State takes step to close King-Harbor
California regulators moved Thursday to revoke the license of Martin Luther King Jr.-Harbor Hospital, an action that, if not reversed, would force its closure.
The move, the boldest thus far by the state, follows recent findings by the federal government that patients at the public hospital are in immediate jeopardy of harm or death despite years of reform efforts.
The state Department of Health Services has never before made such a threat against King-Harbor and has not revoked any hospital’s license since 2004.
Two of the five members of the Los Angeles County Board of Supervisors said Thursday that they now support closing the hospital without delay.
“I think it’s over for us,” Supervisor Gloria Molina said. “I’m in fact terrified that somebody else might be hurt or neglected or abused at Martin Luther King hospital.”
Supervisor Mike Antonovich agreed. “The time has come to put patients’ lives before incompetent employees or political agendas,” he said.
The state’s decision, which was approved by Gov. Arnold Schwarzenegger, is subject to appeal. That process could take six months to a year.
The state suggested in a letter Thursday to county health director Dr. Bruce Chernof that it could rescind the action if the hospital was able to show that it met state and federal standards -- a goal it has been unable to achieve since 2004.
The hospital will remain open in the meantime.
“We’re really worried that the people will think the hospital closes tomorrow,” said Sandra Shewry, director of the state health department. “It doesn’t mean that. Services continue while this process plays out. The best end point is for that hospital to come into compliance.”
The state’s intervention dramatically increases the pressure on King-Harbor, formerly King/Drew, whose turbulent history traces back almost to its inception. It also marks a change in direction for the state, which in recent months had urged the federal government to continue funding the hospital in hopes that reforms would succeed.
The federal government has for some time dangled the threat of pulling crucial Medicare and Medi-Cal funding -- a matter that could be settled by an inspection next month. But the state’s threat is potentially more potent: A hospital cannot operate, period, without a license.
Concern about King-Harbor has been building in recent weeks after highly publicized lapses in care.
In one case, a 43-year-old woman writhed untreated on the floor of King-Harbor’s emergency room lobby for 45 minutes before dying. In another, a brain tumor patient waited four days for treatment before his family drove him to Harbor-UCLA Medical Center for emergency surgery.
On Tuesday, The Times reported that health inspectors, dispatched to investigate the brain tumor patient’s case, found 16 additional cases of substandard care in the King-Harbor emergency room.
County supervisors are expected to discuss contingency plans for the hospital Tuesday. Supervisor Zev Yaroslavsky said that if King-Harbor failed the upcoming federal inspection, it would need to be shut -- but not suddenly.
For one thing, the county must hold a public hearing before it scales back any services at the hospital.
“If you don’t do it in an orderly fashion, you run the risk of destabilizing not only the clientele who are served by King but the other facilities that serve the southern part of L.A. County,” he said.
Yaroslavsky said he was “very pessimistic” about the hospital’s chances.
“The state has lit the fuse,” he said. “I think it’s going to be hard to stop it. They very well may be justified in it.”
Community advocates said the state’s threat, if carried out, would be a disaster for residents of South Los Angeles who have few other options for care.
“We are playing with not only fire, we have gasoline in the other hand,” said Lark Galloway Gilliam, executive director of Community Health Councils. “That emergency room, you can’t let that go. Closure to me is not an option.”
Chernof said he understood why the state believed that it had to act.
“The state, the federal government and the department and the Board [of Supervisors] all believe the hospital has to meet national standards. Period,” he said. “This is the state’s effort to assure that.”
Chernof said hospital staffers are making changes and correcting problems, trying to prepare for the upcoming federal inspection.
“The hospital is already under very significant pressure to prepare and pass this survey. They have been for months, and the events of the past few weeks just highlight the need,” he said.
Founded in a largely African American area in the wake of the Watts riots, the medical center was seen as a symbol of hope, a testament to racial justice in healthcare and a jobs engine for a struggling region.
But soon after it opened in 1972, the hospital became mired in problems, and it eventually gained the moniker “Killer King.” Over the years, it attracted publicity for patient care failures, some of which resulted in deaths.
The latest problems began in 2003, and within months the hospital was found to be out of compliance with minimum federal standards for patient care.
It has failed a dozen inspections since.
A series of articles in The Times in December 2004 found that, by many measures, the hospital was one of the worst in the nation.
The newspaper also found that the medical center was protected by a Board of Supervisors that ducked responsibility for making changes in part because members were afraid of being branded racist.
Since 2004, the supervisors and the county health department have tried various reforms: closing the hospital’s busy trauma center to take pressure off the hospital; spending more than $20 million on outside consultants; disciplining hundreds of staffers; and, most recently, slashing services and putting the medical center under the oversight of Harbor-UCLA, a sister public hospital with a better reputation.
As the possibility of shutting down King-Harbor has grown more likely in recent weeks, other hospitals in the area have scrambled to gauge how their already overburdened emergency rooms might respond.
A consultant for the Hospital Assn. of Southern California began crunching data last week. A forecast of how King-Harbor’s 47,000 annual emergency room visits might be spread across the system will be delivered to county health officials in the next few days.
As it is, waiting times at emergency rooms in the county can last hours, and one in four ERs is closed to ambulances at any given time because it is full, said Jim Lott, the hospital group’s executive vice president.
“It doesn’t take a rocket scientist to figure out that there would be a significant, dramatic impact if those 47,000 visits are put on the street for other hospitals to handle,” he said.
Most immediately affected would be three emergency rooms within five miles of King-Harbor, including that of St. Francis Medical Center in Lynwood, a full-service trauma center only 2 1/2 miles to the east along the Century Freeway corridor.
Other hospitals close to King-Harbor include Memorial Hospital of Gardena and Lakewood Regional Medical Center.
“They would feel the first wave,” Lott said.
King-Harbor sees about 40% of the combined total of emergency patients now being treated at the three nearest hospital emergency rooms.
Medical rescue agencies warned that the closure of King-Harbor could set off an ugly chain reaction of delayed paramedic responses, because ambulances would have to travel farther and wait longer at emergency rooms.
“This is a very bad scenario,” said Cathy Chidester, acting director of the county’s Emergency Medical Services Agency. “If something happens to this hospital, it will be devastating for the emergency medical system and devastating for the community.”
Just how disruptive a King-Harbor closure would be, however, remains an educated guess.
A large share of its emergency room visits are walk-ins, the sort of patients whose decisions on where to go are hard to predict.
Shewry, who called the state’s move “an extraordinary action,” said she hoped that the hospital could improve before its time is up.
“There’s no more time for trying,” she said. “It’s time for doing and for performing.... It is now -- now -- that they need to act and really deliver the care that I’m guessing most of the staff want to deliver and can deliver.”
(BEGIN TEXT OF INFOBOX)
Revoking a license
The state of California said it would begin the process of revoking the license of Martin Luther King Jr.-Harbor Hospital. Here are the formal steps:
The state must prepare a formal accusation seeking revocation and file it with an administrative court. It must be served on the hospital.
Within 15 days, the hospital has a right to file a notice of defense to contest the allegations. If it does not, the result is a default decision and the license is revoked.
If it does contest the allegations, there is a period for limited discovery and negotiations to set a hearing date.
A hearing must be held before a Department of Health Services administrative law judge, who issues a final decision. It can be appealed within 60 days in court.
Note: The hospital remains licensed while the proceedings take place. The state can rescind its accusation at any time.
Source: California Health and Human Services Agency
On latimes.com More coverage
For complete coverage of the troubles at King-Harbor Hospital, including a discussion board, documents and audiotapes, go to www.latimes.com/kingharbor