King-Harbor fails final check, will close soon

By Charles Ornstein, Tracy Weber and Jack Leonard

Aug. 11, 2007 12 AM PT

Times Staff Writers

Martin Luther King Jr.-Harbor Hospital shut down its emergency room Friday night and will close entirely within two weeks, a startlingly swift reaction to a federal decision to revoke $200 million in annual funding because of ongoing lapses in care.

The extraordinary developments mark an end to nearly four years of failed attempts to reform the historic institution, treasured by many African Americans as a symbol of hope and progress after the 1965 Watts riots.

Los Angeles County health services director Dr. Bruce Chernof announced the closure plan Friday afternoon, hours after the hospital learned that it had failed its final test, a top-to-bottom review by the U.S. Centers for Medicare and Medicaid Services. The hospital, formerly known as King/Drew, has shown itself unable to meet minimum standards for patient care since January 2004, according to the regulators.

Effective noon Friday, the hospital declared an “internal disaster” and redirected each ambulance to one of nine surrounding hospitals. About 5 p.m., staff members posted notices saying the emergency room was closed to walk-in patients.

So many temporary nurses had quit or refused to renew their contracts that too few remained to care for emergency room patients, officials said.

“We are down to skeleton staff,” said Carol Meyer, director of governmental affairs for the county Department of Health Services.

Because of the uncertainty created by the decision, California public health director Dr. Mark Horton said the state will have staff at King-Harbor throughout the weekend to monitor the care provided to the remaining patients.

To treat the poor and minority residents served by the Willowbrook hospital, the county plans to contract with nearby private hospitals and add beds at public facilities. Outpatient clinics and an urgent-care center at King-Harbor will remain open after the hospital closes.

Community leaders say their biggest worry is the closure of the emergency room, which saw about 47,000 patients last year.

But, in a community that has long battled for its fair share of basic services, King-Harbor stands for more than just healthcare.

“It’s a very personal relationship this hospital and the community have,” Lark Galloway-Gilliam, executive director of Community Health Councils, said between sobs.

“People fought to have this place built, and it’s been employment for some people. It’s been a symbol that our community is somewhat whole, that the resources are there that you need when you want them,” she said.

“So much has been taken away, it just breaks my heart,” she said.

For the families who lost loved ones after medical lapses at the hospital, however, King-Harbor had come to symbolize betrayal, and Friday’s news brought bitter satisfaction. Several had shared their stories with The Times in 2003 and 2004. Since then, each new tragedy at the hospital had rekindled the hurt and anger.

“I’m sorry for the people that depended on that hospital, but I’m glad it’s gone,” said Gail Gordon, whose 43-year-old sister died in November 2002 after surgical and other errors. “My sister died an innocent death. . . . If they had kept it open, more innocent people would have died.”

County officials have said they will seek a private operator to take over King-Harbor and try to reopen it within 12 to 18 months. But previous attempts to find any takers failed, and success this time is by no means assured. If no private operator can be found, Chernof said, the county may attempt to reopen King-Harbor itself within the same time period.

The county will seek to voluntarily suspend the hospital’s license rather than have it revoked entirely, easing the way for a new operator to take over.

“The only real failure in my mind,” Chernof said, “will be if we don’t ultimately get to a place where we have a hospital in the community that meets national standards.”

The fate of the hospital’s 1,600 employees is unclear. Some will remain at the outpatient clinics; others could be reassigned to other county health facilities.

Even some of the hospital’s longtime defenders say it is no longer viable in its present form.

Among them are Los Angeles Councilwoman Janice Hahn, whose father, Kenneth, pushed for the hospital’s creation as a county supervisor. Pictures of him shaking the hand of the Rev. Martin Luther King Jr. adorn its walls.

“When someone from this community goes in with a sick baby or a knife wound or bronchitis, they have to be able to trust that doctors and nurses that treat them are giving them excellent care,” the councilwoman said Friday.

Now, she said, the focus must be on creating a facility that “meets basic minimum standards for patient care.”

The Medicare agency’s letter to the hospital, hand-delivered Friday morning, conveyed a deep sense of frustration that King-Harbor had squandered repeated opportunities to avoid this end. Fewer than five hospitals a year lose their federal funding.

In its final inspection last month, the hospital fell below minimum standards in eight of the 23 areas assessed by the agency.

“While some progress has been made, significant problems persist at MLK-Harbor Hospital,” Herb Kuhn, the Medicare agency’s acting deputy administrator, said in a statement. “Conditions at the facility have placed the health and safety of patients at great risk.”

