COUNTY OFFICIALS TOOK the first step this week to shut down trauma care at the King-Drew Medical Center, but not before County Supervisor Yvonne Brathwaite Burke bolted ranks to join a mutinous chorus opposing the action. Burke was the only dissenter Tuesday, but her path to a no vote is most telling in a struggle over health care that will play out over the coming months.
Closing the trauma center was one of two key actions on King-Drew this week. One of them, less controversial, will hand hospital management to a turn-around firm that will be selected by mid-October. The federal government pressured supervisors into this move; the feds control about $200 million a year of the hospitals $400 million budget. Burke joined her colleagues on this vote. The outcry was over a proposal by health department chief Thomas Garthwaite to shut down the hospitals trauma center. The trauma unit performs life-saving interventions for some 2,000 victims of shootings, stabbings and traffic accidents each year. The hospitals emergency room, which serves a larger population of about 50,000 patients, would remain open. King-Drews trauma unit has long been a source of community pride, and to many its also a necessity. The unit serves patients in some of the countys most violence-plagued neighborhoods, people who could die without immediate treatment. Only the massive County-USC hospital handles more trauma cases.
The feds offered no opinion on closing the trauma center that idea came from Garthwaite and staff. Garthwaite argued that trauma care consumes too much attention and resources at King-Drew. The hospital needs to focus instead, he said, on mending its various departments and on improving service to emergency-room patients. The trauma patients can go elsewhere.
That is, of course, if they live long enough.
And that was the rub for speaker after speaker at the Board of Supervisors meeting. The concerns echoed a week of outrage that pulled increasingly on Burke.
The supervisors vote came just one week after all five, including Burke, stood together to endorse closing the trauma unit as the best stopgap to saving the rest of the hospital.
Or did they?
County supervisors offered varying spins this week.
Supervisor Mike Antonovich, the boards most conservative member, very much thinks that he signaled an intent, then and now, to terminate the trauma unit. The hospital cannot be saved without that type of action, he said in an interview after Tuesdays vote. Closing the trauma center is the first step in a long road. There is not an alternative. We want to keep the patients needs foremost.
But Supervisor Zev Yaroslavsky said he, for one, did not vote to close the trauma center. Hes only starting the process, he said, and hes open to other options, though a shutdown is currently the only option on the table.
Burke was in yet a different interpretive world. She said her efforts and the outpouring from the public have effectively bought time for the trauma center.
The board majority did, in fact, make one concession. The new language talks about scheduling a hearing to consider closing the trauma center. It replaced wording that made things sound like a done deal.
I think the language is much improved, said Burke afterward. I think there is a softening of their intent. At least theyre open to look at other alternatives.
NONE OF THE SUPERVISORS moved as much as Burke herself, who represents the area served by King-Drew. Her progression over two weeks has everything to do with her treasured place as one of the most beloved public officials in South Los Angeles, especially among longtime black residents. Burkes pioneering career included stops in the state Legislature and Congress. She is also distinguished by her courtly manner, her smart attire, and her tone of soft-spoken sincerity.
Burke loves the love she gets from her community. And shes fundamentally unwilling to put this mutual adoration at risk. For that matter, her constituents raised some excellent points in defense of the trauma unit.
Her dissenting vote was almost inevitable. The bigger surprise was that she joined her colleagues at first, when it sure looked like they unanimously endorsed closing the trauma center. In fact, Burkes backing looked like the linchpin to this move, which had been gradually organized behind closed doors for two weeks prior.
Burke has the political space to be as tough as she wants. At 71, shes not running for office again. Besides, a challenger hasnt defeated an incumbent supervisor since 1980.
But Burkes never had the stomach for tough love when it came to King-Drew. Shes spent much of her career defending the institution, as during a February interview. Now with King-Drew, she said, you have to realize that three years ago it got 92 on its evaluation, in terms of its accreditation. Just a few years ago one of the departments was in the top 10 in the nation from U.S. News & World Report.
Cheerleading just came more naturally than oversight. Critics cast Burkes habitual posture as akin to negligence. The other supervisors, for their part, declined to meddle in her territory. It follows that these officials, but especially Burke, have abetted and sustained the careers of poor administrators, doctors and nurses, especially when they could muster political clout within the black community.
In that February interview, Burke described the faults of one King-Drew administrator in terms that could be applied to Burke. She never put pressure on them. And some of these [bad] things resulted from that, because she just let them slide.
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To be sure, King-Drew does indeed save lives every day, but its also had the nickname Killer King for years, well before the spate of medical, financial and management disasters pushed supervisors past the tipping point.
A lot of the proactive comes from the reactive, said Burke months ago. When you get enough issues being raised, you then know that something needs to be changed in the system.
Thats one way to run a battleship: Wait until most crew members agree that youre sinking and that it may be too late to save the ship. Maybe Burke was too much the overly indulgent parent, helping the hospital ease by, when she should have been taking out the switch.
The supervisors admitted Tuesday that change should have come long ago. Burke said so, too, but she also found a way, for better or worse, to keep her adoring masses adoring.