Board Cool to Plan for King/Drew

A majority of the Los Angeles County Board of Supervisors expressed serious concerns Friday about a proposal to reduce inpatient services at Martin Luther King Jr./Drew Medical Center by closing units such as pediatrics, obstetrics and neonatology.

Three of the five supervisors stopped short of saying they would vote against the proposal outlined Thursday by county health director Dr. Thomas Garthwaite. But they said they would require major modifications or explanations before they could support it. The two remaining supervisors said they backed the plan in principle.

“I don’t think it’s a very thorough, complete proposal,” Supervisor Gloria Molina said in an interview. “It doesn’t give me a pathway to success on this thing. It only tells me that I’ve got to close more, and eventually they’re going to make it work.”

She said, “It doesn’t merit my support or [that of] anyone on the board.”

Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, called on Garthwaite to reconsider his proposal, which he has said is the last and best hope for saving the troubled hospital. She said she had seen no evidence that halting some inpatient services would help fix underlying problems, such as King/Drew’s inability to recruit permanent nurses.

Both Burke and Molina also questioned whether the reductions were needed to satisfy the U.S. Centers for Medicare and Medicaid Services, which has threatened to eliminate the hospital’s federal funding, or the national accrediting group that pulled King/Drew’s seal of approval earlier this year. The hospital faces several crucial reviews by accreditors and regulators before the end of the year that could decide its fate.

“My No. 1 priority, I’ve said over and over again, is to keep the hospital open,” Burke said. “My No. 2 priority is to make sure it is an accredited hospital and that it also has [federal] funds flowing into it.... I’m not convinced that closing OB and pediatrics is necessary in order to achieve those things.”

Garthwaite’s plan would also keep the hospital’s trauma center closed for the foreseeable future and reduce staff and services crucial to its reopening. But the proposal would expand outpatient services for cancer detection and treatment, diabetes, high blood pressure, high cholesterol and pediatrics.

Supervisor Mike Antonovich said that Garthwaite’s recommendations were “too little and too late” and that some -- such as closing the neonatal unit -- were proposed months ago and went nowhere. The plan, he said, does little to address continuing lapses by nurses and pharmacists at the hospital.

Garthwaite “thinks everything is moving forward,” Antonovich said. “He is living in a dream world.”

The supervisor said he’d back the plan only if it included detailed contingencies in the event that the hospital did not regain its national accreditation or lost its federal funding or its ability to train doctors. He also wants Garthwaite to push ahead with a proposal to hand control of the hospital to an outside company.

The board is scheduled to consider the Department of Health Services’ recommendations Aug. 16. If it approves them, another public hearing and vote must be held before they can be implemented. That process could take six months.

Garthwaite said he was open to the supervisors’ input. “I know it’s not a politically palatable plan, but I think it’s still a rational and reasonable approach, given the total sum of the situation we find ourselves in,” he said. “They’ll make their case, and I need to make my case.”

He said the inpatient services he is proposing to cut are little used. King/Drew delivered only about 600 babies last year, down from about 4,000 a decade earlier. Pediatric admissions have similarly been dropping.

By comparison, he said, no private hospital in the county that delivers fewer than 1,500 babies annually has a neonatal unit.

Because most children and pregnant women have private or public health insurance, they have many choices for their care, Garthwaite said. What the community really needs, he said, are more clinics -- which he is proposing to create -- that can take care of their chronic problems.

Supervisors Zev Yaroslavsky and Don Knabe said they supported Garthwaite’s recommendations, at least in general.

“At the end of the day, the ultimate goal is to try to save that hospital,” Knabe said. “If this is the direction we need to go, I think we should move that way.”

Yaroslavsky said it was too early to gauge the plan’s chances of passage.

“The concept is sound,” he said. “I’m not going to vouch for every detail. If the board’s going to reject what he’s proposed, it’s up to those board members to propose an alternative that’s medically sound. That will be an interesting undertaking.”

Garthwaite said the board had put him in a difficult position by asking him to make changes to restore accountability to King/Drew but taking some of the most far-reaching options off the table, at least for now. One idea he supports is changing the hospital’s governance by transferring oversight from the board to an independent health authority.

“I’ve been essentially advised to back off of that,” he said.

Garthwaite, who previously worked for the federal government, said the supervisors were under enormous pressure. Other elected officials have said they would vigorously fight the plan, which they see as another step toward closing the hospital.

“My experience in general with politicians is that sometimes ... they have to have a public position that differs from what they really know needs to happen,” he said.

Meanwhile, several hospitals around King/Drew said they could pick up the slack if the hospital eliminated its inpatient pediatrics, obstetrics and neonatology wards. California Hospital Medical Center, in downtown Los Angeles, has space and staffing for additional maternity and neonatal intensive care patients, spokeswoman Katreena Salgado said.

Downey Regional Medical Center also can handle more patients in these areas, said Executive Vice President Robert Fuller.

And Miller Children’s Hospital in Long Beach is in the process of expanding its women’s and children’s services, said Dr. Mel Marks, its chief administrative officer. As it stands, the hospital is licensed for 69 beds in its neonatal intensive care unit.

Burke said she was braced for widespread community opposition to Garthwaite’s proposals. Residents, she said, remember well the case of Leonard Deadwyler.

In 1966, before King/Drew was built, he was killed by a Los Angeles police officer while driving his pregnant wife from Watts to what is now County-USC Medical Center, northeast of downtown.