Major Cuts at Hospital Urged

Los Angeles County health officials Thursday recommended dramatically scaling back the services offered by Martin Luther King Jr./Drew Medical Center, including closure of patient care wards devoted to pediatrics, obstetrics and neonatology, in their latest attempt to rescue the ailing public hospital.

In briefings with the county Board of Supervisors, health director Dr. Thomas Garthwaite also said that the hospital’s trauma center should remain closed for the foreseeable future and that King/Drew should reduce cardiovascular surgery, neurosurgery and other staff and services needed to reopen the unit.

The recommendations would effectively turn King/Drew into a small community hospital, a long way from its status a few years ago as a hub of specialty care. It would still train physicians to be specialists, such as internists or psychiatrists, but under the new plan there would be fewer trainees and programs.

The plan, however, includes expanding certain outpatient services, such as those for cancer detection and treatment, diabetes, high cholesterol, high blood pressure and pediatrics. That approach, Garthwaite said, would better meet the chronic health needs of the largely impoverished and minority neighborhoods served by the hospital in Willowbrook, south of Watts.

When the supervisors voted to close the trauma center last fall, angry community members and elected officials demanded that it be reopened this year or next. On Thursday, the officials said they felt betrayed and vowed vigorous opposition to the plan, which they said was part of a preordained design to close the hospital.

“I’ll tell you what: I’ll see them in the street,” said Rep. Maxine Waters (D-Los Angeles), at the end of an evening conference call, not realizing that a reporter was on the line. “I’m not going to sit still for this.”

Los Angeles Councilwoman Janice Hahn said: “Didn’t we say this was exactly their plan? We said they would never reopen the trauma center, and now they’re taking away pediatrics and obstetrics.”

Hahn’s father, revered former county Supervisor Kenneth Hahn, fought to build King/Drew after the 1965 Watts riots, when the lack of healthcare and other services for African Americans fueled deep anger.

The medical center has since become not just an important source of healthcare and jobs, but a symbol of progress and racial justice, even as the surrounding community has become increasingly Latino.

Garthwaite’s plan is at least the sixth effort in two years to fix the hospital, which has lost its national accreditation and has been threatened with the loss of federal funding because of a series of patient care lapses. The hospital is being run by Navigant Consulting Inc., a turnaround firm being paid $15 million for a one-year contract.

The health director’s proposal requires approval by the Board of Supervisors, which is slated to consider it at a public meeting Aug. 16. Should the supervisors approve the changes, a second public hearing would have to held before they could be implemented. The whole process is expected to take six months.

Just one of the five supervisors said publicly Thursday that he supported the plan, at least in principle.

“I think everyone needs to understand how close we have come and still are to that hospital not being able to survive,” Supervisor Zev Yaroslavsky said. “My view is: If you can save the hospital, even with significant downsizing, it’s tough medicine, but it may cure the problem.”

Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, said she had many questions about the plan and wanted to “get some idea of what they’re saying that the final hospital would look like” before committing to it.

Other supervisors declined to comment.

News of Garthwaite’s proposals saddened and angered some King/Drew patients, staffers and supporters who have weathered one rescue attempt after another, only to see prized services scrapped.

Sharron Banks, a Compton mother of five, said she relied on the hospital to care for her children, especially her two youngest, who are adopted and have special healthcare needs.

Her 18-month-old daughter, Nicole, who has short-bowel syndrome, has been treated at King/Drew from birth. But cutbacks in high-end pediatric care already have forced her to seek treatment at Cedars-Sinai Medical Center, in Los Angeles, near Beverly Hills.

“I’m, like, in tears right now,” said Banks, her voice catching. “I do not know what I am going to do. That will be so hard on us. Cedars is 45 minutes away in traffic. I don’t know if they know the hardships they are making on the people that really, really need that hospital.”

In total, the patient wards that may be shut averaged about 38 patients a day last year. They accounted for about 22% of the 176 inpatients King/Drew treated on average each day.

Dr. Hector Flores, head of the medical center’s advisory board, said he was not sure that other hospitals could absorb the patients King/Drew would be casting aside. “I don’t think we’ve done our due diligence,” he said, adding that he worries that children would be harmed.

“I think we’re going to be seeing some adverse outcomes from making these transfers,” Flores said. “By the time they make it to the next facility, it will be too late.”

But in the conference call with elected officials and community leaders Thursday evening, Garthwaite said pediatrics and obstetrics were little-used services at the hospital.

Last year, King/Drew delivered about 600 babies, compared with about 4,000 a decade earlier. Many obstetrical patients and children have private insurance or Medi-Cal coverage and can choose private hospitals for their care, Garthwaite said.

“Virtually everyone has insurance coverage,” he said. “Those that don’t, we can easily handle in our other hospitals.”

Garthwaite said his proposals would initially save the county $3.7 million a year and eliminate 210 to 260 jobs at the hospital, whose expenses are far higher than those at the county’s three other general hospitals.

