Reviving King hospital

There's still a long way to go, and there are still many questions to be answered. Two more years without adequate medical care for the southern portion of Los Angeles County will prolong the suffering of residents there. Buy-in from the Board of Regents of the University of California is by no means certain. But Tuesday's Board of Supervisors vote to approve a framework for opening a full-service facility in partnership with UC to fill the void left by the 2007 closing of Martin Luther King Jr. Hospital is a hopeful sign.

At this early stage, enthusiasm must be parceled out in small doses. The memories remain painfully fresh, not just of the high-profile deaths and instances of substandard care at the old hospital, but of the many times that county leaders announced that they had finally corrected fatal management and personnel problems. After replacing a succession of health department directors, "temporarily" closing portions of the hospital to focus on core services, offering enormous contracts to consultants and turnaround artists to fix the hospital, ordering every employee to be retrained and reevaluated -- only to be confronted with the same intractable problems -- Los Angeles County government has proved itself inadequate to the task.

That's what makes the current proposal intriguing. After running out of options and being compelled to face responsibility for the hospital's failure and closure, the Board of Supervisors has taken a tardy but crucial step: It has loosened its grip. Under the proposal being forwarded to the UC regents, the supervisors would neither operate the hospital nor hire the operator, so administrative decisions would be less subject to sway by contractors, labor unions and community groups with prestige and campaign donations to dispense. In the supervisors' place would be a new nonprofit entity with a board controlled equally by the county and the University of California. The nonprofit would likely hire an established healthcare provider to operate the hospital. Funding would come from the county and from Medi-Cal reimbursements. Physicians would be UC employees. County civil service rules would not apply to staff, who would begin work without a union contract but could organize and engage in collective bargaining if they so chose.

This step forward was made possible by -- and in some ways mirrors -- another decision made by a Board of Supervisors forced, against its will, to embrace change. When the county's top administrator retired in 2007, the supervisors discovered that there was simply no one on the face of the globe willing to manage a government serving 10 million people, knowing that sparring supervisors and their staffs could step in at any moment and override his or her decisions. Decades of making life impossible for a chief executive with full responsibility but without authority finally caught up with the board. So the supervisors reluctantly ceded some of their powers to the new post of county executive and hired William T Fujioka to fill it. The UC regents allowed their negotiators to come to the table to discuss a role in the hospital in large part because they finally could talk to someone at least ostensibly in charge, rather than five supervisors all asserting authority and all undercutting one another.

Some board members and their staffs still grumble about dealing with a huge new executive staff and, more to the point, about losing some of their direct authority over county departments. But if the proposed Martin Luther King Jr. Hospital governance structure proves successful, perhaps they will become comfortable focusing more on oversight and less on day-to-day management. They still have an indispensable role that transcends easy description, as exemplified by at least two of their members. Supervisor Zev Yaroslavsky demonstrated the value of experience and political astuteness when he outlined the partnership proposal in a May 2008 opinion article in The Times. The article forced the county and UC to move beyond the just-chatting phase and to engage in real talks. And Supervisor Mark Ridley-Thomas demonstrated the value of new blood and single-minded focus with his commitment to getting the medical center back in full service.

As Ridley-Thomas said Tuesday, the ball is now in the UC regents' court. Their decision is by no means simple. They must be assured that the county will not leave them in the lurch financially, and they must overcome their wariness about the previous hospital's track record. But if Fujioka, the supervisors and the rest of the county leadership are prepared to work with them and address their concerns, they may finally bring millions of Los Angeles County's people the medical care they deserve.

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