The once-steadfast promise to reopen Martin Luther King Jr.-Harbor Medical Center by February 2009 has given way in recent weeks to the bleak prediction among some officials that it could be years before the linchpin in south Los Angeles County healthcare is resurrected.
Supervisor Gloria Molina is the most vocal about her doubts. According to the way the Department of Health Services is moving, "it will not happen in my lifetime," she recently told The Times.
Others make similar assessments in private, a startling contrast with the optimistic position that county supervisors had previously maintained -- that the hospital, in Willowbrook south of Watts, would reopen soon.
Health services director Dr. Bruce A. Chernof, retiring Supervisor Yvonne B. Burke and others still say the hospital could reopen before long. And the future of King is a prominent issue in the current race to replace Burke. But among county officials and hospital-industry insiders, the path forward is more often seen to be littered with obstacles that are increasing:
* The county is facing broad challenges in its health services department that are some of the most difficult this decade: an oncoming budget deficit expected to exceed $1 billion within three years and a vacancy in the department's top post.
* The hospital industry across Southern California is facing economic difficulties.
* King, in particular, has been troubled for years by problems with patient care, finally prompting the federal government to pull its funding, forcing its closure last summer.
The facility served neighborhoods with some of the sickest and poorest people in the county.
* The county's own complex bureaucracy has been blamed for hindering the search for a new operator.
All of those problems were on display in the county's recent, unsuccessful effort to find such a company to reopen the hospital and run it.
To conduct the search, the county turned to consulting firm Hammes Co. with a contract worth up to $600,000. Hammes already had a contract worth up to $630,000 to find an operator for Rancho Los Amigos Rehabilitation Center but has had no success thus far.
A replacement for the Downey facility was thought to be easier to find because of its strong reputation and higher proportion of insured patients.
Outsiders scoffed at Hammes' chances. "No one ever took the [request for proposals] seriously," said Jim Lott, executive vice president of the Hospital Assn. of Southern California.
Some operators submitted proposals to operate King, but officials said they asked for far more money than the county could pay.
Robert K. Ross, president and chief executive of the California Endowment, a private foundation created to expand healthcare access, attempted to broker a deal separately.
Ross met with top University of California officials in Oakland and held meetings with representatives for Kaiser Permanente, Daughters of Charity Health System and Catholic Healthcare West, according to people with knowledge of the discussions who spoke on the condition they would not be identified, citing their continuing dealings with the county and their desire not to offend county supervisors.
Eventually, Ross phoned County Chief Executive William T. Fujioka with news, according to two of the sources who had asked not to be identified.
Ross reportedly said that if the county would offer ways to allow operators a certain degree of independence, a deal for a partnership might be struck with UC, Kaiser and Catholic Healthcare West. Each entity wanted to help but did not want to be solely responsible, the sources said.
Fujioka ended the conversation, however, when he said he wanted the Hammes process to play out first. Fujioka said in an interview that there was no specific proposal and that he told Ross, "We would entertain any viable option."
In February, county supervisors received a letter from Ross, a copy of which was obtained by The Times.
He said three obstacles stood in the way of reopening King: the likely financial losses in the early years of operation because of the high number of uninsured patients, the potential damage the job could cause to an organization's reputation if things went poorly, and the county's bureaucratic structure.
In short, he wrote, the process had potential operators "flying solo into a perfect storm."
In the letter, Ross said the California Endowment would be willing to fund planning for a new arrangement that might entice the UC system and others to come to the table.
Ross said he did not receive a single phone call in response to his letter offering to help.
The letter did not address another issue that many said was a stumbling block: whether an operator would be required to employ members of the county's public employee unions and be bound by county personnel rules that make it difficult to discipline or transfer workers who harm patients.
Although Fujioka said reopening the hospital is more important than the county's relationship with unions, at least two supervisors -- Molina and Zev Yaroslavsky -- have been reluctant to say county unions could be left out at the new hospital.
Supervisors did not heavily involve themselves in the search, however, saying they felt it would have been inappropriate. "A new operator shouldn't have to negotiate with five people at a time," Burke said.
In March, Hammes officials told supervisors they had one viable option: Pacific Hospital of Long Beach, a small private hospital, would partner with pharmaceutical billionaire Patrick Soon-Shiong to take over the facility. But talks collapsed within weeks, and some complained that Hammes' research leading to the recommendation had been faulty.
"Pacific," Molina said of the proposal, "is garbage. Who is this multibillion-dollar guy? According to Don and Yvonne, they think he's real. I don't know if he's real," said Molina, referring to Supervisor Don Knabe and Burke.
Still, Chernof, who will leave the county's top health services post Thursday, said he believes Hammes still might produce a viable operator to reopen King, which still operates a large outpatient clinic.
"Until we've heard out all of the options completely, there are still some discussions that are ongoing. I think we should give this process a chance," Chernof said.
Some supervisors have said they intend to pressure Gov. Arnold Schwarzenegger and the UC regents to push the UC system to take on a role at King -- an idea that the governor's office has so far declined to address publicly.
Burke said she hopes to take up the California Endowment's offer to help by arranging a meeting with Ross and the operators he has asked to help. Many near the Willowbrook hospital have long since lost faith in the county's efforts, including the Rev. Frederick O. Murph of Brookins Community African Methodist Episcopal Church. He contends that supervisors wanted to close King to direct money to other county hospitals.
County officials deny this.
By a variety of healthcare indicators, the area surrounding King is one of the most disadvantaged in the nation.
Furthermore, the homicide rate among South L.A. adolescents and young adults accounts for 76% of deaths, and the population has the lowest socioeconomic status in the county, with a per-capita income of $11,000 a year.
"The poor are basically on their own. A lot of people are getting sick," Murph said.
Times staff writer Jean-Paul Renaud contributed to this report.