Monday, August 13, 2007

King-Harbor Hospital Closing

We had previously posted (here, here, here and here) about the ongoing troubles at the medical center formerly known as King/Drew and since renamed Martin Luther King Jr - Harbor Hospital in Los Angeles, after the county hospital went from being flagship hospital for the Charles R Drew University of Medicine and Science to a part of Harbor-UCLA 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.

Now the hospital is going to close. Per the Los Angeles Times,

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.

The Medicare agency's letter to the hospital, hand-delivered this 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 also 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.

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.

The story made clear that the closure of the hospital was due to mismanagement and the failures of the political leaders who were ultimately responsible for this county hospital.

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 assure 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.

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 story is a stark reminder of the bad effects of mismanagement of health care organizations. Although it seems we most often discuss pharmaceutical, biotechnology, and device manufacturers in this blog, this story makes it clear that government organizations, local or national, are hardly immune from poor management.

The sorry results are too often failed instutions, reduced access to care, and, most sadly, hurt patients.

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