Martin Luther King Jr.-Harbor Hospital

From Wikipedia, the free encyclopedia

Martin Luther King Jr.-Harbor Hospital (MLK-Harbor), formerly known as Martin Luther King Jr./Drew Medical Center (King/Drew), is a public hospital in the Watts neighborhood of Los Angeles, California, but the hospital is located in unincorporated Willowbrook, California.

MLK-Harbor is operated by the Los Angeles County Department of Health Services (DHS) and has 48 beds. In recent years, widely publicized problems related to incompetence and mismanagement caused the hospital to undergo a radical overhaul: bringing the number of beds down to 48 from 233.^[1] Since 2004, 260 hospital staffers, including 41 doctors, had been fired or had resigned as a result of disciplinary proceedings. It currently has 1,400 employees. To alleviate the large loss of capacity, The Los Angeles County Medical Alert Center(MAC) contracts ambulances take approximately 250 patients per month to other local hospitals. ^[1]

At the turn of the 21st century and before its crisis, MLK-Harbor (then MLK/Drew) had 537 beds, was the teaching hospital of the adjacent Charles R. Drew University of Medicine and Science, and spread over a 38.5-acre site that includes a dormitory for medical residents; with 2,238 full-time employees, and in 2004 treated 11,000 inpatients and 167,000 outpatients. Located near areas of high crime, the hospital has a very active trauma unit. In 2003, it handled 2,150 gunshot wounds and other life-threatening injuries.

Contents 1 History 1.1 Founding and early history 1.2 The Fall of King/Drew 1.2.1 Troubles come to light 1.2.2 Closure of the trauma center 1.2.3 "Make-or-break" inspection 1.3 MLK/Drew becomes MLK-Harbor 2 Notes and references 3 External links

[edit] History

[edit] Founding and early history

MLK-Harbor's founding was spurred by the 1965 Watts Riots. In the aftermath of the unrest, Governor Pat Brown appointed a Commission to identify contributing factors to the unrest. This resulted in the December 1965 McCone Report. One major finding of the Report was the lack of a health care access near the low income neighborhoods of South Central Los Angeles. At the time, the closest major public trauma center was Los Angeles County-USC Medical Center, located over ten miles away --a problem heightened by the amount of gang violence in the area.

In 1966, DHS established a task force to develop a full-service community and teaching hospital operated by the County in conjunction with the USC and UCLA Medical Schools as well as the newly formed Charles R. Drew Postgraduate Medical School, a private, non-profit medical school formed to train doctors to work in areas of urban poverty.

Ground was broken on the hospital in April 1968; originally called Los Angeles County Southeast General Hospital, it was soon renamed Martin Luther King Jr. General Hospital. After a dedication in February, the school opened on March 27, 1972 as a full-service medical center. The facility changed names to Martin Luther King Jr./Drew Medical Center when it became the teaching hospital of the adjacent Charles R. Drew University of Medicine and Science. In 1981 the hospital expanded into psychiatric care by opening the Augustus F. Hawkins Mental Health Center, and it expanded its trauma center in 1998. By the 1980s, the hospital became part of the Drew/UCLA Undergraduate Medical Education Program, which trained physicians through a partnership of UCLA and Drew medical schools. The hospital became a source of pride and jobs in the community.

[edit] The Fall of King/Drew

King/Drew entered the 21st century with an array of problems related to incompetence and mismanagement. Because of a perceived lack of quality at the hospital, it had earned the nickname of "Killer King". Starting with a series of reports in the Los Angeles Times, some of which earned a Pulitzer Prize, the hospital has gone through increasingly severe scrutiny.

[edit] Troubles come to light

On August 22, 2003, the Los Angeles Times reported that two women connected to cardiac monitors died after their deteriorating vital signs went undetected. In December 2003, DHS closed the cardiac monitoring ward of King/Drew after a third patient died under questionable circumstances. A consulting group was hired to help fix issues with the nursing staff, with DHS spending nearly $1 million.

In a January 13, 2004 report, the federal Centers for Medicare & Medicaid Services (CMS) determined that King/Drew was out of compliance with minimum requirements for receiving federal funding, citing the work of government inspectors who identified five patients who died at King/Drew after what were determined to have been grave errors by staff members. By March, CMS declared King/Drew patients were in "immediate jeopardy" of harm or death because of medication errors at the hospital, citing numerous mistakes and threatening to pull federal government funding from the public hospital. An example in this report cited a meningitis patient receiving a potent anti-cancer drug for four days. In June CMS again stated that patients were in jeopardy, citing the use of Taser stun guns to subdue psychiatric patients. Yet again, it threatened to pull federal funding but backed away; federal funding makes up over half of King/Drew's $400 million operating budget.

