Closing Martin Luther King Hospital

ON MONDAY, AUGUST 13, the Los Angeles County supervisors held a special four-hour board meeting to discuss the closing of Martin Luther King Jr.–Harbor Hospital. Among the subjects on the table for discussion were the reasons why the hospital failed so miserably, whether it will ever reopen, and what the Los Angeles County Department of Health Services intends to do to handle about 45,000 emergency-room patients who will now have to be treated elsewhere.

The health department’s director, Dr. Michael Chernof, took pains to explain that, although the hospital was closing, parts of the medical center weren’t going out of business. The most crucial closure was that of MLK’s emergency room, which shut its doors at 7 p.m. last Friday night. Plus, all of the facility’s inpatient care will be parceled out to other hospitals in the next 10 days, said Chernof. But an “urgent-care center” will operate in the hospital, he said — an on-site clinic that deals with non-emergency issues such as fever, rashes, burns, insect bites and fractures. And the medical center’s walk-in clinics — dealing with such specialties as HIV/AIDS, diabetes and infertility — will remain open.

Yet it is the emergency-room closure that’s causing intense public anxiety, so Chernof laid out a plan in which MLK’s ambulance calls will be redirected to nine of the closest hospitals. In addition, he said, all inpatient care will be parceled out to facilities like Harbor-UCLA Medical Center and Rancho Los Amigos National Rehabilitation Center, each of which will get some additional beds courtesy of the county to help cope with any influx.

With the region’s emergency medical system already badly overloaded, handing off MLK’s emergency-room patients to nearby hospitals was, according to some in attendance, a potential health-care crisis in the making. “We’re a little concerned about whether the safety net will hold,” said Mark Gamble, the regional VP of the Hospital Association of Southern California.

“And if we ever really have a real crisis, like a terrorist attack or a disease outbreak,” DHS spokesman Mike Wilson muttered gloomily later, “then how will L.A.’s hospitals cope?”

But if county and regional officials had the jitters, the affected hospitals are even less cheerful. “We’re pretty worried,” confides Dr. Richard Guest, the medical director of Downey Regional Medical Center’s emergency room. About seven miles from MLK, Downey is one of the facilities tagged to pick up the slack. “We normally see about 18 or 19 ambulance runs a weekend,” Guest says. But in the two days after MLK closed on Friday, “We had 26.” He adds that Downey’s “ER wait times are already stretched to the limit. St. Francis is even closer to Martin Luther King than we are, and they’re stretched to the limit too.” As is White Memorial Medical Center in East L.A. “This could be a real nightmare,” says Guest.

Still, there seemed little doubt in anyone’s mind that, come what may, the troubled hospital needed to close. The reasons were detailed in a 124-page final survey report in which the CMS federal Centers of Medicare and Medicaid Services listed MLK’s latest failures. At first, county officials weren’t going to let the public see the federal report. But after repeated requests from both press and public, county Supervisor Gloria Molina pushed for its release, and on Monday night, it was posted on the five-member elected board’s Web site at .

In dizzying detail, the federal report describes a medical landscape littered with incompetence. Inspectors found nurses who were unable to “correctly calculate dosages for medication” to be given to pediatric patients, and worse, nurses incapable of locating “critical equipment and medications on the pediatric emergency cart.” The federal inspectors outlined how MLK patients were “placed at serious risk for exposure to contagions, such as tuberculosis” because of such basic lapses in hospital hygiene as the staff’s failure to “clean and track” bronchoscopes.

One particularly alarming section describes a psychiatric patient who was “observed through the window of the room door, cutting both arms with a scalpel.” When questioned, MLK staff members insisted that the arm-gouging psych patient smuggled in his own scalpel in “a bag of Doritos chips.” In fact, the Medicaid investigators found that the scalpel’s lot number matched scalpels in MLK’s locked emergency-room cabinet. Simply put, the scalpel came from the hospital. When the inspectors looked still further, they found that the psych patient had been observed standing alone next to a “gurney that had open drawers” holding “needles . . . tubes, and scalpels.”

Not good.

In all, the report painted a picture of a hospital that had been in deep water for a long time and, despite warning after warning, had not made the most basic of changes needed to save itself. As the federal officials pointed out in a summary letter, “Repeated certification surveys and complaint investigations have identified serious health and safety violations and documented the hospital’s inability to comply with these federal standards.” As a consequence, the feds saw no choice but to pull the hospital’s Medicare provider agreement and, with it, $200 million in federal funds MLK needs to operate. “This decision is final,” said the letter — in case anyone hoped there might still be wiggle room.