Board to Revisit Plans for Ailing Hospital

The Los Angeles County Board of Supervisors today will try once again to solve the intractable problems at Martin Luther King Jr./Drew Medical Center, days after county health officials scrapped plans to close some of the public hospital’s wards.

For months, supervisors have tried to craft plans to stabilize the hospital’s management, keep its federal money flowing and regain national accreditation. But reforms have not taken hold quickly enough, officials said.

On Friday, the county Department of Health Services said King/Drew would not be ready to reapply for its seal of approval from the Joint Commission on Accreditation of Healthcare Organizations until March, rather than December as previously promised. King/Drew lost its accreditation in February because of a series of patient care lapses identified last year.

In addition, the hospital, in Willowbrook just south of Watts, is increasingly relying on temporary nurses instead of permanent employees to provide care in many wards, another sign of a hospital’s instability. And the $15-million, one-year contract for the consulting firm running King/Drew expires at the end of this month. An extension is likely.

“I’m rapidly losing confidence in our internal ability to deal with this issue,” Supervisor Zev Yaroslavsky said.

“There’s been an incredible number of mistakes made out there,” Supervisor Don Knabe said. “By moving in and watching it closer, things were getting better. I think we’ve taken a few steps backward,” especially in light of the abandoned downsizing recommendation.

The plan, proposed in August by county health director Dr. Thomas Garthwaite, called for shutting down the obstetrics, neonatal and pediatrics units at the hospital. Garthwaite rescinded the plan Friday after learning from state officials that moving ahead would have jeopardized some $29 million in government aid.

Garthwaite said the gloomy pronouncements about progress at the hospital were overly grim. He pointed to developments that he termed major successes, such as hiring a permanent chief executive officer, who starts next week, and disciplining hundreds of employees for misconduct, absenteeism and fraud.

“It may not be perfect, but it’s way different than a year and a half ago,” he said.

That said, as evidence of the supervisors’ growing concern, five of the items on their regular weekly agenda deal with King/Drew, which serves a largely minority and impoverished community in South Los Angeles. The items are:

* Discussing the future of the hospital’s relationship with its affiliated medical school, the Charles R. Drew University of Medicine and Science. The county wants to reduce the size of some of the programs for physician trainees, but the medical school does not fully agree.

* Creating a contingency plan in case federal regulators pull $200 million in funding from the hospital, more than half its budget. The federal money has been threatened for nearly two years because of lapses in patient care, some of which have resulted in deaths. Regulators are set to decide by year’s end whether to cut off the money.

One part of the contingency plan could be to turn control of the hospital over to a private firm. Catholic Healthcare West, a nonprofit chain, has been talking to the county and has asked for data but has not decided whether to enter into formal negotiations, Garthwaite said.

* Voting on a $1.4-million contract for radiology services at the hospital. The Times reported in April that King/Drew had paid $1.3 million from March 2004 to March 2005 to a temporary agency for the services of one contract radiologist, who said he worked an average of 20 hours a day, seven days a week, during one six-month stretch.

* Formally canceling a public hearing, scheduled for Oct. 18, on the downsizing plan.

* Voting on the bylaws of King/Drew’s hospital advisory board, formed by the supervisors in February to help them run the medical center. In a memo last week, Garthwaite said that after community health advocates had joined the board, it is “far more professionally conflicted and significantly less focused on hospital management.”

Garthwaite recommended rejecting the board’s bylaws, reconstituting its membership and changing its focus from King/Drew to the entire county healthcare system. He strongly favors removing decision-making over the county’s public hospitals from the supervisors and giving it to an independent health authority, a move the supervisors have long resisted.

Any such board, Garthwaite said in his memo, should specifically exclude “members who represent employees, the county, affiliated institutions, contractors and direct competitors.” The current board includes several members who would be excluded under such a model.

Kathy Ochoa, a labor union official and member of the advisory board, criticized Garthwaite, saying he was trying to blame others for his own failures. She said Garthwaite should have publicly disclosed the risk that his proposal to make cuts at King/Drew would cost the hospital money, but instead he pushed ahead.

“His credibility is in question,” said Ochoa, a senior health policy analyst for Service Employees International Union Local 660. The hospital advisory board, “in its entirety, has questioned his judgment on any number of initiatives.... He wants a board that says ‘yes’ to his proposals. That’s the bottom line.”

Ochoa said King/Drew’s progress had stalled in recent months because health officials and the hospital advisory board were consumed with Garthwaite’s downsizing recommendations.

“We have spent an inordinate amount of time debating the merits of that, coming up with alternatives, listening to Tom Garthwaite’s analysis, rather than focus on the real issues at hand,” she said.

Jim Lott, vice chairman of the advisory board, said the hospital has made progress since closing its treasured trauma unit in March, but not enough to regain accreditation and keep federal funding. He said the hospital must reduce the percentage of temporary nurses providing care at the hospital, now more than 60%. “There has been improvement -- not enough, regrettably,” said Lott, executive vice president of the Hospital Assn. of Southern California.

The supervisors will not receive a scheduled update on the expense reports of the consulting firm running King/Drew. The Times reported last month that Navigant Consulting Inc. inflated its own expenses by double-billing airfares and charging Los Angeles County for first-class travel and trips unrelated to the hospital.

County auditors have asked for another week to review the expenses and reconcile them with Navigant’s explanations. On a preliminary basis, the auditor-controller has rejected more than $500,000 of Navigant’s $1.3 million in expenses, well beyond the questionable expenses identified by the health department.

All told, Supervisor Gloria Molina called King/Drew an “unbelievable problem.”

“I don’t know why it is so bad and why things can’t be fixed,” she said. “Every which way we go, we’re not getting out of the thicket of problems we have.”