Martin Luther King Jr.-Harbor Hospital

Martin Luther King Jr.-Harbor Hospital (MLK-Harbor), formerly known as Martin Luther King Jr./Drew Medical Center (King/Drew), is a public hospital in Willowbrook, an unincorporated section of Los Angeles County, California, north of the city of Compton and south of the Watts neighborhood of Los Angeles.

MLK-Harbor is operated by the Los Angeles County Department of Health Services (DHS) and has 48 beds. In recent years, widely publicized problems related to incompetence and mismanagement caused the hospital to undergo a radical overhaul: bringing the number of beds down to 42 from 233. Since 2004, 260 hospital staffers, including 41 doctors, had been fired or had resigned as a result of disciplinary proceedings. It currently has 1,400 employees. To alleviate the impact on the community of the large loss of capacity, The Los Angeles County Medical Alert Center (MAC) contracts ambulances take approximately 250 patients per month to other local hospitals.

At the turn of the 21st century and before its crisis, MLK-Harbor (then MLK/Drew) had 537 beds, was the teaching hospital of the adjacent Charles R. Drew University of Medicine and Science, and spread over a 38.5-acre site that includes a dormitory for medical residents; with 2,238 full-time employees, and in 2004 treated 11,000 inpatients and 167,000 outpatients. Located near areas of high crime, the hospital has a very active trauma unit. In 2003, it handled 2,150 gunshot wounds and other life-threatening injuries.

Founding and early history
MLK-Harbor's founding was spurred by the 1965 Watts Riots. In the aftermath of the unrest, Governor Pat Brown appointed a Commission to identify contributing factors to the unrest. This resulted in the December 1965 McCone Report. One major finding of the Report was the lack of a health care access near the low income neighborhoods of South Central Los Angeles. At the time, the closest major public trauma center was Los Angeles County-USC Medical Center, located over ten miles away --a problem heightened by the amount of gang violence in the area.

In 1966, DHS established a task force to develop a full-service community and teaching hospital operated by the County in conjunction with the USC and UCLA Medical Schools as well as the newly formed Charles R. Drew Postgraduate Medical School, a private, non-profit medical school formed to train doctors to work in areas of urban poverty.

Ground was broken on the hospital in April 1968; originally called Los Angeles County Southeast General Hospital, it was soon renamed Martin Luther King Jr. General Hospital. After a dedication in February, the school opened on March 27 1972 as a full-service medical center. The facility changed names to Martin Luther King Jr./Drew Medical Center when it became the teaching hospital of the adjacent Charles R. Drew University of Medicine and Science. In 1981 the hospital expanded into psychiatric care by opening the Augustus F. Hawkins Mental Health Center, and it expanded its trauma center in 1998. By the 1980s, the hospital became part of the Drew/UCLA Undergraduate Medical Education Program, which trained physicians through a partnership of UCLA and Drew medical schools. The hospital became a source of pride and jobs in the community.

The Fall of King/Drew
King/Drew entered the 21st century with an array of problems related to incompetence and mismanagement. Due to a perceived lack of quality at the hospital, it had earned the nickname of "Killer King". Starting with a series of reports in the Los Angeles Times, some of which earned a Pulitzer Prize, the hospital has gone through increasingly severe scrutiny.

Troubles come to light
On August 22 2003, the Los Angeles Times reported that two women connected to cardiac monitors died after their deteriorating vital signs went undetected. In December 2003, DHS closed the cardiac monitoring ward of King/Drew after a third patient died under questionable circumstances. A consulting group was hired to help fix issues with the nursing staff, with DHS spending nearly $1 million.

In a January 13 2004 report, the federal Centers for Medicare & Medicaid Services (CMS) determined that King/Drew was out of compliance with minimum requirements for receiving federal funding, citing the work of government inspectors who identified five patients who died at King/Drew after what were determined to have been grave errors by staff members. By March, CMS declared King/Drew patients were in "immediate jeopardy" of harm or death because of medication errors at the hospital, citing numerous mistakes and threatening to pull federal government funding from the public hospital. An example in this report cited a meningitis patient receiving a potent anti-cancer drug for four days. In June CMS again stated that patients were in jeopardy, citing the use of Taser stun guns to subdue psychiatric patients. Yet again, it threatened to pull federal funding but backed away; federal funding makes up over half of King/Drew's $400 million operating budget.

