For 3 1/2 years, Martin Luther King Jr.-Harbor Hospital has survived on a steady diet of last chances and last-minute reprieves.
Since January 2004, the public hospital has flunked more than a dozen inspections, and four times has been cited for problems so severe that regulators deemed patients in "immediate jeopardy."
Not once, however, has the government followed through on its threat to pull certification and the vital federal funding that comes with it.
"Let's be honest," said Dr. Dennis S. O'Leary, president of The Joint Commission, a hospital accrediting group, "if this were a hospital different from King/Drew, this would have been over a long time ago."
He and other experts interviewed by The Times said the government would have moved much faster and more aggressively if King-Harbor, formerly known as King/Drew, didn't have a unique history and special standing in the community.
The hospital was one of the few gains from the 1965 Watts riots and still is one of the few places poor people in South Los Angeles can turn to for acute care. African American politicians, in particular, have embraced its salvation.
Experts in patient safety said King-Harbor's problems raise nearly as many questions about the conduct of the U.S. Centers for Medicare and Medicaid Services as about the hospital's leadership.
"At some point, the threat has to be real or it's not a threat," said Dr. Robert Wachter, chief of the medical service at UC San Francisco Medical Center. "What they've done is set a low bar and an expectation of opportunity on top of opportunity, third chances on top of fourth chances."
At this point, experts said, the federal inaction runs the risk of undermining regulators' power, at least when it comes to King-Harbor.
"If you keep drawing a line in the sand and you keep erasing the line in the sand, at some point the hospital and the community and the politicians think you don't mean it," O'Leary said.
The Joint Commission pulled its accreditation -- considered a seal of approval in the industry and a benchmark for many insurers -- from King/Drew in February 2005. The hospital, in Willowbrook, south of Watts, has not gotten its accreditation back.
Last week, the Medicare agency again notified King-Harbor that it was putting emergency room patients in immediate jeopardy of harm or death. King-Harbor now has 23 days to correct the problems or lose its funding, a threat even Los Angeles County officials said they expect, once again, to avoid.
