US: Local and federal agencies threaten to shut down Los Angeles hospital

By Rafael Azul and Joe Kay
2 July 2007

County, state and federal agencies are threatening to shut down Martin Luther King Jr.-Harbor UCLA Hospital in South Central Los Angeles. The attempts to close King-Harbor have received new momentum after another highly publicized incident involving the death of a patient at the California hospital due to neglect and mistreatment.

On Friday, the California Department of Health Services released a report detailing the results of nine inspections between 2004 and 2007, which found repeated failures. The state agency is arguing that that the hospital’s license should be revoked because its nursing staff is allegedly incompetent and the lives of patients have been endangered. The hospital will be forced to close if the agency’s findings stand.

Actions at a federal and county level are taking place in parallel. On June 8, the federal Centers for Medicare and Medicaid Services, which oversees hospitals across the country, threatened to deny funds to the hospital. The hospital made changes, and received the approval of the government, however another review is due in July. On June 22 the County Board of Supervisors set up a contingency plan for the hospital’s closure, but it has voted to delay the closure until the completion of the new federal review.

Up until 2005, King-Harbor hospital, formerly known as King-Drew, was a full-service 233-bed teaching facility that included a trauma center, obstetrics and other departments. In response to earlier threats by the federal government to cut off funding, many of its services were shut down. It was formally merged with Harbor UCLA, though the two hospitals still operate on a largely independent basis. A severely scaled-down King-Harbor now has only 48 beds.

The moves by state agencies to cut off funding for the hospital follow revelations that in May, a woman, Esther Rodriguez, bled to death in the hospital’s emergency room in full sight of triage nurses and other medical personnel. Previous to Rodriguez’s death, a man with a brain tumor had waited for four days at the hospital’s emergency room before his family took him to another hospital for emergency surgery.

The incident led federal government inspectors to conclude that emergency room patients were in “immediate jeopardy” by conditions at King-Harbor. There have been a string of widely reported fatal mistakes and instances of neglect at King-Harbor, and a 2005 series in the Los Angeles Times was devoted to reporting problems at the hospital.

These incidents, however, are being used as pretexts to close a hospital that provides necessary services to thousands of poor residents in the area. King-Harbor’s closure would end emergency room services that last year treated 47,000 residents of Watts and South Central Los Angeles. The closure would shift the burden of emergency care to Saint Francis Medical Center (3 miles away), Harbor UCLA (10 miles), and County USC (12 miles away) and other overcrowded emergency rooms in South Los Angeles County.

When in 2005 King-Drew hospital was transformed, it lost its role as a major teaching hospital that attended to the health needs of 167,000 patients, many of whom were poor and uninsured. Valuable research in sickle cell anemia and internal medicine was dropped and patients no longer benefited from specially trained residents and technological advances. Obstetrics was significantly reduced and the trauma center was closed. The loss of the latter meant that more than 2,000 trauma victims each year, mostly victims of shootings and automobile accidents, must now seek help in facilities that are further away.

If King-Harbor is completely shut down, the loss of the emergency room will add to the time it takes ambulances to take patients to emergency rooms and put extra strain on an already taxed system. Last year, King-Harbor received 12,000 ambulance patients.

The emergency room at King-Harbor, as with many hospitals in lower-income areas, has become a place for routine care for the uninsured. The closure of King-Harbor’s ER will take that last option away from 36,000 people each year, for whom King-Harbor is the principal source of health care. Proportional to its size, King-Harbor already has twice the average number of patients with difficulty traveling, for whom going to another hospital will represent further hardship.

Federal, county and state authorities are indifferent to the human impact that the closure of King-Harbor is having, and will continue to have, on South Central Los Angeles. Rather than allocate the massive resources needed to improve medical care in this neighborhood, they are contemplating closing the hospital down.

The hospital, located in Watts, opened its doors as a full service hospital in 1972. It was part of a series or recommendations by the McCone Commission, appointed by the Governor of California to recommend responses to the 1965 Watts riot.

The decision to shut down the hospital now takes place in the context of broader moves to scale back health care spending in the California and throughout the US.

In May 2003, 800,000 uninsured residents of LA County lost access to neighborhood medial care when the Board of Supervisors shut down 16 community clinics and terminated a Public-Private partnership, a program under which LA County contracted health care with private clinics for the uninsured. As part of that process, 2,475 county health workers were laid off.

In June of that year, pink slips went out to 79 doctors, 152 nurses, and 210 administrative personnel at what was then King-Drew. At the time, a Los Angeles Times article indicated that the cuts had the hardest impact on adolescent, pediatric and neonatal care. This was a particularly devastating move for a community that has the highest rate of infant mortality in the California, a 15 percent teenage pregnancy rate, and a 38 percent incidence of low birth-weight newborns.

The story is the same for public health services throughout California, despite a dramatic 13 percent surge in the number of uninsured patients since 1995. Health care cuts have been most devastating in the high unemployment areas of Alameda, Santa Clara and Sonoma counties.

In the late nineties, King-Harbor began experiencing significant budgetary shortfalls from which it never recovered.

There is no doubt that mismanagement and neglect are serious at King-Harbor, and that they contributed to Rodriguez’s death and to those of other patients. The solution is not to shut down the hospital, but to devote the necessary resources to restore and improve King-Harbor, to reverse the shutdown of clinics and hospitals throughout the state, and to provide needed medical care for all Californians.

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