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.

King/Drew Now King-Harbor, but Woes Continue

We had previously posted (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.

The troubles continue. The hospital regained notoriety after a patient who was left to writhe in pain on the Emergency Department floor eventually died. As the Los Angeles Times recapped the story (re-ordered to make it chronological),

[Edith Isabel] Rodriguez a California native, was poor and uninsured. She reportedly had a history of narcotics use and lived with various relatives.

A security videotape showing the woman writhing for 45 minutes on the floor of the emergency room lobby....

[In response to] 911 calls from Rodriguez's boyfriend and a female bystander. One dispatcher curtly told the bystander that the situation was not an emergency; the other said there was nothing she could do because Rodriguez was already in a hospital.

[A] video show[ed]... her extended time on the floor and a janitor cleaning around her.

She died of a perforated bowel, which probably developed in the last 24 hours of her life, according to a coroner's report.

Meanwhile, the Times also reported that

In new signs of turmoil at Martin Luther King Jr.-Harbor Hospital, officials said Tuesday the chief medical officer had been replaced and more than 40% of licensed vocational nurses and nursing assistants recently failed initial skills tests.

The disclosures came as the Los Angeles County Board of Supervisors, grappling with federal findings that the hospital continues to endanger patients, bluntly discussed preparations for possible closure of the public facility.

The people more directly involved in the case of Ms Rodriguez were treated more leniently, also according to the Times,

Six staff members at Martin Luther King Jr.-Harbor Hospital — including a nurse and two nursing assistants — saw or walked past a dying woman writhing on the floor of the emergency room lobby last month but did not help her, according to a report made public Friday.

Their discipline: a letter outlining how they should behave in the future.

The six are in addition to two others whose roles have already been made public by The Times: a contract janitor who cleaned the floor around the woman as she vomited blood and a triage nurse who oversaw the whole episode and pointedly refused requests to intervene.

The janitor was counseled verbally; the triage nurse was placed on leave and later resigned, the report said.

What we said last year about what was then King-Drew still seems relevant. 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. And to make an addendum, although we have been writing a lot lately about the shenanigans of pharmaceutical management, mismanagement, conflicts of interest, and corruption seem to afflict the leadership of all kinds of health care organization.

ADDENDUM (21 June, 2007) - See this post on The Health Care blog on King-Harbor's plight.

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.

King/Drew Managers Wake Up After Their "Serious Lethargy," Discipline or Fire One-Fifth of Their Staff

At the end of 2004, the Los Angeles Times ran a multi-part series on the troubles of Martin Luther King Jr./Drew Medical Center, many of which were attributed to management's failings. We posted on King/Drew more than a year ago.

This week, a follow-up story shows that a clean-up is beginning, but that there is a lot of cleaning to be done.
The new story focused on personnel issues. In summary, "more than a fifth of the staff ... has been fired or disciplined since January 2004 in an extraordinary crackdown prompted by revelations of widespread misconduct at the troubled public hospital."
Some of the more vivid anecdotes were:

• A critical care nurse dozing off in a break room while one of her patients decompensated. She was fired, as was her supervisor, who had previously "frequently witnessed" her sleeping on the job.
• A nursing attendant was arrested on her lunch break for battery. She then "had a family member call the hospital to say an 'unexpected emergency' would keep her from her shift. She was in jail."
• "Several custodians goaded a belligerent patient struggling with a police officer, urging him to 'kick the police's ass.'"
• The hospital "sent some chronically absent staffers what it called 'where are you?' letters after they didn't show up for days or weeks at a time." A technician was suspended after getting four such letters. After that, he missed three months out of the next seven, and was then fired. A nurse was fired after seven such warnings.
• etc, etc, etc

Jim Lott, executive vice president of the state hospital association, said "there was a serious lethargy in management for years." That seems to be an understatement. But maybe the new management has woken up. That's good news, but the ongoing problems at King/Drew are a reminder that we need a better way to ensure good management of our hospitals and academic medical centers.

King/Drew's New Managers' "Liberal Spending"

We posted a while back about the ongoing troubles at King/Drew Medical Center in Los Angeles. Long viewed as a symbol of progress for poor and minority patients in the city, the Medical Center 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.
Eventually the County of Los Angeles brought in Navigant Consulting to run the hospital. But now that company appears, as per the Los Angeles Times, to have exhibited "a pattern of liberal spending normally off-limits to those working on the public dime." The County Department of Health Services plans to reject about $300,000 of the firm's $1.3 million in travel and related billings. The Times uncovered instances of bills submitted for the wrong person, for trips that were never taken, twice for the same trip, for apparently personal travel, and for first-class seats. The Navigant project executive for King/Drew, Kae Robertson, blamed it on Navigant's own accounting office, and the County's insistence on paper recipts.
Meanwhile, Navigant was supposed to "re-instill a sense of accountability among employees...."
Furthermore, "many of Navigant's stated goals at King/Drew remain unmet," including restoring the hospital accreditation from the Joint Commission on Accreditation of Healthcare Organizations.
It is amazing that a second generation of hospital administrators, specifically hired to clean up past abuses at a hospital which serves a predominantly poor patient population, felt they deserved to fly first-class at the taxpayers' and patients' expense.

King/Drew, Again: Putting Symbols Ahead of Patient Care?

