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THE KING / DREW COLLAPSE

Take the Medicine

County supervisors must stop ducking the difficult choices surrounding the troubled hospital.

September 12, 2004

The Los Angeles County Board of Supervisors may not have a clue on what to do about the troubled Martin Luther King Jr./Charles R. Drew Medical Center, but it does know this much: It wants the county-owned hospital out of the headlines.

For years, the supervisors have tolerated King/Drew's life-threatening problems and obscured them behind the closed doors of lawsuit settlements and between the covers of scathing federal and state reports. For the last year, however, the hospital's long pattern of failure -- desperately ill patients ignored and left to die, dangerous medication mix-ups, undertrained and unsupervised nurses, shady business dealings, doctored patient charts and timecards -- has leaped into the public eye through insistent reporting by The Times.

Supervisors are feeling the heat, and last month they went after the usual scapegoat: the chief du jour of the county Department of Health Services. But before they could chew up and spit out Dr. Thomas Garthwaite as they did his predecessors, Supervisor Zev Yaroslavsky broke ranks. "It's hard to fathom sometimes what this board's direction is," he said. "I wouldn't put all the onus on Dr. Garthwaite."

What a masterful understatement.

The supervisors had reason to be riled up. Auditors last month released a report, ordered by Garthwaite, on the county's contract with the private Drew medical school, which trains the graduate-level physicians, or residents, who serve as the medical staff at King hospital. The county pays Drew $13.6 million a year -- 57% more per resident than it pays Harbor/UCLA Medical Center to run a much better-regarded training program. But Drew keeps such pathetic records that no one can say where the money goes, except to department chairmen who earn 31% more than their Harbor/UCLA counterparts. (So much for the old excuse that King/Drew's problems stem from stinginess on the county's part.)

Shocking as they were, the audit's findings were in line with recent Times stories on sloppy, if not criminal, bookkeeping throughout the medical center. King/Drew paid nearly $1 million in the last five years to a surgical instrument company owned by one of its orthopedic surgeons. Not only did this violate the county's conflict-of-interest laws, the disposable devices cost twice as much as more conventional (and reusable) instruments preferred by most hospitals. Another orthopedic surgeon lied on his timecards and referred patients from King/Drew to his private practice.

The supervisors would like nothing better than to hang this whole mess on Garthwaite, whom they hired from the federal Department of Veterans Affairs 2 1/2 years ago to beat back a huge health department deficit. (He did.) But the problems long predate Garthwaite. For decades, supervisors have let King/Drew's political history inhibit any hands-on oversight.

The hospital and the medical school were founded after the 1965 Watts riot to train minority medical professionals to serve a then mostly black community. Sensitive about being viewed as not supporting that goal, supervisors have long buckled when doctors or administrators complained about reforms ordered by the health department.

When Garthwaite, for example, recently attempted to close King/Drew's neonatal intensive care unit to save money and concentrate expertise at Harbor/UCLA, the supervisors caved in to protests from King/Drew supporters, even though neonatology is one of three troubled training programs that accreditors have ordered shut down.

To be sure, the low-key Garthwaite is no William J. Bratton, the outspoken reformer brought in to turn around the Los Angeles Police Department. By his own description he is a "systems" guy, fond of uttering such maxims as: "Systems deliver the products they were designed to deliver." The supervisors, by design or default, created the system that "runs" King/Drew. The headlines just describe the product delivered.

On Tuesday, a group of prominent doctors and educators is scheduled to advise the supervisors on how to fix Drew's training programs. Any antidote to the disastrous audit released last month would have to include bold and politically unpopular changes -- a much smaller program, an alliance with UCLA or USC and a drop-dead date for the county to take over the training programs if Drew doesn't meet strict goals.

The broader question is whether the troubled hospital, on which a desperately poor community depends, would better survive if it severed ties with the problem-plagued medical school altogether. Rather than make that call, the supervisors will be tempted to hide behind the task force, just as they were tempted to sacrifice Garthwaite, and hope the headlines will go away.

They won't.

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