|Building photos by Slobodan Dimitrov|
Every weekday for at least six weeks last fall, between noon and 1 p.m., Lillian Mobley picketed at the main entrance to Martin Luther King Jr. Medical Center, the county hospital that sits in the long-impoverished triangle of Compton, Watts/Willowbrook and Southeast Los Angeles. Many of those days, Mobley was joined by a small band of supporters. Their signs: “Save Our Hospital” and “We’re Staking Our Claim.” But on some days, Mobley, a determined-looking woman with a habit of holding her chin up even in moments of rest, stood vigil alone, silently exhorting passersby not to protest but to take notice of a black institution that is becoming more endangered by the day.
She rarely gets the media attention of other Watts activists, like Ted Watkins or “Sweet” Alice Harris, but everybody connected to King/Drew knows who Mobley is. She serves on the board of Charles R. Drew University of Medicine and Science, which is across the street from King and was named for the pioneering black doctor and blood researcher who officially made King/Drew a teaching hospital in the early 1980s, establishing both a medical and an educational institution in the middle of the hood. Mobley also serves on a host of other committees and organizations, most significantly the special task force convened by county Supervisor Yvonne Brathwaite Burke and headed by former Surgeon General David Satcher to address the many problems at King/Drew. A research clinic at the hospital was named after her. There is no question that Mobley is dedicated to the survival of King/Drew. She carried her sign not so much as a protest against the growing swell of bad press and managerial shakeups at the beleaguered institution but as a daily reminder to the world that she cares about the hospital’s fate, that, for good or ill, it is indeed her place.
And lately, her place is in crisis. King/Drew has been unsteady on its feet for much of its life, and the newspapers have been reporting for the last dozen years a litany of troubles: racial tension among top management, needless patient deaths, absentee or negligent supervising doctors, students matriculating through the residency programs alarmingly ill-prepared for their chosen professions. By late 2003 the story appeared to have evolved into the last stages of a terminal condition: Struggling hospital meets an end that, in retrospect, was only a matter of time.
But Lillian Mobley knows that there is much more to the story, and to King/Drew itself. For King/Drew is a brick-and-mortar manifestation of the Dream, a towering signifier of the last serious age of possibility that many blacks say is not done, not yet. I know the Dream well. It is shorthand for the Great Society vision of true racial progress and equal access most famously articulated by Martin Luther King Jr. himself, and assumed as spiritual community property by blacks in the 1960s who felt — and still feel — that they had the greatest stake in the Dream and every reason to follow its course. More than thirty years and innumerable disappointments later, the Dream is battered, stagnated, in many ways circumvented, awaiting all the things that should have happened institutionally, politically and culturally. But it lives, and a critical number still believe and still follow. Lillian Mobley believes in the Dream.
Much about Mobley recalls Harriet Tubman — her dark complexion and tendency to wear African-style dress, and a fixed, fierce expression that reflects the uncompromising approach to black concerns that’s been her trademark for at least 30 years. She can be maternal too: Whenever I see her, she softens, breaks into a smile and inquires eagerly after my father, whom she’s known for years as a fellow foot soldier in the battle to realize King’s Dream in its fullest sense.
Right now, Mobley is fighting on one burning front of that battle — a battle for the continued growth of a teaching hospital in the black community where it took root. It is a battle for personal and cultural enrichment being fought on public ground, a conflicted but common scenario in black history that is notably lacking in wealth, property or other material enrichment accumulated over time. Blacks consider this county hospital, like public schools, to be for us even though it is not by us. The tension between ownership and stewardship is but one of many things that has complicated its progress.
Historically, big public entities have opted out of serving the colored public, leaving blacks to create those entities on their own, among themselves. This was actually a workable solution in the days of segregation, when the constant threat of marginalization birthed institutions like Howard University, Meharry Medical School and other havens where the best and brightest black intellectuals created out of pressing necessity places to excel on their own terms. But if those days were officially gone by the late 1960s, when the last vestiges of Jim Crow were outlawed for good, the black mistrust of public entities remained — along with the feeling that any project created for the benefit of blacks must still be done by black people themselves.