Over time, he said, the county needs to restructure King/Drew’s entire staff to make it as efficient as those at other county hospitals, cutting “significantly” more jobs and paring millions more from its budget.

In making his recommendations, Garthwaite ruled out turning the hospital into a large community clinic because he said other area hospitals could not take in all of the patients that would spill into their wards.

But he said the county would continue to explore the option of handing control of King/Drew to an outside company in case his proposed fixes didn’t work. That would take at least six to 12 months of planning, based on a consultant’s review.

Because of all of its problems, King/Drew has treated far fewer patients in the last year. Emergency room visits are down nearly one-fourth, outpatient visits 12% and inpatient discharges 9%. Yet the hospital’s costs have increased, in part to pay for Navigant and to cover the cost of temporary nurses, needed because the hospital is having trouble hiring permanent staffers.

The general manager of the labor union representing King/Drew’s workers said the county should allow the hospital’s incoming chief executive, whose name is expected to be announced next week, to review the hospital’s operations and have a say in the recommendations.

“Get that CEO in place and wait several months,” said Annelle Grajeda of Service Employees International Union Local 660.

“There’s no one there that wants to defend a hospital that’s endangering patients,” she said. “On the other hand, they’re very proud of the services that it delivers and there’s an awful lot of good work that goes on there that’s not noticed by anybody.”

Assemblyman Mark Ridley-Thomas (D-Los Angeles) was troubled as well by Garthwaite’s plan. “A case has to made for how reducing services to arguably the most needy portion of the county can be justified or defended,” the legislator said.

But Jim Lott, executive vice president of the Hospital Assn. of Southern California and a member of King/Drew’s advisory board, called Garthwaite’s proposal “logical.”

“It’s very realistic, and it will help us turn the corner,” he said. “We need to focus our efforts on what we can do and what the community really needs King/Drew to do.”

This is not the first time that Garthwaite has proposed changes to the neonatal intensive care unit. In January 2004, he recommended downgrading its status and restricting its ability to care for the sickest newborns. But after intense criticism, the county months later put the idea on hold.

Dr. Xylina Bean, director of neonatology at the hospital, said the county’s latest proposed cuts would “devastate access to pediatric care” for the families that rely on the medical center. Some King/Drew patients, Bean said, may have to take two or three buses to get to other hospitals that provide complex pediatric care.

Bean said that she couldn’t argue with plans to expand care for such pervasive illnesses as diabetes, but that the proposed cuts would shortchange the community’s children.

“If they’re using as a justification that they are meeting the needs of the people in the community, I can tell you they are not meeting the needs of children in this community,” said Bean, who started at King/Drew in 1973, the year after it opened.

“When they say ‘safety net,’ we are the safety net for the children in the community,” she said. “We’re it.”

Councilwoman Hahn said the latest recommendations were a “real injustice to this community” and in fact amounted to making King/Drew a “clinic.”

“That is not what everyone fought for 40 years ago,” she said. “They fought for a full-service hospital so that from the time you were born to the time you died, you had access to healthcare if you lived in the Watts community.

“Hopefully, the community will fight,” she said. “It’s unfortunate that this community has to fight for quality healthcare.”

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(BEGIN TEXT OF INFOBOX)

A history of key developments at King/Drew

Los Angeles County health officials have proposed various plans to address major patient-care lapses at Martin Luther King Jr./Drew Medical Center. Here’s a timeline:

* October 2003: Dr. Thomas Garthwaite, county health director, dispatches his top managers to the hospital several months after nurses failed to respond promptly when cardiac monitors showed two patients in distress. Both patients died.

* December 2003: Garthwaite expands his management team, and the county hires the Camden Group consulting firm to help fix nursing services. The county ultimately spends more than $930,000 for Camden’s services.

* April 2004: Garthwaite proposes hiring a consultant to ensure “appropriate management controls” at a cost of $466,800 for one year. He withdraws the request two months later, when some members of the county Board of Supervisors complain about the cost.

* September 2004: Garthwaite proposes closure of King/Drew’s trauma center, which the Board of Supervisors later approves. The board also enters into an agreement with the federal government to hire a new consulting firm to assume control of operations at King/Drew for a year. In November, Navigant Consulting Inc. takes over, and the county ultimately agrees to pay the firm up to $15 million.

* February 2005: County supervisors form a hospital advisory board made up of health experts and other interested parties to give them advice on King/Drew.

* March 2005: Trauma center closes.

* May 2005: County supervisors order the health department to study handing control of King/Drew to an outside company. After an initial review, a consulting firm says the process could take six months to a year.

* Aug. 4, 2005: Garthwaite proposes closing inpatient pediatrics, obstetrics and neonatal units at King/Drew and dropping the idea of reopening the trauma center in the foreseeable future. He also recommends adding some outpatient services.

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Source: Times research

Graphic reporting by Charles Ornstein

Los Angeles Times