Federal regulators have told Martin Luther King Jr./Drew Medical Center that it will have one last chance to prove it has fixed lapses in care that repeatedly led to patient deaths.
An unannounced top-to-bottom inspection will be held within 90 days -- months later than had been expected, the regulators said this week. If the long-troubled public hospital fails any portion, it stands to lose all of its federal funding.
In that case, Los Angeles County supervisors say they would have little choice but to downsize it, close it or give it to someone else to run.
The county Department of Health Services had expected the crucial inspection by the U.S. Centers for Medicare and Medicaid Services by January but regulators did not follow through. Without the review, it remained unclear whether the hospital had corrected serious deficiencies identified by government inspectors.
The federal announcement follows an unusual rebuke from California's top health official, accusing the federal agency of jeopardizing patients' safety by moving too slowly.
Health and Human Services Secretary S. Kimberly Belshe complained in a May 26 letter that the process of fixing King/Drew had stalled because the federal government inexplicably had not provided the hospital with detailed results of previous inspections.
"Without these findings, the hospital does not have the information needed to improve patient safety.... " Belshe wrote.
Days after the letter was sent to Medicare's top administrator in Washington, D.C., the findings were released to King/Drew, making it possible to re-inspect the hospital at any time.
Federal officials deny the process was stalled.
"There's been a lot of activity at that hospital," said Jeff Flick, the Medicare agency's regional administrator. "It's been nonstop.... The efforts to improve that hospital have been steady, consistent and strong."
But Flick acknowledged that it took a while for his agency to arrange the make-or-break inspection. "Getting it right matters more than trying to go fast."
The hospital, in Willowbrook just south of Watts, has been out of compliance with Medicare standards since January 2004 and has repeatedly been threatened with a loss of $200 million in federal funding, which accounts for more than half of its budget.
In the last two years, federal inspectors have visited the hospital 14 times.
The Medicare agency entered into an unusual contract with the county in September 2004, giving it a year to overhaul King/Drew's operations under the guidance of a hospital turn-around firm. That memorandum of understanding expired in September. Federal officials did not renew the agreement but did not explain its plans either -- until this week.
In the upcoming inspection, Flick said, "If they are out of compliance, basically the funding stops."
There is one catch. If the hospital fails, the county can propose a radical alternative, such as turning the hospital over to an outside operator or selling it outright -- and the federal government would consider whether to continue funding, Flick said.
The Medicare agency, however, has put some effort into helping King/Drew pass the upcoming review, Flick said. It has trained nurses and other staff how to prepare and explained what surveyors will be looking for.
Supervisor Mike Antonovich accused the Medicare agency of stringing the hospital and its patients along.
"I'm appalled that they have taken as long as they have, given the conditions that the hospital has been operating under," Antonovich said. "They have not been as aggressive as they ought to be."
County Supervisor Yvonne Brathwaite Burke said she didn't know if King/Drew had finally improved. She said she had heard conflicting rumors -- some pointing to ongoing problems at the hospital and others suggesting things are going well.
"I have heard that there are changes that have been made and progress that has been made," she said. "Obviously we won't know until they come."
Supervisor Don Knabe said he's "cautiously optimistic" about King's chances.
"Now is the time," he said. "This is what everyone has been waiting for. When they give the call and it's unannounced, [the hospital] had better be ready."
Dr. Bruce Chernof, the county's health director, said the hospital is prepared. "The staff is really getting to the point where they would welcome the survey," he said. "They've put a lot of energy in this and they're kind of ready to take the final exam."
County officials, however, have said repeatedly over the last 2 1/2 years that King/Drew has turned a corner. Each time inspectors returned to assess the hospital's progress, they found problems.
State inspection reports released last week, for example, found that one patient died in March 2005 after nurses failed to notice declining vital signs on a cardiac monitor. The patient's nurse later was determined to be sleeping in the break room.
King/Drew personnel left a guide wire inside a patient in August, improperly gave blood intended for one King/Drew patient to another that same month and in February failed to monitor a patient on the way to get a diagnostic scan, according to the state reports. The patient went into cardiac arrest and later died.
Chernof said most of the deficiencies identified last week occurred before the arrival of the hospital's current management team, led by Antionette Smith Epps, who took over as administrator in October.
Belshe in her May 26 letter suggested that the incidents would have been investigated earlier, but the federal government asked her inspectors to hold off -- a contention Flick disputed.