Closure of the trauma center
On September 13 2004, DHS recommended the closure of King/Drew's busy trauma unit, stating that the hospital needs to put its full energy into fixing problems in other areas. Despite intense community opposition, the unit closed in early 2005. A few days later, the Joint Commission on Accreditation of Healthcare Organizations (now Joint Commission) threatened to pull its seal of approval, citing the medical center for failing to correct severe lapses in patient care and jeopardizing over $14 million in physician training funds. Despite being a rare move (99% of hospitals pass Joint Commission audits), King/Drew's seal of approval was revoked in February 2005. Soon afterwards, in 2004 the Los Angeles Times revealed that the American College of Surgeons had revoked its approval of the quality of King/Drew's trauma unit in 1999 and 2003 because it failed to properly investigate questionable patient deaths and that doctors routinely skipped meetings held to discuss treatment problems. Also in September, the Los Angeles County Board of Supervisors agreed with CMS to hire a new consulting firm to take over operations at the hospital: hiring Navigant Consulting takes over, and ultimately paying the firm more than $17 million for 18 months of work.

By November 2004, massive neighborhood resistance to the proposed closures (particularly the trauma center) had formed, led by U.S. Representative Maxine Waters and joined by the Rev. Jesse Jackson, Los Angeles Mayor James K. Hahn, actress Angela Bassett and children of the Rev. Dr. Martin Luther King Jr. Despite the protests, negative media editorials and the near-unanimous opposition of city political leaders, the five-member Board of Supervisors elected to move forward with the closure by a vote of 4 to 0 with one abstention. A temporary restraining order was filed by a group of doctors and residents, but was denied and the closure was completed in early 2005. Patients that had normally gone to the King/Drew trauma center were dispersed among three other hospitals, both public and private (with county subsidy).

The move gained national attention after the Los Angeles Times ran a Pulitzer Prize-winning five-part series reporting on "The Troubles at King/Drew". The series found that the problems at the hospital were far deeper than the public already knew and faulted the Board of Supervisors for shying away from making needed changes, often because of racial politics. Among the other findings was that King/Drew spent more per patient than any of the three other general hospitals run by Los Angeles County, the opposite of what many hospital supporters had assumed.

Meanwhile, in December 2004, CMS declared King/Drew patients are in "immediate jeopardy" for a third time; this time citing the staff's heavy reliance on county police to shoot aggressive mental patients with incapacitating jolts of electricity. Federal funds are again threatened, but, like the previous times, action is not taken.

Problems for King/Drew were exacerbated in March 2005, when three patients died due to medical care lapses and mistakes over a period of four days. The Board of Supervisors considered severing the hospital's relationship with Charles R. Drew University of Medicine and Science and partnering with another medical school such as UCLA, USC or Loma Linda University. In April, reports of a seventh death attributed to lapses in care by the hospital was reported by the Los Angeles Times; this time, nurses and staff virtually ignored the audio and visual cues of vital-sign monitors over a period of hours.

"Make-or-break" inspection
After the three previous warnings holding King/Drew out of compliance with federal guidelines since January 2004, CMS and federal authorities held an unannounced, last chance inspection of the hospital on July 31 and completed on August 10 2006.

On September 22 2006, CMS informed King/Drew that the hospital still did not meet minimum patient-care standards, failing nine of the government's 23 conditions for federal funding, and thus had failed the final, "make-or-break" inspection. Federal regulators identified problems in nursing, pharmacy, infection control, surgical services, rehabilitation services, quality control, patients' rights and the hospital's governing body and physical plant. Inspectors found more problems during the final inspection than they had at any time in the previous three years.

The final report stated, and underlined, that "Termination of the Medicare provider agreement is final." This finding jeopardized $200 million a year in federal funding, forcing Los Angeles County to close the public hospital, give it to someone else to run or turn it into a clinic.

Radical restructuring
DHS elected to move forward with a radical restructuring plan that eliminated the hospital's specialty services, severed its relationship with the Drew medical school and proposed to place it under the management of Harbor-UCLA Medical Center (Harbor-UCLA). The plan downsized and refocused the hospital on community medical care, including emergency room and outpatient services; the two central pillars of the plan were to identify and remove under-performing staff and integrate the two hospitals "under one medical management and administrative leadership team at Harbor-UCLA." King/Drew became King-Harbor to reflect the change.

