Excising Hospital Politics

Stung by criticism that it put politics ahead of patient care at Martin Luther King Jr./Drew Medical Center, the Los Angeles County Board of Supervisors has agreed to consider setting up an independent board of healthcare experts to govern public hospitals. This major reform would remove the hospitals from immediate political pressure and could improve not just struggling King/Drew but healthcare services countywide.

More and more public hospitals nationwide are making the change, from Denver to New York City; in the latter city, public hospitals recently scored as well or better than private hospitals in national accreditation reviews.

The most recent convert is Hennepin County Medical Center in Minneapolis. County supervisors there agreed last month to transfer day-to-day operations of the hospital to a board of specialists -- doctors, healthcare executives and two county commissioners -- appointed by the county.

An independent health authority was the one King/Drew reform recommended by nearly every expert The Times consulted while documenting more than a decade of medical incompetence and political interference. Navigant Consulting, the outside management team hired to turn around the troubled hospital, issued a preliminary report earlier this month that cited politics as a problem at King/Drew and recommended that the board remove itself as overseer of all county hospitals.

At stake, really, is the survival of public hospitals. Like everything else in healthcare, the role of public hospitals has changed dramatically in recent decades. Such hospitals thrived between 1930 and 1950, with support from philanthropies and generous subsidies from the federal government. But the spread of private health insurance after World War II drastically changed their patient base as middle-class and unionized workers sought care at private hospitals. Managed care and government cuts have further squeezed public hospitals.

The move toward more specialized governing structures is seen not just as a way to get politics out of hospitals, in which jobs are fodder for patronage, but to make public hospitals more responsive to changing needs and conditions. Los Angeles’ public hospitals, for example, must negotiate the huge county bureaucracy for everything from purchasing supplies to hiring personnel.

County Supervisor Mike Antonovich is the lone holdout to considering an independent healthcare authority. Yet Antonovich has long supported ridding the hospitals of countywide personnel protections and other rules that have made it difficult to offer competitive salaries or fire negligent employees. This reform could be accomplished largely through a change in governance.

Much of the groundwork has been laid for a healthcare authority, with a 2003 report by USC the most recent of numerous studies. Such a change would take time and legislative approval to implement, so in the meantime, the stabilization of King/Drew must go on. Navigant Consulting has issued a preliminary blueprint of 1,000 proposed fixes. But the fact that the supervisors are even considering a new governing board means that they understand they are committed for the long haul, even if that commitment leads to stepping aside.