Citizens like Mobley were therefore always caught between reasonable paranoia and pragmatism, between keeping the county at arm’s length and demanding that it give its all with few questions asked. And those black King/Drew doctors and other staffers who worked for the county were expected to also work apart from it, to service the Dream and an inchoate but ambitious black agenda before anything else.
Mobley admits to being involved in too many aspects of the fight at this moment, when so much hangs in the balance at King/Drew. Decisive news about the place is breaking faster and faster, building to a crescendo, decades in the making, that has finally peaked, just across the threshold of another new year. Mobley is integral to that news; I need to talk to her. “And as soon as I get free,” she reassures me, “I’ll call you back, honey. I will.”
She doesn’t. I believe she wants to call back. She can’t. She won’t get free and likely never will. I can never ask her about her part in the troubled history of King/Drew, because I am not meant to ask — because Mobley, though hardly the whole story, is an irreducible element of it; beyond her, there is no one left to ask. She knows. She is a point of truth that could doubtless untangle the complex web of truths that is King/Drew, a source of answers for all the questions I have carried about too carefully for too long: Is Mobley the community? Is the community Mobley? Are Mobley and that community as problematic as people say they are? Is it possible that the layperson most associated with the medical endeavors at King/Drew and most lauded for its achievements is also its heaviest ball and chain? And why give a rip about a place that seems pathologically incapable of getting better, like so many other things in our — excuse the word — community?
This is an exaggeration, surely. But I have spent years criticizing the problem of accountability in the black community and only rarely the people themselves; now is the time to call them out. Lillian Mobley could have given me names and faces; she might have even been courageous enough to give me her own. Mobley, however, cannot talk to me about this, or anything else. She is too compromised to speak in this story, even if I were never to mention her by name.
I deeply believe in King/Drew in its original and enduring abstract — a hospital for a People who went too long without — but I realize I know too little about its ordinary life over the last 30 years to put much spine into that conviction. At the hour of King/Drew’s greatest need, I am anxious for the details about everything — its decline, its triumphs — details that must start with the black community that, after all, willed it into existence with the force of its own misery a generation and a half ago. This is our story, flawed though it is, and Lillian Mobley knows it far better than I do. Yet with her or without her, I have to tell it. I may not be qualified to tell it, but I have no choice. The questions that I ask I will have to answer, however imperfectly, myself.
King/Drew has been in one spotlight or another for a long time, from its improbable beginnings in the late 1960s right up to the moment of its current crisis, the worst in its history. This crisis is an accumulation of several smaller ones over time that finally converged in a single year and led to recent decisions by medical-education accreditation officials to shut down two of King/Drew’s key residency programs, surgery and radiology, in June. Without residents, particularly in surgery, it is doubtful that King/Drew can continue as a full-service hospital and emergency room. Another important residency program, neonatology, was recommended for closure, and several more, out of 18 total, that are on probation may follow the same fate. County health officials shut down a patient-recovery unit where three women died last year under questionable circumstances. As an institution, King/Drew has received two consecutive ratings of unfavorable from the accrediting body, a distinction it shared this year with only 13 other U.S. hospitals that have a comparable number of residency programs. Two weeks ago, partially in response to criticism from the Satcher-Burke task force, Drew University placed its president, Dr. Charles K. Francis, on paid administrative leave.
Everybody who supports King/Drew knows that the institution is not what it should be, and they agree that this is all the more reason it must go on, preferably to greatness. Missing in this age of diffused demographics and lax, King-less leadership, however, is a consensus about exactly how King/Drew should go on — who should do what, and when. A crisis of direction that has never been taken seriously must now be suddenly, expertly solved by an increasing number of interim management teams, task forces and oversight committees that seem to materialize every week.
The odds of the problems being solved quickly don’t look good. Public institutions that chiefly serve black people rarely reach parity, let alone soar. Take education, another crucial aspect of the Dream: Improvement seemed imminent 40 years ago, but crises now endlessly fester in a climate that feels entirely separate from the sunny outlook Americans still like to associate with their national character. The discussion of what to do about black/poor/urban schools has taken on an independent, insular life that might go on forever, with increasingly fewer people outside the actual discussion taking any notice. Fortunately or not, the future of a black hospital (which King/Drew initially was, and still is to many) cannot be so open-ended — success and failure are not measured in anything so subjective as test scores and exit exams, but in botched surgeries and body counts. People’s lives are at stake every moment (just as they are in education, although not as dramatically), and so we must have a solution.
