Medical School Facing County Fines

Los Angeles County health officials are moving to sanction the university affiliated with the troubled Martin Luther King Jr./Drew Medical Center, saying the school is not complying with some requirements in its new contract.

The action illustrates the difficulty in healing the fractured relationship between Los Angeles County, which owns King/Drew, and Charles R. Drew University of Medicine and Science, which is paid to run doctor-training programs there.

Last September, the county Board of Supervisors renewed its contract with Drew University after a debate about whether the school could be a trusted partner. Accreditation for three of King/Drew’s 18 doctor-training programs had been withdrawn, and supervisors said Drew University had not been turning over critical reports as scheduled.

Top county health officials say Drew again has failed to submit required information about its training programs on time. In a March 10 letter, the officials said they have given Drew extra time to comply, but the school must now adhere to the commitments in the contract.

The amount of the sanctions will probably total $10,000 to $20,000, said John Wallace, a spokesman for the county Department of Health Services.

The county pays Drew University about $12 million a year to oversee the hospital’s 15 remaining doctor-training programs and provide some clinical services.

Drew officials say they have made substantial improvements in their programs and are assiduously implementing the contract. They have also maintained that solving the hospital’s problems will require giving the university a greater say in operations and management.

In an interview, Dr. Thomas Garthwaite, director of the county health department, said he still believes the county’s relationship with Drew University can succeed, but he pointed to several key tests in coming months. Drew still needs to name a new president, fill numerous vacancies in key clinical departments and pass a major accreditation review later this year.

“I remain cautiously encouraged that the board has taken some good steps, but we need to see more than that,” Garthwaite said of the university. “I really think that we don’t have the luxury of time.”

Harry Douglas III, Drew’s interim president, said Drew was doing everything possible to comply with the contract’s provisions, many of which were not in previous agreements. Both sides, he said, were working in good faith to improve the flow of information.

“If they want to impose sanctions, that’s their prerogative, but I don’t think there’s any reason to impose sanctions,” Douglas said.

Overall, he added, the relationship between the two sides has improved. “Things are a heck of a lot better from my vantage point.... The trust is better today than it was a year and a half ago -- substantially better.”

Some members of the county Board of Supervisors have criticized Drew because national accreditors stripped the hospital of its ability to train aspiring surgeons, radiologists and neonatologists.

King/Drew also is the only hospital in the United States to have received the lowest possible rating in its last two reviews from the Accreditation Council for Graduate Medical Education. Extensive problems with resident oversight were highlighted in a five-part series on King/Drew in The Times last December.

When the county renewed its contract with Drew, the length of the contract was limited to 21 months, instead of the usual five years. The contract also spelled out sanctions for noncompliance. Supervisors say they want to measure Drew’s progress before committing to a longer-term agreement.

Some supervisors have said they would prefer to have King/Drew partner with a more established medical school such as USC or UCLA.

Even so, many outsiders see value in the county’s relationship with Drew. Both institutions were founded after the 1965 Watts riots with the goal of improving healthcare for minority communities and training health professionals to serve them.

Navigant Consulting Inc., the firm hired to run day-to-day operations at King/Drew, cited the hospital’s relationship with Drew University as one of its strengths and recommended that the county keep academic and residency training programs intact.

A steering committee of experts created by the California Endowment likewise has said the partnership was vital.

“There needs to be trust between the two partners to make the enterprise work. That’s been lacking for decades,” said Dr. Michael Drake, a member of the steering committee and vice president for health affairs at the University of California system. “That is the solution for the future.”

Drew officials say they have achieved a major turnaround in the last year. Ten of 11 physician programs reviewed since January 2004 have been fully accredited, including one that had previously been on probation.

Drew has also re-formed its board of trustees, replacing longtime members with prominent leaders in medicine, healthcare and law.

“Drew University has not been without its own issues and need for change,” university officials wrote in a March 18 open letter to the community. “But the university has met its challenges, changed its course, stabilized its finances, strengthened its programs and is poised for growth in the future.”

Garthwaite said continuing problems at King/Drew -- mostly involving lapses in patient care -- have slowed progress on two key elements of the Drew contract.

Officials have yet to transfer oversight of the residency programs from the university to the county, as agreed in the contract. Officials also have not identified which residency programs should be eliminated or cut back, a recommendation made in December 2003 by a task force led by former U.S. Surgeon Gen. David Satcher.

County Supervisor Zev Yaroslavsky said he was pleased to see the health department holding Drew University accountable, something he said had not happened for years. At the same time, he said he has not written off the relationship with Drew.

“The hospital is a sick place, and the university is a sick place, and they both have to be rehabilitated,” Yaroslavsky said. “I’m not as troubled by the individual hiccups that occur along the way as I am at the general direction that both the hospital and the university are going in. I think the jury is still out on both cases.”

Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew, said she also wants the partnership with Drew to succeed.

“We’re all trying to help, and we’re trying to make sure that the affiliation agreement is extended, and the only way we can do that is if we have their total 100% cooperation,” Burke said. “We can’t fight to get it extended unless they abide by it.”