King/Drew Trauma Unit Faces Closure

The Los Angeles County Board of Supervisors on Monday unexpectedly moved to shut down the trauma unit at Martin Luther King Jr./Drew Medical Center, immediately drawing the ire of physicians, politicians and community activists.

The only public hospital serving a large swath of South Los Angeles, King/Drew treats more trauma patients than any other hospital in the region except County-USC Medical Center.

The proposed trauma closure, expected to take effect in about 90 days, amounts to a last-ditch scramble to save a foundering hospital that repeatedly has been cited by regulators for harming patients and in some cases contributing to their deaths.

Under pressure from federal health officials, the supervisors also agreed to hire outside managers to run the hospital -- replacing the team of county health leaders who have run it for nearly a year.

The reaction from community leaders was swift and mostly negative. Assemblyman Mervyn Dymally (D-Compton), who has led legislative hearings on the future of King/Drew, was outraged.

“I could see if they were going to close some other department, but not the trauma center. My God, this is a crisis,” he said.

But Assemblyman Mark Ridley-Thomas (D-Los Angeles), applauded the board’s latest actions, saying they were long overdue.

“It’s about time that the Board of Supervisors faced up to their responsibility, and has chosen to take appropriate action, albeit unpopular,” he said. “There’s no expert in the area of public healthcare worth his or her salt who would deny that Martin Luther King hospital was in need of radical intervention.”

The proposal to shut the hospital’s trauma unit is subject to final approval by the county supervisors after a public hearing, which has yet to be scheduled.

County health officials were quick to point out that King/Drew’s emergency room will still be open, just not the trauma unit. The ER treats about 45,000 patients a year for such ailments as chest pain, infections and pneumonia.

The trauma unit, dedicated to treating life-threatening injuries from such incidents as shootings and car accidents, served 2,150 patients last year.

At a news conference Monday, all five supervisors endorsed the changes -- an unusual showing of unanimity on an issue that has frequently divided the board.

In part, the board’s action was an effort to appease regulators, who have threatened to yank the hospital’s federal funding several times this year for failings that included giving a patient with meningitis a potentially toxic cancer drug and using stun guns on mental patients.

Supervisor Michael Antonovich deemed the county’s efforts to fix King/Drew over the last eight months “pathetic.”

“It took so many losses of life and inferior medical treatments to bring us to the stage where we are today,” he said at the supervisors’ news conference.

In some instances over the last year, county officials have conceded that they were unaware of problems at King/Drew until they were identified by The Times.

County officials said they would make every effort to persuade other hospitals to open trauma centers. But health experts said the loss of King/Drew could further jeopardize a beleaguered system that has lost about 10 trauma units in the last two decades. The county now has 13, including King/Drew.

Just two of the county’s trauma centers are within 11 miles of King/Drew: Harbor-UCLA and St. Francis medical centers.

King/Drew serves one of the most violent areas of the county, with the highest rate of homicides.

“Closing down a [trauma unit] within a couple miles of the most violent parts of the city? South Los Angeles? Compton? Lynwood?” asked Sal La Barbera, homicide supervisor in the Los Angeles Police Department’s Southeast Division station, which covers Watts. “This will definitely have an impact on how many lives are saved.... Harbor [UCLA] is an extra 10 or 15 minutes.”

Bryan Hubbard, a King/Drew trauma surgeon, said closing the center is “ludicrous.”

“People will be dying in the streets or dying in transport to other facilities,” he said, because they would have to travel farther during the crucial first hour after being injured.

The closure of the trauma unit, officials said, does not stem from failings in the unit, which has long been a source of great pride and prestige to the community. At one point, the U.S. military trained surgeons in the unit because it so closely simulated wartime medicine

Rather, the proposed closure is intended to relieve pressure on the rest of the hospital. Running a trauma unit is costly because the patients are so sick, many are uninsured and the hospital is required to have a host of specialist doctors on standby 24 hours a day to respond immediately when an emergency arises.

Health officials did not provide an estimate of how much money would be saved by the proposed closure.

The 233-bed hospital in Willowbrook, south of Watts, serves a predominantly minority and impoverished community, with one of the highest rates of uninsured residents in the country.

The hospital was created on the recommendation of a state panel that investigated the causes of the 1965 Watts riots. The McCone Commission concluded that residents in Watts and surrounding communities, then overwhelmingly African American, suffered from grossly inadequate healthcare, in part because the nearest county hospitals were “distant and difficult to reach.” That is the very problem that critics say the supervisors are now re-creating.

Some county supervisors on Monday gave the health department credit for trying to make reforms, but said they had no choice because the problems seemed never-ending.

“The risk of maintaining the status quo far outweighs the risk of what is being proposed,” said Supervisor Zev Yaroslavsky. “We’re threatened with losses of life. That’s what this is about. It’s about human life.”

Supervisor Gloria Molina added, “We are here to rescue Martin Luther King.... The reality is these are bold steps, but they are important steps.”

The commitment to hire professional turn-around managers was part of an unusual one-year contract with federal officials.

“In effect, the hospital has been on a bit of a high wire for the past eight or nine months,” said Jeff Flick, regional administrator for the U.S. Centers for Medicare and Medicaid Services. “It is not a comfortable place to be. This community absolutely needs the services of MLK.”

During the next year, the county must file progress reports to federal health officials every 60 days, and faces the loss of federal funds if problems are found, Flick said. “We will not relinquish any of our authority,” he said. “If we encounter a serious problem at that hospital, we will bring to [bear] all of the regulatory power that we have.”

In addition to hiring the outside managers, the county plans to create a panel of experts from USC and the University of California system to offer advice on not just the hospital but its doctor training programs, which also are plagued with problems.

Dr. Thomas Garthwaite, the health department’s beleaguered director, defended his agency’s actions, but conceded that they were not enough to halt the crisis.

Over the last nine months, his agency removed the hospital’s administrator and medical director, hired a nursing turn-around firm, installed an internal team of crisis managers and responded to demands from a host of accrediting groups and regulatory agencies. “We didn’t know how much we were going to find and how hard the process would be,” Garthwaite said.

But many politicians said the county supervisors’ actions would inevitably lead to the closure of the entire hospital.

“Many have said they are trying to get rid of this hospital, colleagues of mine have said it, and now it seems as if that is what is happening,” said Rep. Juanita Millender-McDonald (D-Carson). “They are leaving a shell. It seems like the hospital is pretty much lost.”

Supervisor Yvonne Brathwaite Burke expected the outcry but said her top priority was keeping the hospital open, as difficult as it will be to close the trauma unit. She hopes to reopen the unit someday.

“It is not a death by 1,000 cuts because [the hospital’s] going to be alive,” Burke said. “It’s going to be existing. It’s going to be operating.”