The current crisis at King/Drew is, in some respects, the end of history. It is the possible end of King/Drew as a racial movement — a prospect more unsettling to its supporters than a lack of money or attention, which after all has become the norm. Losing or even diminishing King/Drew’s status as a local touchstone of unfolding freedom dreams in a black community that dwindles each year would be a terrible reminder that we have lost what we should have had but never got; it would be like watching Koreans assume control of the convenience stores and markets of South L.A. 20 years ago and realizing with a start that we never had those stores to begin with, that the economy ‰
was never even ours to cede or give away.
After years of maneuvering around the uneasy questions and bad terrain, King/Drew has come to a precipice and is being told there are no more curves left on which to learn. For those long vested in its success and those who are sick of the setbacks, who know well that achieving King/Drew is about tangibly achieving so many other dreams that lost definition long ago, this is a terrifying and liberating thought — get it right, or go home. No more waiting and no more excuses, no more sheltering dream. No time left for experiments. No going home.
In 1965, the McCone Commission, appointed by the federal government to study the root causes of the Watts Riots, found that one crucial service the area lacked was a hospital. County Supervisor Kenneth Hahn immediately took up the cause, and in 1972 the hospital opened its doors at Wilmington Avenue and 120th Street. Hahn ensured that it was named after Martin Luther King Jr., the martyred civil rights leader who had provided Hahn with a golden moment when he visited Los Angeles in 1961 and Hahn turned out to be the only elected official in California to greet his plane; a black-and-white photo of that meeting hangs prominently in the foyer of the hospital’s mental-health wing. Directly across the street on the 120th side is Drew University, which opened in 1981 as the full academic complement to King. (Prior to ’81, Drew existed as a residency-training program for King, but not as a university. Drew also has a College of Allied Health, which offers certificates and independent degrees in a variety of medical support professions and never developed the questionable reputation of the medical school.) The hospital and university are collectively known as the King/Drew Medical Complex, and though one is public and the other private nonprofit, it is nearly impossible to separate their functions and fortunes. This is a public hospital bound from the beginning to private interests — but not money interests.
Consider that King/Drew grew the careers of many black doctors, sometimes exponentially, and gave their concerns about community medicine a place to live and breathe — concerns they had held at bay at places like Columbia and Walter Reed and Yale. When it opened, it became a nexus for the smallish world of black health professionals on the West Coast who came to build their résumés and fill positions and head departments that had never existed for them before. Many came and left and then came back, including just-ousted Drew University president Charles Francis and just-appointed interim president Harry Douglas, who was until recently the university’s executive vice president. Special-task-force head David Satcher once chaired Drew’s department of family medicine and in the ’70s instituted the community advisory council that has figured so prominently in the university’s fate ever since.
Like Los Angeles itself, King/Drew is not a place people tend to leave easily or permanently. Veterans refer to their multiple tenures at King/Drew as “tours of duty,” and they say they come back because there is always more that must be done, more aspects of the Dream to refine. It’s also possible that many come back because they have nowhere else to go: Career-minded black doctors and other health professionals were held down by racism and glass ceilings at other places 30 years ago, and they still are today. But there is also a belief among some staffers and others that chronic nepotism and cronyism — allowed by management and often reinforced by the community powers that be — have over the years stunted the professional and institutional growth of King/Drew. “There were a lot of people promoted because of who they knew and who they slept with,” says a former King staffer, who asked not to be identified. “There’s a whole cadre of people holding on to their power.”
Another current Drew staffer added, “Over and over, the Peter Principle comes into play. Many people [here] are just doing paperwork.”
Many, but not all. This is the second tour for Douglas, a genial man with silver hair and a tweed jacket. He worked first in King/Drew personnel during the ’70s and came to the university in the early ’80s to set up the College of Allied Health, an accomplishment of which he says he is most proud. He says Drew’s vision is to be the Howard University — his former employer — of the West Coast, and go beyond.
