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How King-Harbor has stayed alive

Defended by its community, the hospital hangs on to certification despite repeated lapses.

June 12, 2007|Charles Ornstein | Times Staff Writer

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.

"Plans to address the findings are underway and many changes have already been put in place," hospital Chief Executive Antionette Smith Epps wrote in a staff memo Thursday night. "This challenge must be met with total commitment to quality patient care."

To be sure, it is rare for the federal government to withdraw funding from hospitals; it does so fewer than five times a year. The goal in most cases is to bring them into compliance. Hospitals usually either improve or voluntarily shut down.

But records show that officials have acted against other troubled hospitals much faster, sometimes after a small number of serious lapses.

In May 2004, federal officials withdrew funding from Angels Hospital, a small facility in Rancho Cucamonga, after four patients died from allegedly inadequate medical care. Inspectors accused the staff of calling 911 on several occasions because no doctors were present, relying on paramedics to treat patients in life-threatening situations. The state pulled the hospital's license, leading to its closure.

In 2003 and again in 2005, the Medicare agency revoked funding from Vermont State Hospital, a psychiatric institution in Waterbury, Vt. The first time was after two patients committed suicide within weeks. The second time came after back-to-back escapes by patients.

But Leslie V. Norwalk, acting administrator of the U.S. Centers for Medicare and Medicaid Services, said her agency has granted hospitals more time in other instances when the agency sensed a community need and a commitment to improve.

She cited Greater Southeast Community Hospital in Washington, D.C., which managed to improve after troubles in 2002 and 2003 but is now at risk of closing because of poor performance and financial reasons. That hospital serves a poor, primarily minority community, just like King-Harbor.

Norwalk said significant changes have been made at King-Harbor in response to federal pressure -- including its recent downsizing from more than 200 beds to 42.

She also noted that the hospital had voluntarily agreed in March to stop billing Medicare and Medi-Cal until it could prove that it met basic standards. That way, the hospital would remain federally certified -- key to keeping staff and maintaining a dialogue with regulators.

"This is something that we take very seriously," Norwalk said. "Every single time that there has been a deadline ... we have moved it [the pressure] up a notch."

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