County Suspends Nursing Director

The Los Angeles County health department has suspended the nursing director at Martin Luther King Jr./Drew Medical Center as it seeks to turn around the troubled hospital, officials said Monday.

Nursing Director Rosemary M. Haggins will not be paid while the county Department of Health Services investigates a host of nursing problems recently identified by government inspectors, agency Director Dr. Thomas Garthwaite said Monday.

Separately, Garthwaite and his chief operating officer, Fred Leaf, warned the county Board of Supervisors in a six-page memo that reforming the 31-year-old hospital would be enormously difficult, even after new leaders are installed.

“There exists a pattern of behavior among clinical managers at the facility that significantly challenges the attempts of new leadership to institute change,” the memo said.

The memo alerted supervisors that King/Drew’s “substantial problems” placed it in danger of failing a crucial upcoming inspection by an accrediting organization that judges patient care. The regular inspection by the Joint Commission on Accreditation of Health Care Organizations is expected in the spring.

The county and its Willowbrook medical center are under intense pressure to make changes, as a growing number of regulators find serious problems there, including physician training and patient care. The county-owned hospital’s funding and ability to function are threatened if its failings are not corrected.

Garthwaite has been directed by the Board of Supervisors to take quick, decisive action. Last week, supervisors encouraged Garthwaite to make politically difficult decisions, including removing top staff at King/Drew.

The suspension of Haggins, the nursing supervisor, follows a government inspection earlier this month that found the most basic expectations for nursing care were not being met.

Inspectors acting on behalf of the federal government found that King/Drew nurses showed a serious lack of attention to patients when they were first examined, while they were being treated at the hospital and specifically when they were in pain. King/Drew nurses also were responsible for errors and omissions in patient records, according to a county summary of the inspectors’ findings.

During a separate investigation into two deaths at the hospital this summer, state inspectors found that nurses failed to notice that the patients’ conditions had deteriorated dramatically. Also, some nurses apparently had never been taught to use new bedside monitors and one nurse lied about performing crucial tests ordered by a doctor, inspectors found.

As a result of these and other internal findings, Garthwaite said, he will likely hire an outside “turnaround” firm to run nursing services at King/Drew.

“We want to continue to take pretty aggressive actions,” he said.

Haggins hung up the telephone when asked for comment by a reporter.

Garthwaite also said he has asked two top managers from other county hospitals to temporarily take on full-time roles running the hospital.

Dr. William Loos, medical director at Olive View-UCLA Medical Center, and David Runke, chief financial officer at Los Angeles County-USC Medical Center, have been given direct management authority for personnel and operations at King/Drew, Garthwaite said. Both had been working part-time at King/Drew as part of a management oversight team appointed this fall.

Despite the many challenges facing the hospital, Garthwaite said, his agency had made some progress in reforming physician training, financial operations and patient care. Among recent changes noted in his memo:

* Eight doctors in training were fired because they were not part of approved residency programs, in conflict with county regulations.

All of the hospital’s 18 physician training programs are being reviewed for “need, size and viability,” Garthwaite said.

In addition, a task force led by former U.S. Surgeon General David Satcher will issue recommendations on how to improve Charles R. Drew University of Medicine and Science, which runs the training programs at the hospital.

* A system was created to ensure that patients receive medications ordered by their doctors. Garthwaite said in an interview that his team had been alarmed at the number of medication errors at King/Drew that were not reported to hospital officials.

* Responsibility for human resources was transferred to health department headquarters after the county found that the hospital had not been keeping up with personnel evaluations or following through on disciplinary actions.

The management team also is looking at moving some little-used medical services to other county hospitals.

These include pediatric surgery, pediatric intensive care, gynecologic surgery and gynecologic oncology.