“I’ve often thought that if we had the talent here that we had at Howard,” he says, “we could rule the world.”
He admits to having struggled with returning to King/Drew because it frankly was never easy to accomplish what he first had in mind to accomplish. “What I didn’t get initially was that this was a new place and you had to establish everything — support services, departments, everything,” says Douglas. “You had to clear your head of everything that you knew and build from there.”
This was the second tour for Charles Francis as well. The first chief of cardiology at King/Drew, from 1973 to 1977, Francis was most recently a principal investigator with the Urban Health Institute at Harlem Hospital before he “got the calling” to come back. He is quiet-spoken and assured but has an edge, an excitability that is most evident when talking about King/Drew. He says the place has been a magnet for black doctors almost by definition, and that when he first arrived, in ’73, “There were more black neurologists, cardiologists and other specialists in L.A. simply because of the presence of King/Drew.”
Francis thinks people forget the good things — the full-degree programs in the College of Allied Health, Drew’s role in building the academically successful King/Drew Medical Magnet High School within Los Angeles Unified School District, its role in building a similar magnet at an elementary school campus in Compton, that school district’s first. Some 80 percent of Drew grads go on to work in underserved and minority communities, and Drew has spun off nearly 20 community-based health and education programs, including the Saturday Science Academy for youth. Drew has steadily increased its research funding in the last three years and has added research opportunities at a time when the health gap between blacks and Latinos and the rest of the population, always wide, is growing dangerously wider. While it has been cited for not supporting enough trials and research, the university is raising funds for construction of a new life-science building for that purpose.
It’s not that Francis thought that all the encouraging stats gave him license to ignore others. “Things haven’t gone as I expected [at King/Drew], or to those of us who were here from the beginning,” he says. “That’s why I [came] back. A lot of the mission has been fulfilled, but I continue to be frustrated.”
That’s likely an understatement. Francis had plenty of detractors long before he was put on leave, beginning with Drew board president Alfred Haynes, who testified during a public hearing in September that although there was far too much ball-dropping between Drew and King hospital, the person ultimately responsible for the residency crises is the university president. This came in the wake of a controversial move last year by Arthur Fleming, King/Drew’s former longtime chief of surgery, to take on two more residents than are allowed by accreditation rules. The excess rankled accreditation officials and was widely seen as the beginning of a concerted crackdown on the surgery residency and other lingering deficiencies at King/Drew. Fleming lost his position, but strenuously maintains that he did nothing wrong and that he never received the accrediting council’s warnings; Francis claims that Fleming most certainly had. Fleming told me that he plans to fight his removal, but he didn’t tell me exactly how.
Late last year, a letter signed by several local groups but authored by no one specifically (though it implicates Lillian Mobley and a few others by praising them in the text) began circulating in protest of the intensifying censures and shutdowns. The letter is a kind of declaration titled “Back of the Bus Is Waiting,” and it denounces what it sees as the racism of county officials, interim management and other white outsiders who are determined to take the hospital out of the hands of the people — which include, by the way, King/Drew’s “wonderful Hispanic employees,” who are being as rudely treated as their black brethren. The letter mentions no political leaders by name but pointedly enthuses over “the wonderful FEMALE COUNTY SUPERVISOR OVER USC who demands the BEST.” (Gloria Molina is widely known to fight tirelessly on behalf of “Big County,” as County-USC is colloquially known; no mention is made of her colleague on the Board of Supervisors, Yvonne Brathwaite Burke, whose territory includes King/Drew.)
The letter is chiefly a complaint about staffing decisions and department shutdowns, and it illustrates the necessary proactiveness and inevitable pitfalls of community involvement. The authors decry the loss of the African-American Fleming, who was removed over the summer as the surgery-residency issue heated up. They criticize Francis for criticizing Fleming in public and question his leadership. The letter maintains a righteous tone from the start, but gets explicitly religious in its conclusion, which prays for more things than one. “THE FIGHT IS NOT OVER!” it reads. “We will continue to fight the unfairness. It will be many rainy nights in Georgia before anyone is found competent enough to replace Dr. Fleming . . . GOD is on our side, and WE WILL WIN!” The final rhetorical flourish is “To God Be the Glory.” One of the groups listed as signatories at the bottom is the Christian Women for Justice, but it’s clear that the many individuals cc’d and named as community leaders — Assemblyman Herb Wesson, Congresswoman Maxine Waters, Mayor Hahn, Mobley herself — are expected to share in the passion, if not the faith.
