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Death Watch

THE MOST SHOCKING THING about the latest calamity at South L.A.’s beleaguered Martin Luther King Jr./Drew Medical Center is that the news can still shock and amaze. After all, the 252-bed hospital has lost a key accreditation, endured needless patient deaths and produced one of the worst nicknames possible for a health facility: Killer King.

And yet many inside and outside county government were floored by last week’s announcement that King/Drew had failed its final inspection — botching nine out of 23 sometimes life-and-death subjects, jeopardizing $200 million in federal funds and paving the way for its possible demise. One union leader sobbed after learning the news, while one county supervisor declared the outcome “shocking.”

“We were really hopeful of passing [the test], there’s no doubt about that. The department, the hospital, everyone was,” said Supervisor Gloria Molina. “And yet at the end of the day, it didn’t happen.”

How could so many have been caught off-guard? Molina, for her part, had been encouraged by the practice drills performed by King/Drew over the summer in preparation for the federal exam — and by the candor of Bruce Chernof, the newly hired head of the county health system. Supervisor Yvonne Burke had grown optimistic after seeing the work of King/Drew’s new chief executive, Antoinette Epps, who now presides over a hospital that has seen 239 employees quit or be fired since 2004.

Privately, the hospital’s supporters kept comparing King/Drew to a college student, the type who had blown off the first half of the semester, crammed for weeks and yet never quite caught up. In one particularly damning academic metaphor, King/Drew had seen the exam and knew the answers but still couldn’t make the cut. “They’re 100 percent better than where they were a year ago, but it wasn’t good enough,” said Jim Lott, executive vice president of the Hospital Association of Southern California. “It was too short a period of time for them to turn around.”

Burke, who represents the district where King/Drew is located, insisted that she wasn’t surprised by the federal government’s announcement. But if so, why did she have so few specifics on the county’s backup plan? “We don’t have a plan,” Burke said Tuesday. “We’re putting everything in the hands of Dr. Chernof, and Dr. Chernof is analyzing all of those alternatives that come to him. And may I just say, I think there are new proposals coming in every hour, every day.”

Three other supervisors said they too weren’t surprised by the latest piece of bad news, which was administered by the federal Centers for Medicare and Medicaid Services, which oversees public hospitals and goes by the abbreviation CMS. Supervisor Zev Yaroslavsky said he pushed Chernof throughout the summer to develop contingency plans in case King/Drew flunked. “I’m always prepared for the worst, hoping for the best. I think anybody who wasn’t was a bit naive,” he said.

Yet only two weeks ago, Supervisor Don Knabe told a crowd at the Los Angeles Current Affairs Forum that he was cautiously optimistic about the hospital’s prospects. And last spring, Yaroslavsky used the word “optimistic” three times when asked to assess the hospital’s future.

“I believe we have a very good likelihood of passing that CMS inspection when it comes, whenever that comes — I suspect it will be this summer,” said Yaroslavsky, as he campaigned in May for a fourth four-year term. Yaroslavsky even threw in a sarcastic dig at the city’s largest newspaper, which produced a five-day series on King/Drew’s problems in December 2004. “If King does pass, I’m sure it will be prominently displayed in the Los Angeles Times,” he said.

During her own re-election campaign, Molina said the county’s health bureaucracy — as well as the late supervisor Kenneth Hahn — had tried to discourage her from looking into King/Drew once she joined the board in 1991. Over the following decade, Molina said her energies were focused on the battle to rebuild L.A. County-USC Medical Center, the hospital in her supervisorial district. “I’d love to be the queen of everything, but I am not. And I have my limitations,” Molina told the L.A. Weekly last May.

“I fought during that time to build a 750-bed hospital. That was my battle. I had my own demons to deal with in the health department. That was my battle at that time. So now I was not in charge of MLK. I had enough going on.”

The supervisors responded much more aggressively to King/Drew’s problems two years ago. Yet critics argue that the board was still unprepared for King/Drew’s latest crisis. “I just feel like they were completely out of touch with what was going on at that hospital,” said Los Angeles City Councilwoman Janice Hahn, whose father helped open the hospital. “If they failed, they should have had a backup plan. And now they’re scrambling.”

With so much disarray over King/Drew, it’s easy to overlook the fact that Los Angeles County operates three other hospitals — Olive View-UCLA Medical Center in Sylmar, Harbor-UCLA Medical Center in unincorporated Torrance and County-USC in Lincoln Heights. But none of those facilities carry the same political and emotional baggage as King/Drew, which opened in Willowbrook in 1972 as the county’s most dramatic response to the Watts riots.

KING/DREW WAS SUPPOSED TO ADDRESS the lack of access to quality health care in South L.A., whose African-American residents had been forced for years to drive all the way north to County-USC for medical care. Yet after it opened, King/Drew failed to provide care commensurate with the county’s other publicly run hospitals. As the situation at King/Drew worsened in recent years, other emergency rooms began disappearing, leaving residents in the region of South L.A. — the section of the county with the high number of gunshot victims — with fewer and fewer medical choices.

With nine weeks to go before King/Drew loses its funding, the supervisors essentially have two choices: Find a private company to run King/Drew, or put the hospital under the oversight of Harbor-UCLA, which still has an unblemished federal license. Yaroslavsky voiced strong doubts about turning King/Drew over to a private company, saying he fears such an entity may be more focused on profits than on health care. Yaroslavsky also warned that the county does not have the time to engage in lengthy negotiations with an outside company.

Supervisor Mike Antonovich, a conservative pol who usually favors privatization, said he is leaning toward Harbor-UCLA, not a private contractor, as the way to save King/Drew. Such a move would allow the county to remake dramatically King/Drew’s work force, with the hospital’s employees forced to reapply for their jobs — and possibly face reassignment elsewhere in the county, Antonovich said.

But placing King/Drew under the auspices of Harbor-UCLA comes with its own set of risks. Given its track record, King/Drew is certain to get another surprise inspection from the federal government, said Lott, who heads the hospital association. “If they failed a second time, not only would King/Drew’s medical certification be revoked, but so would Harbor-UCLA’s,” he said. “Harbor could be brought down by King/Drew’s inability to pass an inspection.”

In that scenario, the county would lose not one but two hospitals, plus the trauma center operated by Harbor-UCLA. In terms of shocking the public, the county Board of Supervisors would have found a way to outdo itself once and for all.