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Key promises unfulfilled at King-Harbor

County health officials haven't removed most of the hospital's staff or fully transferred control to Harbor-UCLA.

June 19, 2007|Rich Connell, Robert J. Lopez and Susannah Rosenblatt | Times Staff Writers

The reform effort at Martin Luther King Jr.-Harbor Hospital appears to be faltering, as the county backs off key promises to purge most of the staff and effectively hand control of the hospital to highly respected Harbor-UCLA Medical Center.

The two pledges were cornerstones of a plan last year that persuaded regulators to hold off on pulling all federal funding, which would have effectively shut down the troubled Willowbrook hospital.

With little explanation, county health officials disclosed during a Board of Supervisors budget meeting Monday that they had reassigned only about one-third of the 1,200 employees they initially projected would be shifted to other institutions.

Officials have also suggested to the board in recent days that Harbor's leaders have had a less significant role in reshaping the hospital formerly known as King/Drew than supervisors previously envisioned.

The revelations come as King-Harbor is under scrutiny once again for allegedly mishandling the care of patients.

A woman last month died after writhing untreated on the floor of the emergency room lobby for 45 minutes.

In February, a brain tumor patient languished in the ER for four days before his family drove him to Harbor-UCLA for emergency surgery.

Federal inspectors concluded, based partly on the February case, that King-Harbor's emergency room patients are in "immediate jeopardy."

That finding elevates concerns about the hospital's ability to pass a crucial inspection next month that could determine its fate.

The disclosures about reform efforts seemed to take the county board by surprise.

"We were all assured that Harbor would be supervising here, and they are not anywhere in the process," said Supervisor Gloria Molina at a meeting last Tuesday. "Is that [collaboration] just a facade or is that real? It looks like a facade to me."

The tension between supervisors and health department officials could come to a head today. The board has ordered the top brass involved in the King-Harbor rescue effort -- including administrators at Harbor-UCLA -- to appear in person to answer detailed questions.

Expectations of a turnaround at King-Harbor rose in October when the county successfully pitched a last-chance salvage plan to the federal government.

That plan called for the hospital, which serves some of the county's neediest residents, to radically downsize and refocus on community medical care, including emergency room and outpatient services. Two pillars of the plan were to weed out underperforming staff members and, as a health department news release put it, integrate the two hospitals "under one medical management and administrative leadership team at Harbor-UCLA."

In a symbolic break with King/Drew's past, the hospital was repackaged as King-Harbor.

Chernof wrote to the U.S. Centers for Medicare and Medicaid Services in October that "every employee and every physician" would be reassigned.

"These sweeping changes ... provide the specific evidence that the safety and quality of care required by statute and regulations will assuredly be met," he wrote.

But the changes did not materialize as promised, recent testimony and reports show. Most employees remained in place.

About two-thirds of the 388 registered nurses on King-Harbor's staff shortly after the reform plan was adopted -- including at least two with previous suspensions -- remained on staff as of the end of last month, according to records reviewed by The Times.

On Monday, Supervisor Zev Yaroslavsky questioned why those suspected of being problem employees remained at King-Harbor.

"We're in the situation we're in because we didn't go as far as we knew we needed to go in purging the organization of its underperforming personnel," he said.

Chernof said the estimate of the staff changes needed was not a "terribly informed number, because nobody's ever done anything like this ever before."

Other problems emerged during efforts to retrain King-Harbor staff. The most promising employees were supposed to go to Harbor-UCLA for instruction. But that became unmanageable, health officials said, because King-Harbor needed these staffers to continue running the beleaguered hospital. So the training had to take place at King-Harbor.

Meanwhile, deficiencies persist among King-Harbor nurses. New data obtained by The Times show that in April, 60% of 285 registered and licensed vocational nurses failed one or more parts of basic clinical competency assessments. More than one in 10 failed three or more sections of the assessment.

Nearly half of King-Harbor's specialized nurses -- those who work in intensive care units and post-anesthesia care, for instance -- failed at least one section of a separate round of competency assessments last month. The same was true of more than 60% of operating room RNs and surgical technicians.

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