Francis responds to the criticism, and particularly the role of community at Drew, delicately. Like other high-ranking people at King/Drew who have come and gone — perhaps too many — he neither fully accepts nor denies culpability. His position on Fleming is that he only iterated the findings of the accrediting body, nothing more. As to the community, “There’s always been that tension between them and the institution, but there’s no particular culprit here,” he says. “Certainly the community is entitled to express its opinion about what goes on. It’s evolved into a kind of operational watchdog, though perhaps not in concert with the leadership of the university.” He pauses. “Its intentions are good.”
It almost goes without saying, though it generally goes unwritten, that King/Drew has had successes. The hospital’s emergency room has saved many a life and limb threatened by bullet wounds, drug overdoses, heart failure and other conditions that have grown all too common in neighborhoods with too much street violence, too few jobs and too little preventive health care. (King/Drew actually trained Vietnam medics in its earliest days, though no one anticipated its one day treating urban war victims in greater numbers than the medics did on the front in 1974. It does now, and then some.) Defenders of the hospital like to cite the story of Alfredo Perez, a young South L.A. teacher struck in the head by a bullet in 1996 and then saved in dramatic fashion by King/Drew surgeons, as an example of the quality care and swift response to community needs the hospital stands for.
But always there were tragedies of error that, unfairly or no, sucked up all the attention and consigned King/Drew to a permanent probation in the mind of the public, including the public it served. Among the many high-profile mistakes were the patient who died of a swelled brain in the late 1980s because the neurosurgery department was understaffed; Sheriff’s Deputy Nelson Yamamoto, who died in 1992 from multiple gunshot wounds after lingering for two days; Torin Comeaux, who died in 1997 at King/Drew because his vascular surgery was too long delayed; a patient who died in 1998 after mistaking a toxic solution of formaldehyde left at her bedside for drinking water; and three women who died last year due to the malfunction of a new patient-monitoring device and, it was discovered later, to human error that had gone unreported. These mistakes are unjustifiable on their face; arguing institutional neglect, however true, in defense of King/Drew’s transgressions sounds like something less than a bad excuse.
For 30 years, management and internal problems at King/Drew have developed faster than the scope and quality of its services, threatening to eclipse the whole enterprise. Those problems are considerable. Racial tensions that were originally black and white — the community against county officials and other “outsiders” — have expanded over years of demographic change in the Watts/Willowbrook/ Compton triangle to black and Latino; today, Latinos are nearly 60 percent of King’s patient population. Then there are the other doctors and residents of color, many of them foreign-born — Thai, Indian — attracted to King/Drew in part because its mission of racial equity and social justice via medicine resonated with experiences and expectations of their own. ‰
But often the new ambitions of the global South ran up against ancient black frustrations rooted in the American South, resulting in workplace harassment perpetrated by some black doctors, which their non-black victims then fought publicly in county hearings and lawsuits. All this made for irresistible headlines: New black racism was tearing King/Drew apart and making a mockery of the Dream. When the dust settled — more or less — the stakes of improving life at King/Drew were as high as they had been before. But no one seemed to have a clearer idea of what to do or a will strong enough to do it.
And so the problem, says state Assemblyman Mervyn Dymally (D-Compton) with a big sigh, is always not so much what’s happened at King/Drew but what hasn’t. The real story here is a tedious one of negative space and neglect that is by definition invisible — not a story so much as a condition. It’s not something that ever grabbed media attention or galvanized public interest, not even in the ’70s afterglow of the civil rights movement, except when things blew up or went sideways.