All employees of the hospital were interviewed with half permitted to stay and the rest transferred to other hospitals, approximately 1,400 employees remain. As a result of these measures, Medicare agreed to continue funding the hospital until March 31, 2007. After further negotiations, federal inspectors agreed to delay inspection until August 2007 otherwise end federal funding on November 30, 2007. As a part of the March deal with the federal government, Los Angeles County agreed not to bill Medicare for hospital services until August 2007, giving it time to fix problems at the hospital. If federal funding ends, among other problems, MLK-Harbor would permanently lose 250 medical resident slots, 15% of the 1,700 in Los Angeles County.

On March 6, 2007, officials from Charles R. Drew University of Medicine and Science announced that they will sue Los Angeles County for $125 million for breach of contract, claiming that the restructuring of the hospital terminated support to 248 medical residents and gutted the adjacent university. The two entities had collaborated since 1972. In response, Los Angeles County Board Supervisor Mike Antonovich stated "Drew University will fail in court as they failed as a medical school."

Problems surface again
Despite initially upbeat official reports from hospital officials, King-Harbor found itself under public criticism once again after different stories ran in both the Los Angeles Times and LA Weekly in late May 2007 citing serious lapses in care, one fatal, at the renamed hospital. The case of patient Edith Isabel Rodriguez, who bled to death on the emergency room floor after being ignored for 45 minutes, in particular became a cause célèbre about the failures and bureaucratic indifference of both King-Harbor as well as political and health leaders in the Los Angeles area; creating or reinforcing fears that the health care system will not take care of people in a time of dire need. In response to public outcry, the chairman of the U.S. Senate Finance Committee, Sen. Max Baucus (D-Mont.) asked federal regulators to address how they will protect patients at King-Harbor in light of "horrific" and "appalling" lapses in patient care.

The reports spurred a multi-day inspection by state and federal officials, and on June 7, 2007, federal health officials declared that King-Harbor had put emergency room patients in "immediate jeopardy" of harm or death, that it remained in violation of the Emergency Medical Treatment and Active Labor Act, and gave it 23 days to fix the problems or lose federal funding once and for all. During the inspection, CMS found that 17 patients, among 60 whose cases were reviewed, received substandard care at the hospital. If the problems are resolved in that timeline, the hospital could still lose its federal certification because it had failed to meet the terms of a March agreement with the U.S. Centers for Medicare and Medicaid Services. Despite multiple threats from the government, experts in hospital accreditation cite the federal government's relatively tempered response due to the hospital's unique history and special standing in the community, as well as its support from African American politicians.

On June 12, 2007, the Los Angeles Times reported that King-Harbor had replaced its chief medical officer, Dr. Roger Peeks, who had been brought in to fix problems three years earlier. During a June 18, 2007 meeting with LA County Board of Supervisors, county health officials disclosed that they were still unable to meet the cornerstone pledges they had made to CMS: only about one-third of the 1,200 employees they initially projected would be shifted to other institutions had actually been reassigned, and significant control had not been effectively handed off to Harbor-UCLA. In April, 60% of 285 registered and licensed vocational nurses failed one or more parts of basic clinical competency assessments; while more than 10% failed three or more sections of the assessment. The staff of Harbor-UCLA was surprised by the by the amount of training King-Harbor employees needed.

On June 21, 2007, the state California Department of Health Services (CDHS) moved to revoke the license of King-Harbor. The process, supported by state politicians including Gov. Schwarzenegger, could take six months to a year and would force the hospital's closure. CDHS could rescind the action if the hospital was able to show that it met state and federal standards. There remain serious concerns over how King-Harbor's 47,000 annual emergency room visits might be spread across the system with minimum disruption if the hospital were to close. In response to the state's decision, Los Angeles County Supervisors considered having the county close the hospital ahead of the state; hoping to gain the ability to plan and implement an orderly plan to divert patients, and by suspending King-Harbor instead of allowing it to lose its state license it would be easier to reopen later. The County ultimately decided to not move for County closure. The hospital received a brief reprieve when a June 25, 2007 inspection showed critical problems with its emergency room identified earlier in the month had been corrected, preserving federal certification and funding for the hospital until August 2007, when it must pass a broader federal review.

