Consultant Report Lists Problems at King/Drew Medical Center, Includes 1,000 Recommendations

Addressing all problems at Martin Luther King Jr./Drew Medical Center will take longer than one year and cost more than committed by Los Angeles County to date, county health officials said after receiving a preliminary report issued Monday by Navigant Consulting, the Los Angeles Times reports. The county has hired Navigant to assess the hospital and propose solutions to address its problems (Weber/Hymon, Los Angeles Times, 1/4).

Regulators have repeatedly cited King/Drew for patient care problems, and on Nov. 23 the Los Angeles County Board of Supervisors voted 4-0 to close the trauma center at King/Drew and hire outside managers to operate the hospital. The King/Drew trauma center, which provides care for patients with life-threatening injuries, treats about 2,150 patients annually, and the hospital emergency department treats 45,000 patients annually (California Healthline, 11/24/04). County officials have begun reducing services at the trauma center, and it is expected to close by Feb. 1 (California Healthline, 12/3/04).

King/Drew on Jan. 19 also is scheduled to lose $200 million in CMS funding after failing an inspection by federal regulators in December. The hospital will have one final opportunity to address the problems before it loses the funding, country health officials said (California Healthline, 1/3).

The Joint Commission on Accreditation of Healthcare Organizations also recently issued a preliminary denial of accreditation after JCAHO inspectors visited the hospital several times in response to reports of patient deaths. Last month the organization denied the hospital's appeal of the accreditation decision.

Loss of JCAHO accreditation could affect the facility's contracts with private insurers, its eligibility to participate in federal programs and its physician-training programs.

King/Drew plans to file an additional appeal, but JCAHO officials have said they are not likely to reconsider their decision (California Healthline, 12/10/04).

The Los Angeles County Department of Health Services from December 2003 until November directly managed the hospital.

Navigant in November was awarded a one-year contract to propose strategies to address the hospital's problems. Navigant's report will be finalized Feb. 1, and following its issuance, county officials will have 30 days to decide how to proceed.

According to the Times, the report "implicitly criticizes" county DHS and "explicitly suggested that the problems would not get better so long as the Board of Supervisors continues to be in charge."

The report refers to problems with King/Drew's "culture," in which management officials do not demand adequate accountability and staff members do not take adequate responsibility for their jobs.

Other findings of the report include:

• Inadequate performance reviews of physicians;
  
  
• An ineffective disciplinary system;
  
  
• Improper sterilization of surgical instruments and improper operating room attire by personnel;
  
  
• Lack of availability of physicians in the emergency department;
  
  
• Improper credentials for some nurses;
  
  
• The use of unreliable medical equipment for monitoring patients' vital signs;
  
  
• Operating room staff failing to routinely ensure instruments and sponges were removed from patients;
  
  
• Storing sterile and nonsterile equipment together;
  
  
• Unsafe patient rooms in the psychiatric units; and
  
  
• The lack of a process to report unusual patient deaths and to analyze medical and medication errors.

The Navigant report includes about 1,000 recommendations to improve patient care. Among these recommendations, the report suggests:

• Appointing a separate, independent board to oversee the hospital;
  
  
• Re-evaluating all hospital staff for competency;
  
  
• Firing staff members who do not meet qualifications;
  
  
• Improving prescription drug security policies and procedures and installing security cameras;
  
  
• Hiring a senior human resources professional to review all existing workers' compensation claims, which 8% of staff have filed;
  
  
• Downgrading the neonatal intensive care unit and focusing on infants with less serious conditions;
  
  
• Reducing the number of physician-training programs at the facility; and
  
  
• Giving some physicians who have served in leadership roles and are nearing retirement "emeritus status."

According to the Times, some findings in the report "appear to point to additional violations of state and federal health regulations" and could "trigger a fresh round of inspections" (Los Angeles Times, 1/4).

KPCC's "Talk of the City" on Monday reported on the executive summary. The segment includes comments from KPCC reporter John Rabe (Rabe, "Talk of the City," KPCC, 1/3). The complete segment is available online in RealPlayer.