Like other black politicians of his generation, Dymally is familiar with this dynamic. He is an assemblyman representing the Compton area and King/Drew turf, a position that caps a lengthy political career distinguished early on by a bill he authored in the late ’70s creating Charles Drew University as a full medical school offering undergraduate degrees and, later, the College of Allied Health. Because the undergraduate program couldn’t exist on its own, Dymally forged a partnership with the University of California, under an agreement in which students would spend their first two years at UCLA, the second two at Drew, then graduate with degrees issued by UC but jointly conferred by both institutions. It was not quite a shotgun wedding, but neither was it ever ideal.
“Historically, there’s always been this antagonism towards UCLA, this feeling from certain people on the Drew side that at some point [they’re] going to come in and take over,” says Dymally, who chairs the Assembly Select Committee on King/Drew, created late last year. He says the antagonism on the Drew board expanded over the years to include “anti-Drew factions, pro-Latino factions and the anti-faction faction. And who’s in charge? Nobody.” To own up to being in charge, of course, would mean taking charge of the pooling mess of sanctions and closures at King/Drew. UCLA is the entity most likely to take over residency programs at the university, if it comes to that, though it isn’t exactly leaping at the chance.
King/Drew insiders say, curiously, that the entity most in charge is the community. This is not meant as praise. Community involvement in any enterprise is a tortured thing; like democracy, it is often poetic in theory only. And community involvement in King/Drew’s management is widely regarded as a hindrance to real progress, even as it is also acknowledged as vital to King/Drew’s post-riot mandate and to the eternal drive toward self-determination that powers the Dream. Drew officials also tout their campus as an early and important model of the urban university — the “communiversity” — that forges direct ties to the surrounding neighborhood rather than iron fences to keep it out; what was once discussed as an ideal of higher education in the ’70s and ’80s is now being commonly implemented, they say, thanks in part to Drew.
But what people really mean when they talk about the problem of the King/Drew community — a term used very haphazardly when speaking of black people — is not the entirety of Watts or Willowbrook, but the Lillian Mobleys, a small handful of locally influential folks who sit on boards and advisory councils at the hospital and university, among other places. They tend to have been around since the hospital’s beginnings, have been residents of the area even longer than that and see themselves as the truest believers in the struggle to realize the Dream. Which indeed makes them veterans but doesn’t necessarily make them paragons of justice and evenhandedness.
Critics say that the community has routinely protected jobs and its own personal and political interests at the expense of what’s best for the administration of King and the university; the warrior battling the dragon of the system has become the snake devouring its own tail. “They [community people] got on the ground floor of this thing and never got off,” says a current Drew employee who asked not to be named. “It’s a bunch of old folks who always show up to protest when something happens that they don’t like. They mau-mau, they bogart. They don’t want anything to move. And the administration is simply not dealing with it.”
Even Supervisor Burke, who has been all but silent for years about the troubles at King/Drew, admitted in recent months to having bowed to grassroots pressure — against her better judgment. “Personally, I think I should have pushed for many of these people to be replaced,” Burke told the Los Angeles Times in reference to department chairs at King hospital. “But anytime anything is done, the community has become totally upset.” Though Burke has adopted a tough-get-going attitude in the wake of the new crises, her comment provokes big questions of accountability — if she really knew what should have been done at King/Drew, why on earth didn’t she do it, community objections be damned? Whatever influence these community folks have, they are not county supervisors or health-department officials whose job it is to run a major hospital. It is fine for Burke to say that the Dream must live on and that closure or downgrading the hospital’s rarefied status as a Level I trauma center “is not an option.” But kowtowing to a community that’s allowed to operate as a kind of shadow government smacks of buck passing. The former King staffer who started a career there in the early ’70s says that Burke epitomizes the laissez-faire political approach that has always been a big part of the problem. “She’s a piece of work,” says the staffer. “Every month there’s this huge exposé about King/Drew, and she appears shocked and innocent about the whole thing. Why doesn’t she get a handle on things?
