Los Angeles County Department of Health Services Recommends Downgrading King/Drew Neonatal Unit

The Los Angeles County Department of Health Services has recommended that Martin Luther King Jr./Drew Medical Center's neonatal care unit be "downgraded" from a regional unit to an intermediate care unit, which would restrict the facility's services for newborns in intensive care and infants who need ventilators to breathe for more than four hours, the Los Angeles Times reports. The proposed downgrade is set for July and could require approval by the county Board of Supervisors. Under the proposal, infant patients who are severely ill will be transferred to County-USC Medical Center or Harbor-UCLA Medical Center. According to Thomas Garthwaite, the director of the county DHS, 135 of the 783 babies born in 2002 and 2003 at the hospital were in the category planned for transfer. According to county health officials, high-level neonatal units are not needed at the four full-service public hospitals in the county because the number of births at the hospitals has decreased by more than 85% since 1991. The proposal is part of a countywide plan to save money and consolidate services; the neonatal unit at Olive View-UCLA Medical Center also would be downgraded to an intermediate unit.

In a separate action, the Department of Health Services last month withdrew its recognition of King/Drew as a "highly specialized hospital for care of newborns and children," the Times reports. DHS attributed its decision to "lapses in care by physician trainees and incomplete nursing assessments, among other things," according to the Times (Ornstein, Los Angeles Times, 1/13). The Accreditation Council for Graduate Medical Education last month recommended closing King/Drew's neonatal residency program (California Healthline, 1/12).

Dr. Xylina Bean, director of neonatology at King/Drew, asked DHS to reconsider its decision, adding that she would be willing to create partnerships with other hospitals to gain more experience for medical residents. With regard to the county action, Bean said that the King/Drew unit had a higher patient volume than the unit at Harbor-UCLA and serves a community with less access to medical care, higher rates of poverty, lower rates of health coverage and limited transportation to private hospitals. Bean said, "You're telling the people in this community that you don't care about their problems." Garthwaite said that he made the decision to downgrade the neonatal unit because its costs are relatively high and the facility's patients do not need that level of care.

County DHS officials said that they would discuss renegotiating the county's $13.8 million contract with the Charles R. Drew University of Medicine and Science, the medical school affiliated with King/Drew, at a meeting Tuesday. In addition, county DHS officials said they would discuss changing faculty members' pay structures and the makeup of King/Drew's board of trustees (Los Angeles Times, 1/13). Last Friday, the medical school placed President Dr. Charles Francis on paid administrative leave, following a task force report stating that he had lost the confidence of many members of the hospital's board, faculty and surrounding community. The task force report also said that it is not possible to sustain the school's 18 residency training programs at King/Drew given its average of 200 inpatients; recommended a cooperative medical residency program with a larger, more prestigious institution; called for the school to establish a "culture of accountability"; and recommended a leadership transition at the school (California Healthline, 1/12).