Symptom of a Body in Distress

For Los Angeles County’s five elected supervisors, news that their most embattled public hospital failed a make-or-break medical inspection only added to a pile of controversies that have buffeted them for years and piled up in recent months.

Along with the crisis at Martin Luther King Jr./Drew Medical Center, there have been breakdowns in their juvenile probation department, riots in their overcrowded jails and continued uncertainty about how to handle a homeless population that numbers in the thousands.

As daunting as it may be to preside over a county more populous than all but eight states, longtime observers say none of these problems are a coincidence. Rather, they are a predictable consequence of a management style that divides power by five, has relatively few checks and balances and often cedes leadership on issues to the supervisor whose district is most affected.

Combined, those tendencies have distracted the board and contributed to what could be a catastrophe in healthcare for the poorest residents, say elected leaders and others who follow the board’s work.

“I am very disappointed with them, particularly because it’s clear they did not have a contingency plan” for King/Drew, said Los Angeles Councilwoman Janice Hahn, whose father, longtime Supervisor Kenneth Hahn, led the campaign to build the hospital after the 1965 Watts riots.

Federal inspectors announced last month that Washington would soon cut off crucial funding for King/Drew because of continuing lapses in patient care, and the supervisors are scrambling to find alternatives.

Hahn added: “Their plan was based on hopes and prayers. That is irresponsible. They waited too long in the first place to take action, and when they did, there was a series of wrong decisions.”

Others believe that even though racial politics have always complicated the debate over King/Drew, which serves a predominantly low-income black and Latino population, the supervisors cannot blame that issue for their actions or inactions.

“I don’t think [the board] ever got a handle on just how bad that place was,” said Joe R. Hicks, vice president of Community Advocates and a former chief of the Los Angeles Human Relations Commission.

“I have no patience with people who aren’t willing to tear away the blinders and say, ‘Here is what we need to do: Plant a bomb under the place, blow it up and start all over again,’ ” he said. “Anything short of that isn’t bringing leadership; it’s trying to protect some sense of nostalgia over what the hospital represents in a larger political world.”

The five supervisors -- Mike Antonovich, Yvonne Brathwaite Burke, Don Knabe, Gloria Molina and Zev Yaroslavsky -- serve a county that spans more than 4,000 square miles and has about 10 million residents and 88 cities. They are invested with both executive and legislative power by the California Constitution, leading even Yaroslavsky last year to compare the construct to the old Soviet Union’s Politburo.

Raphael Sonenshein, a political scientist at Cal State Fullerton, put it this way: “You have the largest county in the U.S. by population and you have 2 million people represented by a supervisor, and no elected executive. The structure is not one that promotes accountability. And they are tasked with giant issues involving social services for the poor and working-class people. What do you think is going to happen?”

Governing together for the last 10 years and free of any term limit restrictions until 2014, the five supervisors have made a tradition of divvying up county resources and responsibilities equally. The practice, known informally as “divide by five,” lets each supervisor dominate certain issues, and the others for the most part defer so they can enjoy the same prerogative.

For example, Antonovich has a disproportionate say in planning decisions because his 5th District, which covers much of northern Los Angeles County, includes most of the remaining open and developable land.

Similarly, Knabe has been the overseer of development at Marina del Rey, some of the county’s most valuable coastal territory, because it touches his 4th District.

Although their colleagues can, and sometimes do, vote against them, the structure of the board allows supervisors to micromanage issues. At the same time, there is no independent chief executive who has the power to take a holistic view of where resources should go to do the most good. The county has a chief administrative officer, but he serves at the pleasure of the supervisors.

“It’s hard for five people to act as one,” Yaroslavsky acknowledged. “Every time you have to make a macro decision, an important decision, it has to be vetted through five people.... We have a five-headed executive. That’s a prescription for slow decision-making and ambiguous decision-making sometimes.

“Notwithstanding that,” he said, “this board has done some important things.”

In the realm of public hospitals, the supervisors have long been fiercely protective of facilities in their districts. King/Drew, in Willowbrook, just south of Watts, is in Burke’s 2nd District.

Ed Edelman, who served as a supervisor from 1974 to 1994, called the “divide by five” practice problematic.

“We have five executives,” he said, “and you can’t make decisions on merit sometimes when you have divided accountability. It brings divided responsibility, and people point fingers and no one is in charge.”

One former county healthcare administrator, who spoke on the condition of anonymity for fear of angering supervisors, agreed: “The absolute practice is for the other supervisors not to meddle in what’s happening in a facility or program or service that is under another supervisor’s purview. No one like Antonovich or Knabe was going to get involved in County-USC [Medical Center]. And along the same line, no one is going to step on Zev’s toes” at the Metropolitan Transportation Authority “or Yvonne’s toes at King.”

That kind of government structure can especially complicate decisions that sit at the intersection of racial politics and healthcare policy, as does King/Drew.

Attempts to fix the medical center often resulted in allegations of racism and that the supervisors’ real goal was to dismantle a hospital run by blacks for black patients.

Yaroslavsky said that the board historically protected King/Drew from the “kind of accountability and oversight that all our hospitals have” and that the supervisors often approached things from a deferential, district-centered perspective before three years ago, when the hospital’s troubles deepened.

“That hospital just went off course like a rocket ship,” he said. “Once you’re off course, the mistakes compound themselves.... When we finally decided to do it, the task was much more difficult than could be achieved in the time we had allotted to us.”

Chester Newland, a professor of public administration at USC and longtime county observer, said Burke reminds him of the late Rep. Augustus Hawkins.

“Augustus brought a lot of urgency to the Watts area despite its problems, and people could go to him with problems and sometimes he could pull rabbits out of hats,” Newland said. “But when it comes to a King hospital, there are limits on politicians. Some problems cannot be solved; they must be ameliorated.”

Newland believes that Burke is a capable politician and that she was constrained because of the community’s strong emotional ties to the hospital. As a result, the county has come to rely on outside hospital accrediting agencies to make decisions about King/Drew that the supervisors were unable to make on their own.

Burke declined to comment for this article.

Solutions have been proposed. In some cases, over and over again. Since the mid-1990s, for example, the supervisors have received at least 12 reports that recommended restructuring the Department of Health Services. One fix that has been suggested is creating an independent health authority to run the four county hospitals.

Instead of restructuring, the board has largely handed the issue off to consultants or new county health chiefs -- in essence, blaming the bureaucracy when things go wrong.

“What they’ve typically done over the years is tell the head of the health department, ‘You do it.’ And when the supes don’t want to do anything too draconian, they can then scapegoat the head of the health department, who then leaves,” said former Los Angeles Councilwoman Ruth Galanter. “There have been a lot of heads of the health department.”

Since a longtime county health chief resigned in 1995, there have been three.

King/Drew’s fate may be decided at Tuesday’s Board of Supervisors meeting. Several members have said they were leaning toward coupling the hospital with Harbor-UCLA Medical Center near Torrance. But other options also may be debated.

The loss or downsizing of King/Drew would cause the surrounding community to suffer most, said Yolanda Vera, director of the nonprofit LA Health Action, a healthcare advocacy group. “It’s one of those situations where failure is not an option. The community needs care.

“If what happened at King/Drew doesn’t cry out for the need to re-look at how we’re governing and administrating our public resources,” she added, “I’m not sure what does.”

steve.hymon@latimes.com

susannah.rosenblatt

@latimes.com