“Burke’s protecting her own people and their positions,” the staffer maintains, “and herself politically. Now she’s in fear of her own job, and this thing is blowing up all around her.” Many others say also that King/Drew suffers because it has no real political patron who is willing to take it firmly in hand and address problems early — say, about 10 years ago — before they mushroom into disasters. They say Burke is no Gloria Molina, her colleague on the board of supervisors who advocates aggressively for County-USC. “It’s not that other places don’t make mistakes like the ones that have happened at King/Drew,” says the staffer. “The difference is that King/Drew is under a microscope, but it has no protector. Bad things happen and it twists in the wind.”
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.”
Garthwaite says he’s personally “tried to go and talk to people and assure them we’re not trying to take away your hospital, we’re trying to save it. There are people on the board who want change. But there is push back in a lot of other directions from others.”
Dymally says that King/Drew has no friends in Sacramento, a situation he is trying to change in part by enlisting the aid of the sizable Latino caucus. “Look, there are six of us now and 36 of them,” he says. “What are we going to do?”
At a recent private meeting of local legislators, concerned community members and King/Drew staff members — a meeting that had Nate Holden pounding his fist on the table and demanding that blacks “speak out about the truth” and “fight for our rights” — a King/Drew resident told a nightmarish story of a nurse in the psychiatric ward, a ward staffed chiefly by women, who was attacked by a disturbed male patient. The nurse pushed what’s called a “panic button” — an alarm meant to immediately summon security at such moments — only to find, inexplicably, that it had been disconnected. Fortunately, the nurse’s calls for help were answered by other staffers in the vicinity, but it was only after that brush with disaster — a year and a half after —that the county responded and the button was repaired. Such is the cautionary metaphor of small things spiraling out of control and too little, too late — one of many metaphors that are too often reality at King/Drew.
There exists an old cliché within the race that generally turns out to be true: Something or someone black has to be three times as good to get over, and sometimes even that’s not good enough. But in this more racially complex, post–affirmative action age, people don’t scrutinize the performance of black institutions so much as they simply ignore them until it’s too late. In the early ’90s, the state medical board was accused of minimizing its investigations of medical negligence at the hospital infamously nicknamed “Killer King” not just for its reputation for incompetent medical care, but for the violent environs in which it was located. But medical-education officials have only lately ‰ really dropped the hammer on Drew University; authorities nowhere to be seen before suddenly turn unforgiving, repeating a pattern of neglect and punishment as old as slavery, waiting until matters have slipped into an unacceptable state before hitting the panic button. Blacks have perhaps exacerbated the problem by elevating King/Drew as a symbol of the Dream, which means it’s an equally large symbol of black dysfunction when things go wrong. The official black reaction to all this has been a kind of paralysis and de facto denial. A recent headline in the L.A. Sentinel, the local black newspaper, heralded “Progress Cited at Drew University,” which sounds encouraging until you get to the second paragraph, where it says that King/Drew was issued its second unfavorable rating by the accrediting council. The headline was not untrue, but it was a hell of a spin. I understand black people kind of need that spin in order to continue investing in the Dream, which at the Sentinel and elsewhere is getting tougher to do because so much news about black people is so disheartening these days. Of course, if we can’t tell the story truthfully to ourselves, we can hardly expect other people to, but many black people, including me, are often not quite sure enough of that story to know the truth.
A former county employee who worked closely with King/Drew told me she had the occasion to be a patient there once in the ER, and was so appalled by conditions — dirty gurney, three-day wait — that she went to Big County, where she claims to have received expert care. A couple at a recent dinner party I attended argued heatedly that the real problem is that King/Drew has been suffocating under the weight of all the negative stories; the wife, who works at Cedars-Sinai, said that all hospitals make grievous mistakes and all hospitals witness, if not hasten, patient deaths. It’s just a matter of who is the most convenient target, and who makes the headlines most often. Longtime staffers say that the infamous moniker “Killer King” was always something of a setup — a name coined by local law enforcement before the hospital even opened its doors. Talk about prophecy.
