What Is Lillian Mobley Fighting For?

The Los Angeles County Department of Health Services (DHS), which owns King hospital, operates on what seems like a permanent budget shortfall, especially in the last few years of lingering recession and advancing political conservatism, forces that have crippled public spending of all kinds. Still, DHS spokesman John Wallace says King/Drew is getting its fair share in the county hospital system, sometimes more. The department sparked a furor last year when it announced plans to trim King/Drew expenditures by 16 percent over a three-year period, the largest funding cut leveled at any hospital in the county system, but state audits showed that King/Drew was getting as much funding as other hospitals but consistently ranking near the bottom in efficiency. The county argued that the hospital could therefore cut personnel and not cut patient services. Personnel at King/Drew didn’t buy it: The doctors’ and physicians’ unions, local chapters of the Union of American Physicians and Dentists and the Joint Council of Interns and Residents, went to Superior Court and got an injunction against the cuts, at least until the county held mandated public hearings about them. The first set of cuts were made last June, and it’s unclear if and when the second and third sets will be made.

DHS director Thomas Garthwaite, a relative newcomer to the county who brings with him a reputation of cutting the fat out of public health budgets, says there is no question that “the greatest need for health care and the greatest health-care disparities are in service planning area six, the area around King/Drew. But all our evidence suggests that the health-care delivery there is not efficient. That’s an important distinction to make.”

For King/Drew supporters, the cutbacks re-aggravate old wounds that have not yet begun to heal. One of their bitterest complaints against the county — against the state, against America — is over a lack of resources, not simply money, but equipment, manpower, talent, planning and administration. The complaints are not unfounded: Over the years, King/Drew has lacked modern medical equipment, to the point where a community group has had to raise funds to buy it. King/Drew has also been deprived, say its advocates, of the kind of holistic, sustained support that guarantees success, the kind that black communities almost never experience. If King/Drew had gotten this support from the start, proponents argue, it would now be a mature adult institution instead of a perpetual adolescent — that is, a place with some accomplishments under its belt, great promise but equally great potential to gloss things over or screw up.

“King has certainly fulfilled its mission to some degree — it’s trained and supported people who otherwise would not have been,” says the former staffer. “That’s very valuable. But accreditation is a problem. They needed to have accreditation goals from the beginning rather than this charade of sprucing up before each annual visit. What bothers me most is that these things continue to happen.” Wallace contends that the numbers do not tell the whole story. The millions King/Drew gets annually may be no match for its workload: Last year its ER treated 40 percent of the county’s gunshot wounds and 22 percent of its “code yellow” patients — vehicular accidents, life-threatening surgical admissions, intentional injuries like assaults and stab wounds — all in a space “the size of a family room in a modest home,” according to the county’s own fact sheet. The state audit also points out that King/Drew performs markedly worse than Big County or Harbor General, which handle similar crises with proportionately similar moneys: The difference at King appears to be bad management, expressed in higher staff-to-patient ratios, which in turn result in higher per-day cost for each patient. There’s also a story behind those figures, however: While King may have more than enough bodies employed, it has too few employed in critical areas like registered nursing — a profession currently suffering through a shortage crisis of its own — which means that underqualified folks tend to fill those positions and mistakes tend to get made more often. Many King/Drew observers say the hospital is chronically understaffed where it could never afford to be.

Now under great political pressure to simultaneously improve things and shave expenditures as another budget crisis looms next fiscal year, the county doesn’t seem to have the time to wait for King/Drew to turn around, let alone indulge the fitful evolution of the Dream. Any sort of compromise would qualify as success, but even that may not be forthcoming: The former King staffer describes Lillian Mobley and company, despite the bold talk, as “actually terrified of the Latino incursion, which is why they’re opposed to change.” The visible community support of King/Drew may be allying with Latinos now as an image-conscious matter of strategy, but not of choice. Supervisor Molina said recently that when she made overtures to King/Drew, she was rebuffed in no uncertain terms. “I’ve never seen such hostility,” she said in a public supervisors’ meeting last month. “I was accused of trying to take over the hospital and change it to Benito Juarez Hospital.”