[edit] Closure of the trauma center

On September 13, 2004, DHS recommended the closure of King/Drew's busy trauma unit, stating that the hospital needs to put its full energy into fixing problems in other areas. Despite intense community opposition, the unit is closed in early 2005. A few days later, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) threatened to pull its seal of approval, citing the medical center for failing to correct severe lapses in patient care and jeopordizing over $14 million in funds for physician training. Despite being a rare move (99% of hospitals pass JCAHO audits), King/Drew's seal of approval was revoked in February 2005. Soon afterwards, in 2004 the Los Angeles Times revealed that the American College of Surgeons had revoked its approval of the quality of King/Drew's trauma unit in 1999 and 2003 because it failed to properly investigate questionable patient deaths and that doctors routinely skipped meetings held to discuss treatment problems. Also in September, the Los Angeles County Board of Supervisors agreed with CMS to hire a new consulting firm to take over operations at the hospital: hiring Navigant Consulting takes over, and ultimately paying the firm more than $17 million for 18 months of work.

By November 2004, massive neighborhood resistance to the proposed closures (particularly the trauma center) had formed, led by U.S. Representative Maxine Waters and joined by the Rev. Jesse Jackson, Los Angeles Mayor James K. Hahn, actress Angela Bassett and children of the Rev. Dr. Martin Luther King Jr. Despite the protests, negative media editorials and the near-unanimous opposition of city political leaders, the five-member Board of Supervisors elected to move forward with the closure by a vote of 4 to 0 with one abstention. A temporary restraining order was filed by a group of doctors and residents, but was denied and the closure was completed in early 2005. Patients that had normally gone to the King/Drew trauma center were dispersed among three other hospitals, both public and private (with county subsidy).

The move gained national attention after the Los Angeles Times ran a Pulitzer Prize-winning[1] five-part series reporting on "The Troubles at King/Drew". The series found that the problems at the hospital were far deeper than the public already knew and faulted the Board of Supervisors for shying away from making needed changes, often because of racial politics. Among the other findings was that King/Drew spent more per patient than any of the three other general hospitals run by Los Angeles County, the opposite of what many hospital supporters had assumed.

Meanwhile, in December 2004, CMS declared King/Drew patients are in "immediate jeopardy" for a third time; this time citing the staff's heavy reliance on county police to shoot aggressive mental patients with incapacitating jolts of electricity. Federal funds are again threatened, but, like the previous times, action is not taken.

Problems for King/Drew were exacerbated in March 2005, when three patients died due to medical care lapses and mistakes over a period of four days. The Board of Supervisors considered severing the hospital's relationship with Charles R. Drew University of Medicine and Science and partnering with another medical school such as UCLA, USC or Loma Linda University. In April, reports of a seventh death attributed to lapses in care by the hospital was reported by the Los Angeles Times; this time, nurses and staff virtually ignored the audio and visual cues of vital-sign monitors over a period of hours.

[edit] "Make-or-break" inspection

After the three previous warnings holding King/Drew out of compliance with federal guidelines since January 2004, CMS and federal authorities held an unannounced, last chance inspection of the hospital on July 31 and completed on August 10, 2006.

On September 22, 2006, CMS informed King/Drew that the hospital still did not meet minimum patient-care standards, failing nine of the government's 23 conditions for federal funding, and thus had failed the final, "make-or-break" inspection. Federal regulators identified problems in nursing, pharmacy, infection control, surgical services, rehabilitation services, quality control, patients' rights and the hospital's governing body and physical plant. Inspectors found more problems during the final inspection than they had at any time in the previous three years.

The final report stated, and underlined, that "Termination of the Medicare provider agreement is final." This finding jeopardized $200 million a year in federal funding, forcing Los Angeles County to close the public hospital, give it to someone else to run or turn it into a clinic.

[edit] MLK/Drew becomes MLK-Harbor

DHS elected to move forward with a radical restructuring plan that eliminated the hospital's specialty services, severed it's relationship with the Drew medical school and placed it under the management of Harbor UCLA Medical Center (Harbor-UCLA).^[1] King/Drew became MLK-Harbor to reflect the change. All employees of the hospital were interviewed with half permitted to stay and the rest transferred to other hospitals, approximately 1,400 employees remain. As a result of these measures, Medicare agreed to continue funding the hospital until March 31, 2007. If federal funding ends, among other problems, MLK-Harbor would permanently lose 250 medical resident slots, 15% of the 1,700 in Los Angeles County.^[2]

On March 6, 2007, officials from Charles R. Drew University of Medicine and Science announced that they will sue Los Angeles County for $125 million for breach of contract, claiming that the restructuring of the hospital terminated support to 248 medical residents and gutted the adjacent university.^[3] The two entities had collaborated since 1972. In response, Los Angeles County Board of Supervisor Mike Antonovich stated "Drew University will fail in court as they failed as a medical school."^[3]

[edit] Notes and references

[edit] External links

• Martin Luther King Jr.-Harbor Hospital