YOU ARE HERE: LAT HomeCollections

The cure that cripples King/Drew

October 06, 2005|Felix Aguilar and Robert Tranquada | FeLIX AGUILAR MD is chairman of the California Latino Medical Assn., Los Angeles chapter. ROBERT TRANQUADA MD is emeritus professor of medicine and public policy at USC.

IS RELENTLESS downsizing really the remedy for Los Angeles County's problematic King/Drew Medical Center? The members of the Board of Supervisors apparently think so. But they're wrong.

Founded 33 years ago, King/Drew fulfilled a desperate need for a full-scale healthcare center serving South Los Angeles' then mostly African American poor. But in the years that followed, chronic mismanagement has made King/Drew the troubled stepchild of the county's Department of Health Services. Even as it continued to be the primary hospital serving a population of more than 1 million people, its problems resisted solution. It was only last year's avalanche of negative media coverage that spurred the county supervisors to invest in a major turnaround effort.

First, the trauma center was closed, as an ostensibly temporary measure to focus personnel elsewhere. Then, Navigant Consulting, a private firm, was paid $15 million to sort out the staff and establish top-to-bottom reorganizing procedures -- tasks at which county officials had repeatedly failed. The firm's effectiveness has been undermined by shoddy billing and an underestimation of the magnitude of the task and the time it would take to fix the problems.

But now, even before Navigant makes its closing reports and recommendations at the end of its yearlong contract, the county seems to be moving ahead of its own paid advisors to make changes at King/Drew that are not in the interest of the hospital or the community it serves.

The Department of Health Services has proposed closing the medical center's infant services operations, including the neonatal intensive care facility and the obstetrics and pediatrics units, on the assumption that reducing current services will help focus attention and resources on the services that remain. Such a move would leave King/Drew generally unequipped to serve acute-care needs of the community (which has a markedly higher-than-average proportion of young people).

Many members of the county's own supervisor-created advisory board maintain that this is the wrong step at the wrong time. The Health Services Department's counterarguments are that Harbor-UCLA Medical Center, South L.A.'s other county hospital, could handle much of the King/Drew pediatric patient load, and private hospitals (in particular, St. Francis Medical Center, which is close by) could handle most of the King/Drew obstetrics services, which are paid for by Medi-Cal.

But the Health Services Department proposal shows scant evidence that Harbor-UCLA has enough resources to take on the postnatal population served by King/Drew, or that the local private hospitals would be financially able to take on the uninsured children and mothers that Harbor-UCLA might not be able to serve.

Five regional private hospitals have recently closed, in large part due to rising indigent-patient loads. As many as eight others are on the brink of closing. Even without these closures, rescinding pediatric care at King/Drew would put hundreds, if not thousands, of unfortunate South L.A. mothers and their children on hours-long bus rides to other county hospitals.

Ironically, such difficult access to routine public medical care was a key factor in the creation of King/Drew in the first place. Can we really afford to throw away more than 30 years of progress for so many people?

King/Drew's trauma unit may be gone forever. Losing its obstetrics, pediatrics and neonatal capabilities would demolish its most important teaching programs, threatening the Charles Drew University Medical School's very existence. The subsequent loss of the culturally diverse residents and interns, who do so much of the most vital work, would devastate the entire facility and affect other inner-city hospitals, which rely on King/Drew alumni to serve their patients.

Without the medical school, King/Drew would turn into a minimal-care hospital, attracting only the poorest patients, with little reimbursement of its deficit.

The Board of Supervisors must bear in mind that the goal of the Department of Health Services is to serve the overall health of the county -- not to make cuts in the short term that would have disastrous and irreversible long-term results.

Los Angeles Times Articles