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Do not resuscitate

County supervisors must close King-Harbor permanently, completely and unalterably.

August 15, 2007

Members of the Los Angeles County Board of Supervisors this week expressed disappointment, anger and frustration over the failure of the hospital complex once known as Martin Luther King Jr.-Charles Drew Medical Center. Each of those feelings is appropriate, but they merely soften the emotion that must lurk underneath, or at least ought to: shame.

Leaders of the largest county in the nation, and one of the richest in talent, resources and history, demonstrated conclusively that they lacked the capacity to effectively channel resources to the people of southern Los Angeles County. King-Drew, now known as Martin Luther King Jr.-Harbor Hospital, culminated years of ineptitude, reorganization, retraining and supposedly fresh starts with a federal evaluation so abysmal that it not only accompanies final revocation of Medicare funding, but it also shocks even the casual reader of the fatal report.

Just walking into the building, inspectors saw that patients were in immediate jeopardy. Further probing showed that staff failed to track records, properly mix medicine and sterilize equipment. At a time when the hospital should have been most on its toes, with staff well aware that they were being evaluated for the quality of care they delivered, a patient notoriously was left writhing on the floor for nearly an hour while nurses ignored her and a custodian swept up around her dying body. Others were left misdiagnosed, untreated or abused.

Five years ago, these same five elected supervisors -- Gloria Molina, Yvonne B. Burke, Zev Yaroslavsky, Don Knabe and Michael Antonovich -- were forced, finally, to come to grips with the horror that was MacLaren Children's Center, supposedly a short-term county shelter for foster children but actually a publicly owned and operated human warehouse where unwanted youth were physically and psychologically abused over months or even years. Under pressure of a lawsuit, the supervisors closed MacLaren, then breathed a sigh of relief that it was gone. They knew the culture that enveloped the center and the people who worked there could not be broken. No one ever suggested reopening the place. Today, no one misses it.

Yet the county supervisors, perhaps unable to confront the depth of their failure at King-Harbor, appear even now to lack the honesty to actually close the hospital as they closed MacLaren. They instead play games with the very definition of "to close." Half the staff of 1,600 remains on-site, on the job, at outpatient clinics and an urgent care center. Capacity to perform surgery is being expanded. Closure is "temporary." A private purchaser will actually be a county "partner." In a year to 18 months, the supervisors continue to insist, King-Drew will be back in full, and perhaps deadly, force.

The prospect is chilling. Anyone tempted to cheer the survival and promised return to full service of the hospital fails to grasp its depressing history of fresh starts and last chances. Virtually everything the supervisors discussed publicly on Monday with Dr. Bruce Chernof, director of county health services, has been tried and mishandled. Reevaluate every employee? Done. Sweep out management and put the hospital under the wing of a successful medical center, such as Harbor-UCLA? Done. Close this department or that department to give the hospital breathing room to get its act together? Done. Shrink the emergency room? Hire management consultants? Search for a private operator? Done -- followed by more needless patient deaths and injuries.

More than one supervisor said that, this time, it "must be done right." Those words are cruel darts thrown at the families of patients who died after the last time, or the time before, supervisors purportedly overhauled the hospital. Did it not need to be done right before?

At a time when the hospital should have been providing badly needed medical service to millions of residents, the people who run the place -- executives, managers, doctors, nurses -- were instead trying to cope with, and in many cases helping to breed, a culture of entitlement and dysfunction. It is painful to say it, but the truth is that preserving an African American-run institution took precedence over providing competent care. The interests of staff came before the needs of patients.

Not everyone who worked there carries some kind of contagious "poison," to use Molina's term. But there is a type of poison that runs through the veins of the institution. The corrosive culture that thrived in the hospital must die. The hospital must close -- permanently, completely and unalterably. Staff members, if they again pass their reevaluations and go through retraining, must be dispersed throughout the county health system -- where they must be carefully watched. They must become the responsibility of all five supervisors. Fairness to employees is important, but not as important as the safety and well-being of patients.

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