The weeklong federal inspection began on July 23, 2007. The next day, inspectors from CMS once again cited King-Harbor for placing patients in "immediate jeopardy" of harm, hours after a psychiatric patient cut herself with a scalpel in an emergency room bathroom.

Federal funding termination forces closure
On August 10, 2007, after the hospital failed a comprehensive review by the U.S. Centers for Medicare and Medicaid Services, federal officials decided to revoke $200 million in funding. Inspectors concluded that there was no functioning quality improvement plan at the hospital. Los Angeles County health director Dr. Bruce Chernof moved quickly to notify the county Board of Supervisors of his decision to begin shutting down the facility. The emergency room was closed by 7 p.m. that day and ambulances were diverted to other area hospitals, the rest of the hospital was closed by August 27, 2007. Some of King-Harbor's 1&thinsp;600 employees would likely be reassigned to jobs at other county facilities.

On August 13, at a specially convened board meeting, LA County supervisors voted unanimously to shut inpatient services and promised to pay up to $16.3 million to nearby private hospitals and doctors bracing for a deluge of patients from the closed facility. They also released the 124-page report by federal inspectors that detailed dozens of errors and failures by the hospital during their final make-or-break review; the citations included improperly sterilized medical equipment, nurses who could not rapidly find medication, a nurse who did not know how to mix medication in an emergency, and a patient who complained of severe chest pain but was not given pain medication for 4.5 hours.

Affiliated high school
King Drew Magnet High School of Medicine and Science, near the school, is a Los Angeles Unified School District magnet school affiliated with the hospital.

Notes and references

 * Charles Ornstein et al, King/Drew Fallout Is Keenly Felt, The Los Angeles Times, September 26, 2006, Accessed Sept. 26, 2006.
 * Tracy Weber and Deborah Schoch, Hospital Backers Concede Choices Tough, The Los Angeles Times, September 24, 2006, Accessed Sept. 26, 2006.
 * Charles Ornstein and Tracy Weber, King/Drew Fails Final U.S. Test, The Los Angeles Times, September 23, 2006, Accessed Sept. 26, 2006.
 * Kevin Roderick, Killer King on KCRW, LA Observed, August 17, 2005, Accessed Sept. 26, 2006.
 * Tracy Weber and Charles Ornstein, Another Fatal Failure at King/Drew, The Los Angeles Times, April 12, 2005, Accessed Sept. 26, 2006.
 * Charles Ornstein and Tracy Weber, 3 King/Drew Deaths Blamed on Lapses, The Los Angeles Times, April 6, 2005, Accessed Sept. 26, 2006.
 * Tracy Weber et al, The Troubles at King/Drew (5 part series), The Los Angeles Times, December 2004, Accessed Sept. 26, 2006.
 * Jia-Rui Chong, Judge Denies Bid to Halt Trauma Unit's Closure, The Los Angeles Times, December 3, 2004, Accessed Sept. 26, 2006.
 * Kevin Roderick, Blame for Killer King, LA Observed, December 9, 2004, Accessed Sept. 26, 2006.
 * Mitchell Landsberg and Jack Leonard, King/Drew's Trauma Unit Ordered Shut, The Los Angeles Times, November 24, 2004, Accessed Sept. 26, 2006.
 * Jack Leonard, Closure of King/Drew Unit Likely, The Los Angeles Times, November 22, 2004, Accessed Sept. 26, 2006.
 * Jia-Rui Chong et al, Waters at Center Stage in King/Drew Drama, The Los Angeles Times, November 17, 2004, Accessed Sept. 26, 2006.
 * Mitchell Landsberg et al, Reaction to King/Drew Plan Loud and Clear, The Los Angeles Times, November 16, 2004, Accessed Sept. 26, 2006.
 * Charles Ornstein et al, A Reeling King/Drew Receives Huge Blow, The Los Angeles Times, September 16, 2004, Accessed Sept. 26, 2006.
 * Tracy Weber and Charles Ornstein, King/Drew to Shut Down Trauma Unit, The Los Angeles Times, September 13, 2004, Accessed Sept. 26, 2006.
 * Charles Ornstein and Tracy Weber, Report Assails Hospital Lapses, The Los Angeles Times, January 30, 2004, Accessed Sept. 26, 2006.