialties at King/Drew.