In fact, reviewers found a host of serious lapses throughout the hospital, some similar to those that county officials swore had been fixed. They included failure to properly clean bronchoscopes -- devices used to look into the lungs -- which put patients at serious risk of exposure to contagious diseases. In addition, the hospital staff could not demonstrate its ability to respond to a pediatric emergency, failing to locate critical equipment or even properly calculate how much medication to give a critically ill child.

The federal decision underscores the failure of Los Angeles County government, which despite slashing services, firing hundreds of workers and paying tens of millions of dollars to consultants, could not ensure the basic safety of patients at King-Harbor.

Supervisor Gloria Molina acknowledged as much. “We keep getting assurances that the personnel there are trained and prepared and ready to deal with this inspection, and unfortunately we failed pretty miserably,” she said.

The hospital has been buffeted by problems almost since it opened in 1972. But the current crisis began in earnest four years ago when a series of patient deaths was linked to serious lapses in care by nurses and other staff members.

In a five-part series published in December 2004, The Times detailed how the hospital had become one of the worst in the nation by a variety of measures, largely because county supervisors failed to take aggressive action for fear of being branded racist.

In August 2006, despite repeated warnings, King-Harbor failed what the federal government billed as a make-or-break inspection. Rather than pull its funding, however, federal officials accepted the county’s plan to radically pare services, reducing the number of inpatient beds from about 250 to 48. The hospital closed its physician-training programs and severed ties with its long-standing academic partner, Charles R. Drew University of Medicine and Science.

It became clear in May that King-Harbor had still not turned around. A 43-year-old woman died after writhing in pain on the floor of the emergency room lobby for 45 minutes. Hospital staffers looked on and did nothing to help; a janitor mopped up around her as she vomited blood. The incident attracted national attention, and, according to some supervisors, seemed to crystallize the hospital’s woes.

Federal officials made it clear that if King-Harbor failed an inspection last month, it would be given no more chances.

Almost from the start, there were signs that the hospital would not pass.

On their second day at the hospital, inspectors declared that patients were in immediate jeopardy of harm or death after a psychiatric patient was left unattended and cut herself with a scalpel she found in the emergency room.

Some members of the county Board of Supervisors -- all of whom have been in office more than a decade -- said closure is the only option left.

“For too long, the status quo allowed mediocrity to be the norm,” said Supervisor Mike Antonovich. “There is no excuse or reason that we had to waste tax dollars and continue to support a failed system.”

Supervisor Zev Yaroslavsky said: “We were given more time than I would have given Los Angeles County if I was the regulator. But we couldn’t move far enough, fast enough, and that was the ultimate verdict. I’m not surprised. I’m not sure anybody around here is surprised by the decision they made.”

The closure was the right thing to do, said Rona Millage, whose mother died at King/Drew in July 2003 after nurses failed to notice that her heart had stopped -- even though she was connected to a cardiac monitor.

“If they were training their nurses and their staff, lives wouldn’t have been taken,” Millage said. “So many lives in the last four years. . . . There’s no money in the world that can bring my mom back. I suffer with that every day.”

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(BEGIN TEXT OF INFOBOX)

Voices

‘I’m still not convinced that the problems at King-Harbor Hospital can’t be resolved if the will to do so is found, but that commitment is missing.’

(D-Los Angeles)

‘This medical facility is still plagued by substantial problems that cannot be defended . . . in terms of the health and safety of the patients.’

(D-Los Angeles)

‘I think that there’s enough blame to go around.’

county supervisor, whose district includes the hospital

‘This thing was poisoned decades ago. And it just doesn’t seem we’ve been able to uproot the kind of culture that was there.’

county supervisor

‘It is very distressing to have to close the hospital that we worked so hard to preserve. It’s a blow to patients, to staff, to the community at large. But as I have stated many, many times before, this department will not operate a hospital that fails to meet national standards.’

county health director

‘I could not have lived with myself shutting down a hospital without trying to fix it first.’

county supervisor

‘This is an opportunity to move forward.’

county supervisor

‘It’s a shame that they are messing up Martin Luther King’s name.’

whose mother died at the hospital in 2003

‘I think everyone that was responsible for fixing the problems, for turning that hospital around, shares some of the blame.’

Los Angeles city councilwoman

‘Passing or not passing, whatever. The status quo was just not acceptable.’

president, Service Employees International Union, Local 721

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