Friday, September 29, 2006

King/Drew Continues Downward Spiral

The situation at the King/ Drew Medical Center in Los Angeles continues to spiral downwards. We had previously posted (here and here) about the ongoing troubles at the medical center. Long viewed as a symbol of progress for poor and minority patients in the city, it had fallen on very hard times, attributed to bad management that for a long time hid behind the banner of the hospital's reputation in the community.

Last week, the Los Angeles Times reported that the medical center had failed a key medical inspection, and is threatened with loss of all its Medicare and Medicaid payments at the end of the year. "During the latest inspection, the hospital failed nine of the government's 23 conditions for federal funding, according to a letter from the U.S. Centers for Medicare and Medicaid Services...." One of the problems found during the latest inspection were a lack of "appropriately trained and competent" staff to attend cardiac monitors on one unit. The letter noted "This is especially troublesome, because previously documented cases showed that patients died when nurses at King/Drew failed to heed heart monitor warnings." Another article early this week repeated the entire chronology of King/Drew's problems. Today the Times reported that the most likely strategy to be used to continue to provide medical care to King/Drew's patients is to hand over operation of a down-sized facility to another Los Angeles County hospital, Harbor-UCLA Medical Center.

A few lessons from this sorry story: in health care, it is often the whole institution and its most vulnerable constituencies that suffer for the mistakes made by top managers; and that bad managers can hide for a long time behind institutions that enjoy a favorable reputation.

1 comment:

rbbruni@gmail.com said...

II used to work at King. I am still proud of having worked at King. I am not surprised that all people know of King is what Charlie Ornstein built his career on: taking down medical services, imagining to be the knight in shining armor, saving the populace from bad medical care. But I'm still grieving over it.

It was very difficult to discipline King employees - because hardly any of the cases found were actual malpractice. Nurses do not monitor - in your or my hospital - a dying patient with a terminal condition. You turn off the monitors, let the family hold his or her hand. Nurses transferred to other county hospitals have discovered that the unreal array of restrictions, prohibitions, rules and regulations that they were all subject to at King are ignored, not existing, or ridiculed elsewhere.

It was mightyly surprising to hear of incompetent nurse in the cardiac unit at the time of the inspection: the training, personnel changes, use of travellers, obsessive supervision that have been the norm at King starting in Oct 2003 made it impossible. Some of us do not quite believe the result of these surveys.

The severity of illness of the King patients way surpasses the standards of what even the other Big County hospital is accustomed to. We have had the data to show it, and have been mocked and humiliated in the public court when those of us who pride themseleds in being King physicians have tried to speak up and rebut a county supervisor's superficial comment. Please remember: Charlie Ornstein dragged on the pages of the LA Tomes the same 5 dead people, all of them highly justifiable, by the way, on the daily news, so that Mike Antonovich was able to claim that he had to stop this DAILY BODY COUNT. It was as if the thousands of people who yearly die unexpectedly in US hospitals all died there, if you listened to the paper. So, Charlie and Mike got busy.

They tore us down starting from the flagship, the trauma center. The Board of Supervisors will forever pay millions to have trauma care done by other hospitals - private ones - where the same King doctors and therapists are welcome part of the regular staff - but in facilities that are neither as modern or as functional as the 1998 King center had been. Somehow the Supervisors did not seem to notice how incongruent would be that the same surgeon vilified at King were honored and sought after at California or Cedars Sinai.

The attack on the Neonatal ICU was unrelenting and eventually succeeded: the best run unit in the whole County , the one at the center of the need. Pretty much only high risk obstetrical patients used to show up at King's door, and both quality of care and survival rates still were comparable or superior to any private hospital. Compassionate care, and incredible specialized follow up for its patients, too. Gone, now.

We used to have fifteen training programs whose graduates consistently chose to remain and serve in the inner city, gone now too. Cui prodest, used to wonder the ancient Romans, to whose advantage is this catastrophe?

Did King have mistakes ? Yes, and so do the hospitals around the country where 80,000-some patients are known to die every year, because medicine is not an exact science, because humans err, because people get exhausted or distracted or whatever, and because the human body is fragile. They happen in any hospital, at any time. Most hospitals, however, do not invite Charlie Ornstein in, like the LA County Health Dept has repeatedly done. If anything, damage control is a science.

Poor administration? yes, plenty. We all know that the downtown little kings and queens - the Supes, the largest bureaucracy in the western US - chose to place a glorified clerk with a late BA and no medical background as head of a health department with 5 major hospitals, a 4 billion dollar budget, and the largest population of insured patients known... 2.8 million people in LA have no coverage and go to public facilities. There are 23 states in the US whose TOTAL population is smaller than that. They later chose to hire MDs to do the same, such as the one responsible for downsizing the VA system - very proud of it, Uncle Tom was: now, what about the news about the veterans' dismal care? , and then fire him furiously, after humiliating him in public over and over, just as they had done in the past to other colleagues...

People around King are now bemoaning the fact that they get transferred elsewhere, that there is no pediatric unit, that premature or sick infants don't stay here any more. Are you aware that there are times when in LA you wouldn't have an intensive care bed for your child if needed? Why close our PICU unit, the option for trauma care for kids in the area where you can get a bullet though your head while sitting in your kitchen? Do you know how many hospitals have closed their doors to emergency cases, to trauma, to high risk deliveries? You may indeed find out in an unpleasant way one day, and I wish you well.

The area of highest need has been intentionally reduced to an inner city ghetto no better, actually much worse than before the 1965 riots. Easy: the locals now are not angry young black men, but immigrant families afraid of complaining. Slam dunk, now you can either clean up the area, sell the renovated hospital, or both.

I am so sorry. I am now far away, and miss LA - but miss my people, my team, my patients more. What is lost won't be recovered. The care of the indigent is not a high priority, the political cover ups are a daily reality in the life of the country. The unions? Kathy Ochoa was indeed at the table, trying to restore some common sense, and trying to support her nurses in the witch hunt of these years. She is worthy of respect, and, no, she never covered up for willful misconduct. She didn't have to. Good luck, LA, and hope for the best. Maybe California is ready for a single payer experiment.