Tuesday, September 14, 2004

Closing the Doors...
Another urban trauma center about to bite the dust: 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.
The trauma unit treated 2150 patients last year, in one of the most violent sections of Los Angeles:
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 savedÂ…. Harbor [UCLA] is an extra 10 or 15 minutes."
King-Drew Medical Center has been under a cloud of scandal for several months:Watts Symbol of Hope Becomes Center of Conflict
King Hospital and its affiliated medical school, the Charles R. Drew University of Medicine and Science, have been rocked by accusations of needless deaths, racial tension, poorly trained medical students and incompetent nurses and tens of millions of dollars in malpractice settlements.

King/Drew consistently ranks at the bottom of American teaching hospitals. A report in January by federal health officials said that at least five of the hospital's patients died needlessly last year, and the county authorities are investigating accusations that hospital officials ordered nurses to lie about the abysmal state of things.

''The hospital is run like a tribal fiefdom, and it's appalling,'' said Connie Rice, a civil rights lawyer here who is African-American. ''You can't ask questions because it's a black institution. If you ask questions, they scream racism. But it's not a question of race, it's a question of competence.''....
According to the January federal audit, three people died last year in ward 4B, where the nurses did not know how the heart monitoring machines worked.

A man who was suffering from gangrene of the intestines was brought to the emergency room last March and was found 18 hours later lying in his vomit, having received no medical care. He later died. Another man suffering from gangrene was neglected for the better part of a day and died, the audit said......

A national accreditation board last year rescinded the private medical school's authority to train surgeons and radiologists. The county has temporarily severed the hospital's relationship with the medical school, because of the quality of education.
As the man selling the Ginsu knives says, but wait, there's more:
A woman with respiratory failure and ovarian cancer received the wrong dosage of an antibiotic on Feb. 28; did not receive an ordered dose of a blood thinner on March 1; and was given only three of 12 ordered doses of respiratory drugs from Feb. 28 to March 2.

A stroke patient had to wait nearly five hours for a drug to help prevent heart attacks and recurrent stroke. At one point, pharmacists wouldn't fill the order because a doctor had spelled the drug's name wrong. Later an inspector watched as two pharmacists within half an hour picked up the pill bag and looked at it but did not approve its use.

In the case of a tuberculosis patient, an inspector found a missing dose of intravenous antibiotics on a pharmacy counter more than two hours after it had been ordered, with a sticker that read "missing dose." The inspector noted errors in three of six medications given to the patient.

A paraplegic with a pressure sore and bone infection was not given a laxative suppository that had been ordered and reordered by a physician over at least five days.
In the past whenever the hospital was criticized the response, as pt forth by Ms. Rice above, was to play the race card, and in the past have played it well:
The hospital's supporters are not sitting still. A rally co-sponsored by the Congress of Racial Equality in late January showed just how deep the racial tensions are. Representative Maxine Waters, Democrat of California, warned county officials that if the neonatal unit was closed, ''we will be on top of your desk.''

In a telephone interview, Ms. Waters elaborated. ''What we're saying is we're going to watch you,'' she said. ''The county only reacts when the spotlight is on them. They're not going to close that hospital. They can't close that hospital. They need to supervise it, and shuffling a few people around isn't going to do it.''

Dr. Ernest Smith, an instructor in the Drew University department of internal medicine who is African-American, is outspoken in his criticism of the county health department, which he sees as unfairly laying blame at the feet of the black administration.

''When things go wrong, why do they point the fingers at administrators and not the master down there at 313 North Figueroa Street,'' Dr. Smith said, referring to white officials at the county health department. ''Maybe the place would operate better if we received our fair share of money.''

Health department officials say, however, that King/Drew receives more money per patient from the county than any other hospital in the system. ''The quality of the administrators isn't there that a hospital needs,'' said John Wallace, spokesman for the county health department. ''It's been allowed to go on for years.''

Yvonne Brathwaite Burke, a black county supervisor whose district includes the hospital, admits there are some problems at King/Drew. But she said the problems had been blown out of proportion. ''It's not a matter that you go there and you die,'' she said, ''it's that the press picks up on every little mistake.''
Reread that last quote carefully gentle reader. Seems to imply that the deaths are no big deal, the big deal is that they are getting the attention of the press and casting the hospital in an unfavorable light.
According to the LA Times the trauma unit is not being closed because it is bad, but in an effort to relieve "pressure" on the rest of the hospital:
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.

The fact that hospitals and their boards are highly politicized is nothing new. The image of a hospital, urban or rural as a nepotistic jobs program, or as Ms. Rice puts it a "tribal fiefdom" is also nothing new. The problem arises when the administration insulates themselves from criticism by using the methods applied here, and because of that insulation people die and a community suffers.
Cross-posted at Galen's Log
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