Key promises unfulfilled at King-Harbor

The reform effort at Martin Luther King Jr.-Harbor Hospital appears to be faltering, as the county backs off key promises to purge most of the staff and effectively hand control of the hospital to highly respected Harbor-UCLA Medical Center.

The two pledges were cornerstones of a plan last year that persuaded regulators to hold off on pulling all federal funding, which would have effectively shut down the troubled Willowbrook hospital.

With little explanation, county health officials disclosed during a Board of Supervisors budget meeting Monday that they had reassigned only about one-third of the 1,200 employees they initially projected would be shifted to other institutions.

Officials have also suggested to the board in recent days that Harbor’s leaders have had a less significant role in reshaping the hospital formerly known as King/Drew than supervisors previously envisioned.

The revelations come as King-Harbor is under scrutiny once again for allegedly mishandling the care of patients.

A woman last month died after writhing untreated on the floor of the emergency room lobby for 45 minutes.

In February, a brain tumor patient languished in the ER for four days before his family drove him to Harbor-UCLA for emergency surgery.

Federal inspectors concluded, based partly on the February case, that King-Harbor’s emergency room patients are in “immediate jeopardy.”

That finding elevates concerns about the hospital’s ability to pass a crucial inspection next month that could determine its fate.

The disclosures about reform efforts seemed to take the county board by surprise.

“We were all assured that Harbor would be supervising here, and they are not anywhere in the process,” said Supervisor Gloria Molina at a meeting last Tuesday. “Is that [collaboration] just a facade or is that real? It looks like a facade to me.”

The tension between supervisors and health department officials could come to a head today. The board has ordered the top brass involved in the King-Harbor rescue effort -- including administrators at Harbor-UCLA -- to appear in person to answer detailed questions.

Expectations of a turnaround at King-Harbor rose in October when the county successfully pitched a last-chance salvage plan to the federal government.

That plan called for the hospital, which serves some of the county’s neediest residents, to radically downsize and refocus on community medical care, including emergency room and outpatient services. Two pillars of the plan were to weed out underperforming staff members and, as a health department news release put it, integrate the two hospitals “under one medical management and administrative leadership team at Harbor-UCLA.”

In a symbolic break with King/Drew’s past, the hospital was repackaged as King-Harbor.

Chernof wrote to the U.S. Centers for Medicare and Medicaid Services in October that “every employee and every physician” would be reassigned.

“These sweeping changes ... provide the specific evidence that the safety and quality of care required by statute and regulations will assuredly be met,” he wrote.

But the changes did not materialize as promised, recent testimony and reports show. Most employees remained in place.

About two-thirds of the 388 registered nurses on King-Harbor’s staff shortly after the reform plan was adopted -- including at least two with previous suspensions -- remained on staff as of the end of last month, according to records reviewed by The Times.

On Monday, Supervisor Zev Yaroslavsky questioned why those suspected of being problem employees remained at King-Harbor.

“We’re in the situation we’re in because we didn’t go as far as we knew we needed to go in purging the organization of its underperforming personnel,” he said.

Chernof said the estimate of the staff changes needed was not a “terribly informed number, because nobody’s ever done anything like this ever before.”

Other problems emerged during efforts to retrain King-Harbor staff. The most promising employees were supposed to go to Harbor-UCLA for instruction. But that became unmanageable, health officials said, because King-Harbor needed these staffers to continue running the beleaguered hospital. So the training had to take place at King-Harbor.

Meanwhile, deficiencies persist among King-Harbor nurses. New data obtained by The Times show that in April, 60% of 285 registered and licensed vocational nurses failed one or more parts of basic clinical competency assessments. More than one in 10 failed three or more sections of the assessment.

Nearly half of King-Harbor’s specialized nurses -- those who work in intensive care units and post-anesthesia care, for instance -- failed at least one section of a separate round of competency assessments last month. The same was true of more than 60% of operating room RNs and surgical technicians.

Supervisor Yvonne B. Burke, whose district includes the hospital, said training staffers at the hospital appeared to undercut the value of the exercise. King-Harbor employees were not being exposed to the operations of a more rigorous institution, she said.

“If they had had an opportunity to go into that setting, they would have had a chance to find out how it worked and also all of the things that made up the difference,” she said Monday.

Under intense questioning, Chernof acknowledged that Harbor-UCLA staffers were surprised by the amount of training King-Harbor employees needed.

“If you’re given bad eggs, how good can you cook?” one Harbor-UCLA physician, who requested anonymity because of the sensitivity of the issue, said to The Times.

Harbor-UCLA officials declined to comment before the supervisors’ meeting today.

Burke and Molina have openly questioned assertions by Chernof and other health department officials that Harbor-UCLA medical managers have been deeply involved in ensuring proper patient care at King-Harbor.

Recent cases allegedly mishandled in King-Harbor’s emergency room have thrown into question how closely the Torrance-area hospital is supervising its fellow county institution.

“Harbor has an excellent emergency room,” Burke told Chernof last week. “I can’t imagine that ... if there was supervision from Harbor, some of these things could have come about.”

One of the cases cast doubt on the level of communication and cooperation between the two facilities. The patient, Juan Ponce, lingered in King-Harbor’s emergency room for four days, suffering from vomiting and dizziness as his family sought to have him transferred to Harbor-UCLA. But they were told no beds were available.

After his condition deteriorated, the family got in a car and drove him themselves to Harbor, where he received emergency surgery within hours.

In general, the fact that the hospitals are separately licensed limits “how intimately involved we would commingle ... the management of the facilities,” said King-Harbor’s chief executive, Antionette Smith Epps. “We can’t do that and maintain separate licenses.”

The Harbor-UCLA physician who spoke anonymously said that despite the renaming of King-Harbor and the public perceptions it might engender, the two hospitals are essentially operating separately.

“Our concern is that we are being perceived that we have oversight,” the physician said. “But we don’t feel that we have very much involvement with day-to-day medical operations” at King-Harbor.

rich.connell@latimes.com

robert.lopez@latimes.com

susannah.rosenblatt@latimes.com