Whatever the truth, the reality is that King/Drew must first tackle the issue of normalization, of just getting to the point of being a hospital not primarily known for missteps. Then there’s the issue of excellence. One is a natural outgrowth of the other, but in the wayward effort to enlarge King/Drew, it seems as if normalization and excellence have gotten stuck in a single bottleneck and neither can squeeze through past the other. Dr. Ernie Smith, a pediatric cardiologist who’s been around King/Drew more than 20 years, says we’ve got the equation all wrong. “We demand a criterion for excellence when there never was any,” Smith huffed before an audience at a public hearing held by Satcher’s force at King/Drew last fall. “This place came out of crisis. People had to die in order to get this hospital in the first place. Excellence was never part of the discussion.” The discussion of how to become the best, Smith continued, is worthy but still largely academic. “The people paying the price for ‘excellence’ are not the surgeons here, but those in the streets pushing the carts,” he said. “The people we serve. They have nothing to do with all the stuff going on in the medical school.”
But others say striving for excellence is the only course of action possible, particularly given the acute needs of King/Drew’s clientele. “We can’t be as indigent as the population we serve, of course,” says Drew vice president Walter Strong. “Our mission requires the playing field to be leveled, period. We need that margin of excellence.”
The believers within King/Drew — administration, staff, residents — and also those outside of it would like nothing more than for their hospital to be exemplary. They would like it to be more than a tourniquet for the blood that flows daily in the black male homicide wars, which spiked (again) last year and got King/Drew back in the papers as ground zero for yet another crisis. This is the part of community medicine that neither veteran nor aspiring doctors quite bargained for, or at least they hoped it would be minimal at this point instead of epidemic. But in 31 years, reality has bitten at every turn.
Because of that, the Dream is solvent and less ethereal. “The hippie in me still believes in it,” says the former staffer. “If they — the county, the community, David Satcher, Burke, whoever — come in from all sides and work together, it can be done. It can happen.” The Satcher committee report, released on Christmas Eve, was measured but not nearly as optimistic, condemning Drew University as so many great intentions gone awry. It recommended a dramatic overhaul of leadership, beginning with the ouster of Francis, called for more UCLA involvement, and criticized board members and others at Drew who have simply stayed too long. Satcher perhaps summed things up best in concluding in his report that the university has “both served the community and failed it.”
But longtime activist John Jackson agrees with the former staffer that a make-over can be done, though not how. Jackson is a youngish street-level proponent of many progressive causes and regards King/Drew as one of them. “How do you shift from the current culture of King/Drew to one of accountability without causing shock and fear?” he muses. “We have great health-care advocates in town, we have well-meaning people who’ve been stretched. But we don’t have the mechanism to hold political officials accountable.”
Maybe that’ll change. Burke, the supervisor who hates making waves and who happens to be up for re-election this year, says that when it comes to King/Drew, “I have to weigh my responsibility against my popularity. If this hospital goes down, I will really go down. If people are angry with me, I have to take it. I’m prepared to take it. I’m not prepared to take the hospital being shut down. It’s not possible.” It is one of the most dire, but also among the most reassuring, statements Burke has ever made as an elected official.
But such courage may be yet another thing at King/Drew that comes too little, too late: This week, before the Board of Supervisors, Garthwaite submitted recommendations for improving King/Drew that included shutting down more residency programs, starting with neo-natology — those considered non-essential or too elaborate for the hospital to support — and turning over management of the programs left to more established local universities like USC or UCLA. To those who view any diminishment of King or Drew as a step backward and an erosion of the Dream, this is very bad news indeed.
Meanwhile, Mervyn Dymally has written a new bill, ACR 139, authorizing a joint-management team for King/Drew made up of officials from Drew, the University of California and L.A. County. Jackson suggests cultivating new, better, more enlightened community involvement to help King/Drew turn back the waterloo and move into the future. “We don’t validate emerging voices, and we need to,” he says. “There’s the value of simply having black doctors here and having kids see that. When they come visit, they walk out not wanting to be a Malcolm X or a Sojourner Truth, but a health professional.”
One King/Drew veteran, by far the most hardened and least hopeful of everyone I talked to, describes how he still sees the glass of opportunity as half full. To him, the crisis gathering now is but a dark underside of the Dream that has become a familiar part of its cycle of having and not having, of contentment, complacency and loss. “We’ve been written off so many times over the last 25 years, this feels like nothing,” he says with a shrug. “When I look around and see that we did all this with no money, I feel pretty good about that.”