King status reports were upbeat

A new federal government finding that the Martin Luther King Jr.-Harbor Hospital emergency room seriously endangered patients has undercut repeated rosy reports in recent months about the progress of a last-ditch plan to save the troubled public facility.

The latest reassuring update on King-Harbor, in Willowbrook south of Watts, came just last week. Dr. Bruce A. Chernof, director of the Los Angeles County Department of Health Services, wrote to the Board of Supervisors that care at the hospital was being closely monitored, that the facility had shifted smoothly to a new management structure and that other milestones had been reached on or ahead of schedule.

Moreover, he said, his agency was heading toward bringing King-Harbor, formerly known as King/Drew, into “full compliance” with federal care standards crucial to the hospital’s survival.

The comments were consistent with months of upbeat memos, some of which seemed to be boilerplate, reporting “no significant disruptions” to services and “no negative outcomes.”

But late Thursday, officials with the U.S. Centers for Medicare and Medicaid Services emerged from a surprise multi-day inspection and dropped a bomb: Once again, patients were in “immediate jeopardy” of harm or death. The hospital was given 23 days to shape up or risk losing federal support.

The inspection was triggered by high-profile patient care failures, including an episode in which a woman squirmed in pain on the emergency room floor for 45 minutes and ultimately died.

It also served as a grim reality check on what was supposed to be the hospital’s final salvation plan, adopted by the county Board of Supervisors last fall.

“The recent episodes indicate there is still a substandard culture operating within that facility,” Supervisor Mike Antonovich said. “I don’t know if that’s the exception or the rule.”

Supervisor Gloria Molina criticized the health department’s upbeat reports on the hospital’s transformation. “Very frankly, I think they’ve been sugarcoating it, and it’s very evident by the outcomes” in the recent high-profile cases, she said.

In a proposed motion drafted for Tuesday’s board meeting, she lists the litany of reforms approved last year and after earlier controversies and concludes: “And still we fail.” Citing a “monumental failure of policies, systems and human compassion” at King-Harbor, the motion calls for the county to draft a plan to divert King-Harbor patients to other area hospitals.

“My gut tells me if that were a facility I had to take my mother to, I would do everything I could to go somewhere else,” she said.

Health department spokesman Michael Wilson said the current controversy focuses on just two of thousands of cases handled by the hospital. “I think the department has accurately portrayed the progress,” he said.

Years of ineffective county oversight, lethal medical lapses and failed inspections prompted supervisors in October to attempt a radical overhaul of the hospital. Health officials scaled back the number of beds, shifted services to other medical centers and merged the hospital under the management and medical supervision of Harbor-UCLA Medical Center, 10 miles away.

To underscore the affiliation with the more highly regarded hospital near Torrance, the name was changed from King/Drew to King-Harbor.

Some improvements appear to have been made in recent months; these include staff retraining and better infection control systems. But by some accounts, staffing problems -- particularly among nurses -- have persisted.

Despite the terminations, reassignments and resignations of several hundred King-Harbor employees, the same hospital staff remains largely in place, Supervisor Zev Yaroslavsky said Friday. Health department officials tried to identify and remove the least competent employees, he told KPCC-FM (89.3).

“It wasn’t that we looked for the best and kept the best,” Yaroslavsky said. “We looked to get rid of the worst and kept the remainder. And the remainder may not be A and B employees.”

Supervisor Yvonne B. Burke, whose district includes the hospital, expressed disappointment at the substandard care provided by emergency room staff to Edith Isabel Rodriguez, the 43-year-old woman who died after video cameras captured her writhing in the emergency room lobby. “I certainly would have liked to see new people in that emergency room, the nurses,” Burke said, echoing Yaroslavsky’s point.

John R. Cochran, the health department’s chief deputy director, said staffers who needed additional training have received it. “I think in general our current staff is quite capable,” he said.

Despite the reform and monitoring efforts of recent months, it is also unclear how seriously officials took another incident that concerned federal inspectors.

In late February and early March, Juan Ponce, who had a brain tumor, lingered four days in the emergency room waiting to be transferred to another hospital for surgery. After he suffered spells of vomiting and worsening headaches, his family checked him out against the staff’s recommendation and took him by car to Harbor-UCLA, where he underwent surgery within hours. Ponce said he believes he would have died if he had stayed at King-Harbor another day.

King-Harbor staff didn’t clearly explain the severity of his problem, nor did they follow up afterward, he said.

The incident, first reported by LA Weekly, does not appear in the report delivered to supervisors last week, which includes a summary of activity and a description of the Rodriguez case. Health department spokesman Michael Wilson said board offices were notified of the Ponce case after a reporter inquired about it in early April.

Yaroslavsky said in an interview that he could not recall whether board members received information about Ponce’s experience, but that if they did, “it was nothing that remotely described what actually happened.”

“There was nothing in the original information about Ponce that caused it to surface” for special review, said Cochran, the health department official. “It had more issues around it than we originally identified.”

Officials said Friday that they did not expect this week’s federal action to delay a long-scheduled and more comprehensive King-Harbor inspection due next month. That review is to determine whether the hospital can maintain accreditation and win back millions in federal aid.

Sandra Shewry, director of the California Department of Health Services, said regulators are in a “really difficult situation” when it comes to King-Harbor.

“This administration has worked really hard with the community to try to keep that facility open and to preserve what is a treasured community asset,” Shewry said. “That being said, the quality of care there must meet state and federal standards.”

As a precaution, the county is drawing up contingency plans to close King-Harbor and possibly reopen it under a contract with a private operator.

“Martin Luther King has to hope for the best and prepare for the worst,” Yaroslavsky said.

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rich.connell@latimes.com

susannah.rosenblatt@latimes.com

Times staff writers Robert J. Lopez and Charles Ornstein contributed to this report.