Looking Back- The King-Drew Medical Center Closure

I remembered writing this for one of my classes. This was my take on the chaotic turn of events for King/Drew Medical center. It has been a while since this has happened, but it's worth pondering. Now, what is the aftermath? What did our health authority do about this?

Feel free to refute, verbally abuse, condemn, or commend me.


To Close King-Harbor or Not

After a series of management mishandlings, clinical practice errors, unmet minimum care standards, and a lot of unhappy people, Martin Luther King Jr. - Harbor Hospital had to be shut down for an indefinite period of time.
The Los Angeles Times editorial article on August 15, 2007, a few days before the finalization of the closure, commented on and justified the then-impending closure of the said institution. It seemed that the Los Angeles County Board of Supervisors has failed to use its wealth of resources and extreme capability to save King-Harbor Hospital and the needing communities of South Los Angeles. The people in charge of the ill-fated center demonstrated poor competence in running hospital operations. Clinicians and practitioners have been practicing below good standards of care. This unfortunate chain of incompetence leads down to the patients and the community- the ones who will end up suffering most of the blow.
The persons who possess the power to close the hospital were not even able to exercise this authority totally when it seemed fit. “They instead play games with the very definition of "to close." Half the staff of 1,600 remains on-site, on the job, at outpatient clinics and an urgent care center. Capacity to perform surgery is being expanded”(“Close King-Harbor”). In essence, the said medical center still operates even though it is doing a lot less than it used to- and probably committing the same mistakes on a smaller scale. The county supervisors are now looking for a private purchaser with strong hopes of coming back as a full medical center in less than two years. Technically, King-Harbor is not really closed at all.
Dealing with the internals of the institution, particularly concerning patient care, there have been a lot of accounts pertaining to poor clinical care, medical malpractice, and staff incompetence. “Just walking into the building, inspectors saw that patients were in immediate jeopardy. Further probing showed that staff failed to track records, properly mix medicine and sterilize equipment”.(“Close King-Harbor”). There was also one incident as specified in The Los Angeles Times that during one of the hospital’s major inspections, a patient who at that time were writhing on the floor for almost an hour was just ignored by the nurse. There also have been numerous accounts of misdiagnosis and maltreatment of patients that have occurred in King-Harbor’s “treatment” phase.
On management issues, the said article presented its concerns on the hospital executives being more focused on corporate issues rather than the much-needed medical care the institution have originally stood for. “It is painful to say it, but the truth is that preserving an African American-run institution took precedence over providing competent care. The interests of staff came before the needs of patients.”(“Close King-Harbor”).
The points seem to be convincing and rhetorically powerful. However, in reading the article, one may find that some, if not most, of the arguments point to very particular instances that are existent in other successful medical centers- which doesn’t really back up the argument for justifying the closure of the institution. Concerning the patient lying on the floor for over an hour and the nurse ignoring him/her- did the inspectors know about triage (where patients are seen in order of the nature and urgency of the disease/injury)? Probably the patient was just having abdominal pains without other severe symptoms accompanying it- digestive problems fall on the lower priority on the triage. On medical malpractice and errors, King-Harbor is a teaching hospital. Errors like these are a commonplace in the medical community, and these clinicians are not robotically perfect. There are disciplinary actions for these incidences that are hidden behind curtains to the commoner, such as Surgical Service Reports, Morbidity and Mortality Conferences (M and Ms), and attending physicians putting the erring clinician in the hotspot, constantly testing its knowledge and skills, known in the medical community as “pimping”.
Concerning management issues, the point that “…preserving an African American-run institution took precedence over providing competent care” is really ambiguous. Are they implying that the corporate ladder took precedence over patients or are they implying something else with regard to a particular ethnic background?
Thomas Scully, then-administrator of federal Medicare and Medicaid programs and presently a Washington law firm senior counsel, contradictorily thought about the issue. In the June 15, 2007 issue of the Los Angeles Times, he claimed that closing the medical center is not the answer.
The problems that King-Harbor Hospital was facing were no different than any other inner-city hospital. Economics, being one of the major problems, would be very difficult to run in a medical center serving mostly uninsured and Medi-Cal patients. “The LA system is almost totally funded by the federal government, and, with that support, L.A. has to deal with the hand it has been dealt — and make the most of it.”(Scully) Given the ample financial capability of the government, successful operation of the hospital is really possible. It just seems that the said medical center does not receive the amount of funding it deserves. Scully also pointed out that King-Harbor Hospital should try to pattern itself to various city hospitals in similar-situation places. “There are many different big-city models to look at… Jackson Memorial in Miami and Grady in Atlanta are huge public hospitals in very poor neighborhoods that do a pretty good job of saving lives, and I would feel confident there as a patient. Philadelphia has no public hospitals yet serves at least as tough a population through private hospitals that get public support and provide great care.”(Scully) King Harbor has a lot of “mentor” hospitals in this case then, and it seems fit to have its administration imitate or at least seek help from these thriving systems. The mere fact that if these big urban medical centers- with situations similar to our dying local hospital- can handle the work, then so could King-Harbor too.
Keeping King-Harbor is extremely important since it is, unfortunately, the only best health care access for the urban underserved in the area. Although Saint Francis Medical Center, a level II trauma center, in just in nearby Lynwood, King-Harbor is a public hospital and it thereby caters more to the uninsured and the poor. The medical center is also significant in medical and allied health population, housing the prestigious Drew-UCLA medical program and the Charles Drew University training programs for allied health. Shutting down the hospital means shutting down a great community resource.
“The best thing for patients is to stop looking for blame, apply the best ER Band-Aid available to King-Harbor and get back to fixing the whole L.A. public hospital system.”(Scully) By saying this, Scully made recommendations-channel more of Los Angeles County’s financial resources to the medical center, downsize the Hospital more hence making services more controllable and efficient, and stop pointing fingers.
Analyzing Scully’s perspective on the issue brought an optimistic light to the matter. As empowering and hopeful his arguments seemed, his points, in general, are vague and somewhat introduces red herrings. How could King-Harbor possibly model itself to other big urban underserved hospitals when those mentioned are operated by different leaders with different objectives, located in different environments with possibly an entirely different underserved population, and enjoying financial and community resources different from what we have in Los Angeles? How does him bringing up what he did to Greater Southeast Hospital in Washington help King-Harbor if that very idea has not been tried out in this problem? What did he mean when he said “Given the situation, the best the federal government can do is to poke, prod and push the hospital — and the county — to improve.”(Scully)? His recommendations were not really specific- they would of course apply to similar hospitals with similar conditions. None would cater to the particularities of this chaotic situation that is King-Harbor Hospital.


