Federal health officials concluded late Thursday that Martin Luther King Jr.-Harbor Hospital had put emergency room patients in "immediate jeopardy" of harm or death and gave it 23 days to fix the problems or lose federal funding once and for all.
Even if the problems are resolved by that deadline, King-Harbor, formerly King/Drew, could still lose its federal certification because it had failed to meet the terms of a March agreement with the U.S. Centers for Medicare and Medicaid Services. The deal, which headed off a previous attempt to strip King-Harbor's certification, called for the troubled public hospital to adhere to Medicare's basic standards.
The hospital had been hoping for a clean bill of health when inspectors visit next month to determine whether to restore full funding.
State and federal inspectors conducted the multi-day inspection at King-Harbor after reports in The Times about a woman writhing in pain for 45 minutes on the floor of the emergency room lobby without receiving medical attention; she later died. The inspectors also were looking into another case, reported by LA Weekly, in which a man with a brain tumor waited four days in King-Harbor's emergency room when he needed to be transferred to another hospital for life-saving brain surgery.
Thursday's action marks the fourth time since March 2004 that the Medicare agency has found that King-Harbor, in Willowbrook just south of Watts, has put patients in imminent risk. The other times related to numerous prescription drug errors and using Taser stun guns to subdue out-of-control psychiatric patients.
In the last 3 1/2 years, the hospital has been cited more than a dozen times by state and federal regulators for rampant care problems that have contributed to patient deaths and injuries. It has faced the risk of losing its federal certification and funding before, but has always been able to avoid it. Gov. Arnold Schwarzenegger has personally intervened in the past to keep the hospital certified.
At one point, Medicare funding accounted for half the hospital's budget. But as part of the unique March deal with the federal government, Los Angeles County agreed not to bill Medicare for hospital services until August, when it expected to finally be rid of the series of threats it had faced in recent years.
In response to its problems, the hospital closed its busy trauma unit, spent millions of dollars on outside consultants, hired new managers, disciplined hundreds of staff members, ended its physician training programs and scaled back the number of beds from more than 200 to 42.
Hospital officials and supervisors at the Los Angeles County Department of Health Services have insisted repeatedly that the hospital is improving, yet it has not met minimum federal standards since January 2004. The Board of Supervisors has made it clear that the county cannot continue operating King-Harbor long term without federal funding. Without another solution, they've said, the hospital could be forced to close.
Separately, the Medicare agency also found that King-Harbor had violated emergency care standards last month in its treatment of Edith Isabel Rodriguez, a 43-year-old patient who writhed in pain for 45 minutes on the floor of the emergency room lobby without receiving medical attention. She died a short time later of a perforated bowel.
Video cameras at the hospital captured Rodriguez on the floor and even showed a janitor cleaning around her. The county will have to correct the problems identified in her care as well.
County Health Services Director Dr. Bruce Chernof acknowledged in a written statement that the findings delivered Thursday were "serious and troubling."
"We are disappointed with these findings given the extensive efforts to reform the hospital," Chernof said in the statement, "but the issues identified are correctable" by the Medicare agency's deadline.
"The scope of change at the hospital is unprecedented and difficult because there is no simple road map, but our focus remains on having King-Harbor meet national standards."
In a confidential memo to the county Board of Supervisors, Chernof said that federal officials had found that King-Harbor had repeatedly violated the Emergency Medical Treatment and Active Labor Act, which requires hospitals to adequately screen and stabilize emergency room patients. Inspectors also found that physician assistants were operating without adequate oversight by doctors.
He did not provide examples, but said a letter outlining the problems would be sent to the hospital Monday or Tuesday. Chernof also said the Board of Supervisors would discuss the matter in closed session next week.
Chernof did not return a telephone call seeking further comment.
County Supervisor Yvonne B. Burke, whose district includes the hospital, said the latest events have been "tremendously embarrassing to me."