Report Criticizes Medical School

A task force headed by a former surgeon general of the United States called Tuesday for the firing of the president of the private medical school affiliated with the troubled Martin Luther King Jr./Drew Medical Center and making other major changes there.

The report by a panel headed by Dr. David Satcher contained scathing criticism of Charles R. Drew University of Medicine and Science and its leadership, but was vague in many details. For instance, it declared that it was “not possible to sustain” Drew’s 18 residency training programs at the county hospital, but it did not say how many programs should be cut or which.

Among other reforms, the report said, the medical school should establish an alliance with a larger, more prestigious institution such as UCLA or USC.

The task force referred repeatedly to the need for a “culture of accountability” at Drew University, which has lost accreditation in two of its major residency programs and faces the loss of a third -- a meltdown that threatens the existence of the hospital. King/Drew, located in Willowbrook, was created by Los Angeles County in response to the 1965 Watts riots and is the only public hospital serving a vast swath of South Los Angeles.

While the report focused on the medical school’s shortcomings, it also stressed the institution’s accomplishments in serving the surrounding community, which is largely poor and almost exclusively black and Latino. The school has encouraged many young physicians to set up practice in low-income communities that typically face shortages in medical care, the panel said.

“There’s some unusual accomplishments there, and that’s what’s sad about the problems today,” Satcher said in a telephone interview after the report was formally released to the Los Angeles County Board of Supervisors on Tuesday afternoon.

“This institution,” he added, “has both served and failed the community.”

Satcher, who served as U.S. surgeon general from 1998 to 2002, was appointed by the Board of Supervisors in September to lead the task force and investigate the medical school’s role in the hospital’s downward spiral. Satcher was an interim dean at Drew University in the 1970s, and created a program -- still in existence -- that allows medical students to study for two years at the UCLA School of Medicine and two years at Drew.

At the center of the task force recommendations is a proposal to create a similar cooperative program for medical residents, who are medical school graduates undergoing on-the-job training. In urging King/Drew to create an alliance with an institution such as USC or a school within the University of California system, the nine-member panel noted that the dean of UCLA’s medical school had discussed such a partnership with Drew’s board of trustees last week.

In urging the university to shut down an unspecified number of residency programs before more of them “receive unfavorable review by accrediting agencies,” the task force said that King/Drew’s average of a little more than 200 inpatients was too low to sustain the 18 it now has.

In the interview, Satcher said the task force had not been more specific because it did not have enough time to review every program. “Our job was the big picture,” he said.

Dr. Thomas Garthwaite, the director of the county health department and a task force member, agreed that the panel had carried out its mandate, saying, “I’m not surprised or disappointed that it doesn’t have more of a roadmap there. But what it does is establish an imperative for determining what that roadmap is.”

The panel reserved its strongest language for university’s president, Dr. Charles Francis, and its board of directors, some of whose members have overseen the medical school since its inception in the late 1960s.

The report said the board of trustees had “failed to hold itself accountable, as evidenced by the lack of demonstrated commitment to regularly infuse the board with new ideas.” It urged the aging board to “commit to self-reformation” by creating a new way to select its members.

The task force also recommended a “positive leadership transition” at Drew, a euphemistic way of saying that Francis should be fired. It said Francis had “not been accountable to the board” and had “lost the confidence of many on the board, the faculty and the surrounding community.”

A spokesman for the university, Michael Downer, said Francis hadn’t read the report and was not available for comment. Dr. Carole Jordan-Harris, who heads the board of trustees, said that she had read only a draft and that it would be inappropriate to comment before she had read the final report.

The report contained no direct criticism of the Board of Supervisors, which serves as the governing body of King/Drew. However, the supervisor whose district includes the hospital, Yvonne Brathwaite Burke, said criticism of her and her colleagues was “inherent” in the report.

“The very fact that there have been these problems ... makes it very obvious that the board has some responsibility and the health department has some responsibility,” she said.

Burke said she couldn’t say what effect the task force recommendations would have. “It’s impossible to say,” she said. “I can’t tell you any recommendations that I see that are problematic. Personally, I think they should be well received.”

Supervisor Zev Yaroslavsky called the report “a very significant set of findings and recommendations” for the school, which has in the past been treated as “autonomous and untouchable.”

He praised Satcher for his “pleasantly surprising” frankness.

“I’m not surprised that he did it, because he’s that kind of man, but it’s unusual to see that kind of frankness in this kind of situation,” Yaroslavsky said. “Only someone with his combination of experience, credentials, and roots at Drew could make such a powerful statement so credibly.”

Yaroslavsky also said the county needed to address significant shortcomings regarding its administration of the hospital.

“There’s two sides to this coin and we’re one side of it,” he said. “We’ve got to clean up our part of it if King/Drew is to survive and there are a lot of things going on now to address the serious problem we have on our hands.”

Toward that end, Yaroslavsky said Fred Leaf, second in command at the county health department, had spent the past week “holed up” at the hospital. On Tuesday, Leaf released a two-page report detailing his actions.

According to that report, since last Sunday, a crisis response team headed by Leaf had temporarily closed one monitored bed ward and, from Sunday night until Tuesday morning, diverted all ambulance traffic away from King/Drew to other county facilities to help “decompress” the hospital.

Leaf has also directed a daily administrative officer to remain overnight in the hospital during the week and from noon to 8 p.m. on weekends, in addition to being immediately available by pager.

Garthwaite dispatched Leaf last week after an incident -- the third in recent months -- in which a patient died after the hospital’s medical staff apparently failed to notice a decline in vital signs as noted on a cardiac monitor that had been supposed to be continuously checked.

Failures of that sort were outside the purview of the task force, which focused solely on Drew University.