Plans to close hospital weighed
A majority of Los Angeles County supervisors said Friday that they are ready to vote next week to begin the process of closing Martin Luther King Jr.Harbor Hospital.
Faced with a threat from California regulators to pull the hospital’s license, Supervisors Zev Yaroslavsky, Gloria Molina and Mike Antonovich indicated that they wanted to act before the county’s hand was forced.
That would enable them to put in place an orderly plan to protect the South Los Angeles patients who depend on King-Harbor for their care, they said.
The action would essentially start the clock ticking toward closure. State law requires 90 days’ notice before an emergency room can be shut down. Such a move would also suggest that the three supervisors are not inclined to do battle with the state over King-Harbor’s fate.
“We might as well get started,” Molina said. “There’s real jeopardy that we may be in a situation where we are going to be closed down. That’s more dangerous, because then we’ll be ill-prepared and ... create a real flood for other hospitals. This is a much more effective way.”
The supervisors would still have the option of reversing course, however, if the hospital passed an upcoming federal inspection and the state retreated from its plan to pull the license.
King-Harbor, formerly known as King/Drew, has been out of compliance with the federal government’s minimum patient care standards since January 2004. The U.S. Centers for Medicare and Medicaid Services has said it would pull the hospital’s funding for good in August if it failed the inspection.
In recent weeks, the hospital’s failures made national news when a 43-year-old woman died after writhing untreated on the floor of the emergency room lobby for 45 minutes. A second case came to light as well, in which a brain-tumor patient waited four days without treatment before his family and friends drove him to another county hospital for emergency surgery.
The board members’ statements to The Times came a day after California regulators threatened to pull King-Harbor’s license. If the state Department of Health Services follows through, the hospital will be forced to shut down. If the county appeals, however, the process may take a year or more.
“The bottom line of all this is the county is moving toward closure, and I think it is more likely than not that the hospital will close,” Yaroslavsky said.
“There’s been a shift, in the last few weeks, of thinking,” he said, from hoping the hospital could be fixed to accepting that it must be prepared for closure.
Supervisor Yvonne B. Burke, whose district includes the hospital, did not return several phone calls seeking comment. Though she has been quiet in recent days, Burke said in 2005 at a public meeting, “I’ll tell you this: That hospital will be closed over my dead body. I want to be clear on that.”
A spokesman for Supervisor Don Knabe said he had no comment.
The three supervisors said independently of each other that they would vote at Tuesday’s board meeting to begin the closure process. The comments came in response to a plan by county health officials for proceeding should King-Harbor fail the federal inspection.
The plan calls for closing the public hospital and its emergency room, rerouting ambulances in the region and trying to find a private company to reopen the facility within a year.
Even longtime supporters of the hospital, including Los Angeles Councilwoman Janice Hahn, conceded Friday that closure appears all but inevitable.
“I do feel like the call for it to close is growing louder and is now across all sectors,” said Hahn, whose father, Kenneth Hahn, led the effort to build the hospital as a county supervisor. “People are coming to the realization ... that they’re going to be better off not having that hospital available to them, even if that means traveling longer distances.”
Hahn said she does not personally support the hospital’s closure because the largely poor and minority residents of South Los Angeles have few other options for care.
“That’s what’s sad to me,” she said. “Their health and safety is being threatened both by the hospital being there and by the hospital not being there. What a horrible statement.”
Previous efforts to cut services at the hospital have been met by rallies and public protests. But reaction to the current threat has been remarkably muted, a mixture of sadness and disappointment. Some said it was because defenders had grown tired of fighting; others attributed it to the ongoing reports of patient deaths and failed reforms.
Another factor could be the death in April of Rep. Juanita Millender McDonald (D-Los Angeles), one of the hospital’s biggest supporters.
In an interview, county health director Dr. Bruce Chernof said he would not recommend that supervisors begin the closure process immediately, because the hospital is busy preparing for the inspection. “I don’t think it’s necessary to start the work at this moment, but I would respect the board’s decision if they chose to move forward,” he said.
Under his contingency plan, King-Harbor would continue to operate large outpatient clinics in such fields as pediatrics and general medicine, as well as an urgent care center that would be open 16 hours a day and staffed by contract doctors.
Ambulance traffic would be redirected to other facilities. Two county hospitals -- Harbor-UCLA Medical Center and Rancho Los Amigos National Rehabilitation Center -- would add acute care beds to serve King-Harbor patients. The county would also pay private hospitals to care for indigent patients.
Meanwhile, the county would put out a request for proposals to seek a private operator to reopen the facility.
Because King-Harbor would offer outpatient services only, the county anticipates that it would need fewer employees. But that probably would not result in mass layoffs of King-Harbor workers.
County rules require that employees with seniority be allowed to transfer to other county hospitals, bumping more junior workers in a process known as a cascade. Those newer employees could be laid off.
The three county supervisors praised the plan drafted by Chernof but said they didn’t have the luxury of waiting to see if the hospital can pass the federal inspection, the chances of which Yaroslavsky described as “slim.”
“My concern is that we’re moving at a snail’s pace,” Antonovich said. “It’s time to move forward. We know that they continue to have failures in the delivery of competent medical care.... There’s a difference between talking about doing it and doing it.”
The labor union that represents King-Harbor workers said the county should be concentrating on fixing the hospital’s problems, not closing it.
“We need to focus on passing the inspection and preserving access for the community there that’s so desperately in need of care and lacks access to it,” said Kathy Ochoa, director of strategic initiatives for Service Employees International Union Local 721.
Political and community leaders lamented the direction events have taken this week.
Rep. Diane E. Watson (D-Los Angeles) said she was given assurances last year by Gov. Arnold Schwarzenegger that the hospital would remain open.
“We cannot let the hospital close, because it serves a wide and broad constituency and most of them are indigent, poor people, minorities,” she said. “And when they become acutely ill or they are victims of some kind of accident, to go another 20 minutes to get help could be a matter of life and death.”
Watson said many were to blame for the hospital’s problems, but she singled out the five-member Board of Supervisors. She questioned why doctors and nurses from Harbor-UCLA Medical Center, which was charged with overseeing the hospital in recent months, were not posted at King-Harbor at all times.
“Somebody dropped the ball there at the county,” she said. “I’m not going to say any one. I’m going to say all five of them.”
Frederick O. Murph, pastor of Brookins Community African Methodist Episcopal Church, said what has happened at the hospital is a national disgrace.
“You look at Martin Luther King and you look at his legacy -- a man who tried to bring this country together and have a dream for all Americans,” he said. “To have a hospital named after him and to have a stigma attached to his name -- that ought to have everybody in an uproar.”
(BEGIN TEXT OF INFOBOX)
Los Angeles County health officials unveiled a plan Friday that spells out what the county would do if it lost federal funding for Martin Luther King Jr.-Harbor Hospital, triggering the state to pull the facility’s license. Among the key details:
* Phase out the hospital’s inpatient services and close its emergency room after holding public hearings. Concerns over patient safety or staffing could result in an immediate cessation of inpatient services.
* Add inpatient beds at two other county-run hospitals -- Harbor-UCLA Medical Center and Rancho Los Amigos National Rehabilitation Center -- and contract with private hospitals to treat indigent patients.
* Redirect ambulances responding to emergency calls to nearby hospitals.
* Keep open the hospital’s outpatient clinics and urgent care center.
* Seek bids from private hospital companies to reopen and operate King-Harbor’s emergency room and inpatient services. The process probably would take a year.
Source: Los Angeles Times