Understanding and analyzing both sides of the issue helped me shaped my prior convictions into an educated and well thought-of stand. Empathically reading and actively doubting the articles gave way for a deeper analysis of the issue at hand, especially with the intricate particularities in each perspective.
Taking a stand on the matter, as blunt as it may seem, considering the harsh and chaotic situation King-Harbor Hospital is in, it would be reasonable to close it. Completely cease operations. Period.
Defibrillate the chaotic cardiac rhythm in the Los Angeles County Public Health system that is the Martin Luther King Jr.-Harbor Hospital. Why? The institution has humiliatingly failed inspections and supposed “makeovers” over and over again. This just implies that the hospital just did not improve and implementations for renovation were simply ineffective. It became a total waste of resources. The same people trying to make desperate changes are the same ones that have been part of the demise. Same ideas will be surmised, and they are the same nonproductive ones. There has to be some new, better light in the administrative heads hence shedding fresh, effective, and more responsible planning and implementation. Current operations are causing more harm than help to the community. Much needed services are being provided ineffectively and inefficiently. Medical education and patient care in the institution is becoming counterproductive, jeopardizing quality physician and health care professionals’ education and experience and straining community access to public health services.
Closing the hospital does not necessarily mean curtailing the much-needed health access for the local urban underserved population. There are a lot of things to do for this community in dire need of quality health care, and there are myriad ways to deal with the transition period between the closure or King-Harbor and opening a new institution.
A good recommendation would be to start fresh with a new culture, a total rebirth. “It would be ideal to create an independent committee outside the bureaucracy to assess what really went wrong and to oversee the construction of a new policy to minimize medical errors, improve patient care and to restructure the operational system. Hence, a better medical institution” quoting Omar Hernandez, a UC Irvine pre-MD/ pre-MPH student. It would be a really wise move to learn from successful and experienced models and integrate them for a while in the system, just like what the county is planning to do- find a private partner institution and take the new King-Harbor under their wing. Or if it would be feasible, have administrators from other hospitals get together and re-form a new medical institution. Another part of the solution, concerning patient care and clinical standards, would be to hire and get more faculty appointments from accessible top-tier medical schools like The David Geffen School of Medicine at UCLA and The Keck School of Medicine of USC to advance and to further residency training programs as well as push patient care to its optimum.
As for the moment, an urgent care center is just enough to temporarily provide basic family medicine and public health services. The county should also develop a better transport system to channel needing patients to nearby hospitals for more specialized care, and it seems also necessary to increase emergency medical system access to the area- more ambulances, more paramedics, and more stations- in order to provide for prehospital emergency care in a trauma-abundant community. Probably another good community resource would be active student-run clinics from Charles R. Drew University of Medicine and Science, UCLA, USC staffed with enthusiastic soon-to-be doctors and allied health professionals who would be more than happy to provide care for free. It would also be good to have more frequent and more comprehensive health fairs.
Simply put, close King-Harbor. Build one that would be better able to address the needs of the urban underserved community.