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King medical chief is ousted; nursing woes are disclosed

June 13, 2007|Susannah Rosenblatt and Rich Connell | Times Staff Writers

In new signs of turmoil at Martin Luther King Jr.-Harbor Hospital, officials said Tuesday the chief medical officer had been replaced and more than 40% of licensed vocational nurses and nursing assistants recently failed initial skills tests.

The disclosures came as the Los Angeles County Board of Supervisors, grappling with federal findings that the hospital continues to endanger patients, bluntly discussed preparations for possible closure of the public facility.

After grilling health department officials about recent patient care breakdowns, including the case of a woman who writhed in pain on a lobby floor for 45 minutes and later died, the board ordered health officials to return in two weeks with contingency plans to close the hospital if it can't pass regulatory muster.

Supervisor Gloria Molina, who pushed for the shutdown plan to be prepared, was openly skeptical about assurances that much of the hospital medical staff has been retrained under a sweeping reform package adopted by the board last fall.

"We are playing Russian roulette with everybody that is right now waiting in that emergency room," Molina said.

Molina and Supervisor Zev Yaroslavsky acknowledged that in previous weeks they had discussed contingency plans for the hospital in closed session, even though such discussions were not, as is required by law, listed on agendas for those meetings.

Federal inspectors last week said emergency room patients were in "immediate jeopardy" of harm or death. King-Harbor was given 23 days to shape up or risk losing federal funding.

As supervisors contemplated a worst-case scenario, Dr. Bruce Chernof, head of the county health department, said the hospital could weather the current crisis and earn the approvals needed to keep its doors open.

"In spite of what you have heard and what has been said, there have been gains in the quality of care," Chernof told board members. "I am more confident today than I was six months ago about the care at MLK-Harbor."

Turning around King-Harbor, which serves some of the county's poorest neighborhoods and has been an icon for many African Americans in Watts and Willowbrook, is among the toughest challenges faced by health officials anywhere in the country, Chernof said in a report to the board. The facility has served "thousands of patients well and a few very poorly" in recent months, he wrote, despite daunting challenges.

Those challenges were underscored by news that the man brought in three years ago to help overhaul medical operations at King-Harbor -- Dr. Roger Peeks -- was placed on "ordered absence" Monday. Health officials declined to elaborate on the action, saying it was a confidential personnel matter.

They named Dr. Robert Splawn -- chief medical officer for the health department -- as interim chief medical officer at King-Harbor.

In his report to the board, Chernof cited problems with the case of Juan Ponce, a brain tumor patient who lingered in the hospital's emergency room for four days in late February and early March, suffering headaches and vomiting spells.

Family members finally checked Ponce out against the suggestions of King-Harbor staff and took him to Harbor-UCLA Medical Center, where he had surgery within hours. That case, first disclosed by LA Weekly, was one of the chief reasons for the recent federal sanctions.

Chernof said the case was not flagged as an unusual incident until a reporter inquired about Ponce's treatment. King-Harbor's medical director then reviewed the case but did not "initially believe there were problems with care," Chernof said. "We now know, after very complete review, that this case had numerous problems, that the transfer was not timely, and that the initial review at MLK-Harbor was inadequate."

Peeks did not return calls seeking comment.

Chernof also disclosed that officials have faced continuing challenges in ensuring that nurses have the proper skills.

Forty-seven percent of 285 licensed vocational nurses failed to pass detailed skills tests on the first try, he reported. After several attempts, most passed, he wrote. Those who did not pass "were removed from patient assignment." More than 40% of certified nurse assistants did not pass their first skills test, though "virtually all" passed after additional training, he said.

Competency tests of King-Harbor's registered nurses, who are more highly trained and perform more advanced medical procedures, are continuing, Chernof wrote.

Those nurses will be evaluated by the end of June, weeks before a scheduled comprehensive federal inspection of King-Harbor that is likely to determine the hospital's fate.

The registered nurses were not tested earlier because the roster and staffing levels were still being finalized, Chernof said. "We're moving as quickly as possible," he said of the nurse evaluation process.

Nursing competency has been a persistent issue at the hospital, with county auditors noting in April 2006 that skills tests had not been completed as planned by a county contractor. In 2005, another contractor had similar difficulties fulfilling a contract requirement to certify the skills of nurses.

Among the immediate corrective actions ordered by federal authorities in a letter to King-Harbor on Tuesday were ensuring that all staff members have passed competency tests showing that they can properly screen patients arriving in the emergency room and that they are fully qualified to provide emergency care.

"We are very concerned by MLK-Harbor's apparent incapacity ... to maintain compliance with" federal standards, said the notice from the federal Centers for Medicare and Medicaid Services.


Times staff writer Charles Ornstein and researcher Maloy Moore contributed to this report.

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