By Hillel Aron
By Joseph Tsidulko
By Patrick Range McDonald
By David Futch
By Hillel Aron
By Dennis Romero
By Jill Stewart
By Dennis Romero
In all its ocean-linerly majesty, the Los Angeles Times veered a few degrees from its usual course last week better to scrutinize the ongoing crisis in Los Angeles’ ramshackle Department of Health Services. The story, which could have appeared at any time over the past year, spoke of endless waits in clinics, understaffed wards, crowded emergency rooms, faltering funding. All of this is true and important to say.
But even more important to say is where to begin straightening out this bureaucracy-clogged entity charged with preserving the health of the poorest 40 percent of our county‘s population. Simply to say that it’s all problematic implies that there‘s no place to begin fixing our DHS. But clearly, there are places where the remedy isn’t more money (scarce everywhere in public health since Proposition 13) but the kind of courage and determination we haven‘t seen in Los Angeles County government since I can recall.
For instance, there’s the DHS‘s albatross-in-perpetuity, Martin Luther King Jr.Drew Medical Center, which has long resisted reform and restructure, scandal after scandal. KingDrew’s hierarchy could teach the Rampart Division a thing or two about closing ranks and clamming up. Particularly regarding its egregious patient deaths and disablings over the past decade.
The latest ruckus at KingDrew, however, is due to its recent designation as the worst U.S. medical school in a single crucial area. Internal medicine is perhaps the most important and inclusive practice category. And 58 percent of KingDrew medical students in that field were not passing their qualifying exams, according to the American Board of Internal Medicine (ABIM).
That‘s quite a distinction, even for a medical complex that’s been criticized like no other in the state. And which has cost the county uncounted tens of millions in patient-injury and death settlements while also being a target for accusations of -- and some successful litigation on -- racial bias.
It‘s a sad climax to a 25-year institutional history. Martin Luther King Jr. HospitalCharles R. Drew University of Medicine and Science rose -- literally -- on the ruins of the 1965 Watts Riots. It was perhaps the most enduring outcome of the collective wills of then--County Supervisor Kenny Hahn and the South Los Angeles stakeholders. It was to remedy one of the black community’s major lacks: a local public hospital for the underserved African-American community. And a university teaching hospital, for the presumed purpose of admitting African-American medical students who were less than welcome at that time at some major medical schools.
This last provision was the project‘s most ambitious aspect: an African-American education center in the medical arts that might one day perhaps equal those of Morehouse College in Atlanta and Howard University in Washington.
But it was not to be. Possibly the problem was that, unlike most teaching-hospital medical-school institutions, KingDrew was not built on the foundation of an extant university, whose administration could regulate both its standards and its performance. Instead, an ad hoc teaching establishment was created out of thin air. Without the traditions and regulatory powers of a genuine educational institution, what was intended as a lighthouse of medical learning became a bedlam of county and local politics. While the original purpose -- adequate treatment of its client population -- fell to a low priority.
One clear indication of this affair was the rating of KingDrew as the national worst (in contrast, the internal-medicine board rated Howard and Morehouse among the top medical schools in the Southeast) in the internal-medicine category. But this rating had one positive effect: It spurred an anonymous handful of KingDrew residents and interns to demand -- in two unsigned missives -- a shake-up of the hospital’s management.
According to one letter (which several interns and residents at KingDrew said they were familiar with, but would not comment on), ”The administration is interested only in preventing the truth from leaking out and . . . not in dealing with the realities of our sub-optimal training.“
It continues: ”The thought of being called the worst is indeed chilling to us . . . certainly, this is not what we were told when we were recruited.“ It‘s further alleged that KingDrew’s reputation has so spread nationally over the past three years that this year, ”despite the growing national demand for primary care residencies, not one person from any part of the country opted to join our program.“ The memo further criticizes the leadership of the internal-medicine department, but does not refer to the egregious settlements the county‘s paid out on KD’s behalf -- including three recent infant-death and infant-disability claims that together totaled more than $2.2 million.
”We are aware of the letter and its allegations,“ said a spokesman for DHS chief Mark Finucane, adding that the allegations were ”being looked into.“ Haven‘t we heard this before? What we have not heard -- over a decade of KD controversy and criticism -- is any forthright DHS proposal to clean house at KD.
Unforthrightly, however, something similar was recently proposed to the Board of Supervisors. In closed session, the board tabled (or, realistically speaking, sank) a Finucane proposal that, although postponed many times, had not been aired in public. Finucane sought the hiring, at $150,000 and for one year, of a special DHS ”consultant.“ This was not a general job posting, soliciting qualified applicants: Instead, a very specific individual -- Dr. Rodney Armstead -- was proposed. Among Armstead’s qualifications was his service as executive vice president at the Watts Health Foundation. Among the duties offered him was ”to provide high-level clinical and administrative consultation [for] KingDrew Medical Center.“