The Martin Luther King Jr/ Drew Medical Center in Los Angeles is back in the news again, unfortunately for all the wrong reasons. The Los Angeles Times major investigative series on the troubles at the hospital suggested many of them appeared attributable to mismanagement. A local pundit had suggested that viewing the hospital as a revered political symbol (of political progress for African-Americans living in the Watts ghetto) prevented people from addressing the real failings of its very human leaders, as we mentioned in Health Care Renewal in December, 2004.
Things at King/Drew do not appear to be getting better, even after Los Angeles County hired Navigant Consulting, to use its turn-around expertise to improve hospital management. The Los Angeles Times has just reported another series of apparently avoidable patient deaths. Meanwhile, county politicians are continuing their noisy debate. For example, Supervisor Yvonne Brathwaite Burke, who represents the district in which King/Drew is located, declared, "I'll tell you this: That hospital will be closed over my dead body." Supervisor Zev Yaroslavsky countered, "The only dead bodies I'm concerned about are the dead bodies that we're seeing here."
A Los Angeles Times editorial blamed a "culture of finger-pointing and blaming." Its examples included that an anesthesologist did not respond to a "code blue" because he had never received a pager. Hospital doctors, through their lawyer, blamed Navigant, which "hasn't gotten around to distributing ... pagers." The editorial wondered "what kind of doctor would sit around and wait for someon to hand out pagers." Whatever the reason, that physicians in an urban American hospital in 2005 do not have them seems absurdly at odds with the hospital's stated mission, "To provide quality comprehensive Medical Care that is Accessible, Acceptable and Adaptable to the needs of the community we serve."
Furthermore, another Times editorial charged that the current Mayor of Los Angeles is using "the hospital born of the Watts riots ... [as] a powerful black symbol," even while he fails to "denounce the death of so many patients, most of them poor, virtually all black or Latino." Thus, the editorial charged "he is pandering to those who see King/Drew as a symbol of power, not protecting the patients who rely on its care."
Again, this is a tragic story which suggests the bad results of putting politics before the core health care mission, and of letting hospital managers hide behind the revered image of their institution, even as it crumbles around them.

King/Drew: "Out of This Mountain of Despair a Stone of Hope?"

An update on the ongoing troubles at the King/Drew Medical Center in Los Angeles.
The Los Angeles Times published an editorial proposing major changes, particularly in the hospital's leadership, to address its ongoing problems. The Times editorial proposed that the hospital's executives should report to a dedicated health authority rather than to the County Board of Supervisors. A Times investigative report had suggested that the Board of Supervisors neglected severe quality problems at King/Drew due to fear of the political cost of challenging the hospital's entrenched leadership. The editorial proposed bringing in the University of California - Los Angeles to help run the teaching programs at the hospital. These programs are now run by the Charles R. Drew University of Medicine and Science. On its watch, the surgery, radiology, and neonatology training programs have lost their accreditation, and the hospital got an overall "unfavorable" rating from the Accreditation Council for Graduate Medical Education (ACGME) . Finally, the editorial proposed restoring the institution's clinical focus on the serious health problems prevalent in its geographic area.
(The quote, which appears in the editorial, is of Dr. Martin Luther King.)

Mismanagement Are Us

The media today contains a host of stories about health care mismanagement at all sorts of organizations.

Not for Profit RI Blue Cross Fights to Keep Paying Directors

The Providence Journal reported that not-for-profit RI Blue Cross is fighting in court to continue providing health insurance to its own board members, including the chair, also the head of the RI AFL-CIO, despite a new law that forbids compensation to board members without state approval. RI Blue Cross , which has about 70% of the health insurance market in little Rhode Island, fired its CEO this year after news reports of his huge salary, receipt of a $600,000 no-interest loan which he did not pay back, and, receipt of free acupuncture treatments from a practitioner who wanted to influence Blue Cross reimbursement policies. Meanwhile, Blue Cross was paying health care professionals poorly (often less than Medicare), while hiking premiums at double-digit rates.

"Where's the Outrage Over King/Drew?"

King/Drew Medical Center in Los Angeles, run by Los Angeles County, was documented by the Los Angeles Times to have a history of medical errors and systemic quality problems, accompanied by high costs, and chronic personnel difficulties, (most strikingly 120 workers' compensation claims involving injuries incurred by falling out of chairs.) Today, op-ed columnist Pat Morrison wondered at the silence of the politicians responsible for its oversight. Perhaps, they were afraid to criticize "the most symbolic and substantive institution in the black community", (per Asseymblyman Mervy Dymally). Morrison concluded that to politicians, "saving the hospital and its jobs matter more than saving the patients whose lives depend on it."

British Foundation Hospital Trust Loses its Chair

The chair of one of the new foundation hospital trusts in the UK was fired by the external Monitor organization after it incurred more than an 11 million pound deficit since April, reported the Guardian. The trust's board and the Monitor organization have been exchanging charges about who is to blame. The Monitor accused the trust's board of covering up the deficit, after initially projecting a large surplus.

Medicaid Money Went for Care of Dead People

Several state Medicaid organizations were accused of mistaken payments. In Colorado, millions went to pay for care of people who were already dead, per the Rocky Mountain News. In Washington (state), 1.4 million pills, including the narcotics Vicodin and Percocet, went missing, per the Seattle Post-Intelligencer.

Flawed Defibrillator Evaded FDA Scrutiny

The New York Times reported how defective defibrillators escaped FDA oversight. The former CEO of Access Cardiosystems, locked in a legal battle with the company, notified the FDA late in 2003 of potentially defective products. An initial inspection did not find major problems, but when the company received more reports of problems last summer, the FDA responded failed to send inspectors back. A recall was finally ordered in November, and the company closed its doors, leaving customers, including emergency services units, scrambling to replace their now useless defibrillators.