King/Drew’s Renewal

Photo by Slobodan Dimitrov

I am rebuked in this issue [see Letters page] for my recent column on Martin Luther King Jr./Drew Medical Center by an old acquaintance, Director Mark Finucane of the Los Angeles County Department of Health Services (DHS). Actually, Finucane, while defending his operations, takes issue with my accuracy on only one point, which I shall return to later.

Otherwise, our local health czar mostly lauds things as they are at the DHS hospital system in general and King/Drew in particular. My contention is that things ought to be and could be better.

Finucane’s basic disagreement is that I suggest that the second-largest hospital in the county system should, without increased funding, be providing better patient care. He criticizes my airing some concerns of the Joint Council of Interns and Residents (JCIR) about working conditions: “In a perfect world interns and residents would be paid far higher wages and work shorter hours,” he says. Actually, I didn’t say anything about those terrible hours. Finucane continues, “We operate teaching hospitals that provide interns and residents with the hands-on experience, oversight and education they need to become physicians.”

There is a classic ideological dictum underlying this statement defending the current, century-old teaching hospital system — it resembles the old drill sergeant’s motto: “Train hard, fight easy.” The problem is, of course, that the “hands-on experience” Finucane refers to involves the health and lives of — as he acknowledges — members of the county’s 3 million uninsured people.

In the dawn of the teaching-hospital era, it was acknowledged by the medical establishment that doctors learned (and, let’s not forget, made their beginner’s mistakes) on charity patients and earned on the privileged clients of subsequent private practice. The fairness of this system is increasingly questioned. Better working conditions for learning doctors probably do little to interfere with the onerous basic process of a medical education. It certainly increases the odds that those doctors’ indigent patients will get better treatment. It may even be one of the cheapest ways to do that.

As to certain favorable official evaluations of King/Drew, I think that Mr. F. is confusing matters. He refers to the Joint Commission on the Accreditation of Health Care Organizations’ rating King/Drew 94 percent overall and 100 percent on “its ambulatory-care survey.” Although this score is nothing to be ashamed of, it has little relevance to the quality of Drew medical school’s teaching and inpatient care that I wrote about. Finucane says the average first-time pass rate for Drew students across the board is about 75 percent. This, while not a disgrace, is not very creditable. He says the American Board of Internal Medicine’s rating of King/Drew’s internal medicine has risen from 54 percent to 90 percent. Sorry, but this didn’t show on ABIM’s own Web site. The most recent figures available are for 1999 and show a pass rate of 54 percent. (In the same DHS system, Harbor-UCLA’s internal-medicine pass rate is close to 100 percent.)

Speaking of the senior teaching, as opposed to junior learning, doctors, Finucane mentions the critical need for “physicians and other health-care professionals who are willing . . . to provide care to the most vulnerable in our community” at the expense of lucrative private practice. This is either wishful thinking or furtive irony. The last time I checked, many, if not most, of the senior teaching doctors in the county system maintained private practices on the side, whose priorities sometimes have allegedly interfered with their public-health work. Indeed, one not-altogether-atypical King/Drew eminence, the recently retired Dr. Ludlow Creary, appeared, from time to time, to have several practices — plus dozens of other personal enterprises.

This may be a DHS-wide problem (and one that is tough to address), but it certainly doesn’t help the quality of education at the Drew school.

King/Drew’s malpractice claims may or may not fall within the county norm, whatever that is. But, adjusted for patient volume, they exceed the claims against the other county teaching hospitals. And individually, each of them stands as a grim indictment of a system that, even if it has treated 2,624 trauma patients last year, as Finucane says, has a substandard reputation among the population it serves.

For whatever reasons, the increasingly Latino South Los Angeles doesn’t sufficiently trust the largely African-American-run institution. Not speaking for attribution, officials in both Supervisor Gloria Molina’s and former Councilman Richard Alatorre’s offices have told me that they are troubled by the extra patient load imposed on County-USC by patients coming from the South-Central King/Drew service area.

This is suggested by the fact that most of Big County’s beds are currently full. There are usually at least a hundred empty beds at King/Drew. It’s about time that the DHS accurately determined to what extent the public distrust of King/Drew is creating the controversial patient load at County and to remedy that mistrust.

Finucane does not mention the rising unrest among the staff at King/Drew. He does state that he’s trying to meet some of the interns’ nonfiscal demands. Good. But I don’t see how he can ignore the need for new management at this long-embattled institution as demanded in the anonymous letter I cited.