County Pledges to Correct Problems at King Hospital

Los Angeles County health officials Tuesday acknowledged scores of serious patient care deficiencies at Martin Luther King Jr./Drew Medical Center and pledged in a lengthy report to correct all problems in order to prevent a threatened shut-off of about $60 million in public health care funds to the hospital.

The corrective actions, which must be approved and verified by state and federal health officials, include hiring more nurses, housekeepers, clerical workers and other staff, as well as adhering to standard hospital practices, such as maintaining cleanliness and keeping proper records, to ensure better patient care.

But health care officials and analysts say it remains to be seen whether officials at the 430-bed, county-operated hospital in Watts can make all the far-reaching changes needed to turn the hospital around by the Dec. 21 fund cutoff deadline set by the U.S. Health Care Financing Administration.

“This hospital obviously has some very fundamental problems,” said HCFA official Tom Morford in Washington. “There’s lots of work to be done both management-wise and resources-wise. . . . Clearly, this is a situation that didn’t start yesterday. This isn’t a place that fell into a little disrepair overnight.”

In reports totaling more than 200 pages, state health inspectors last month cited King for massive, wide-ranging Health Code violations that could jeopardize the hospital’s license and disqualify it from receiving public health care dollars through the Medicare and Medicaid programs. Major breakdowns were reported in the areas of nursing, dietary care, infection control, quality assurance, physical plant and administration. Flunking an inspection in even one of these areas can result in a cutoff of public health care funds.

The reports followed a series of articles in The Times detailing numerous deficiencies in patient care and administration at the hospital.

Remedying these kinds of “systemic problems,” Morford said, requires a tremendous expenditure of money and energy. “But it can be done. It’s not impossible.”

He pointed to Cook County Hospital in Chicago, which narrowly avoided a cutoff of about $80 million in public health care dollars in July. City commissioners allocated an extra $30 million for capital improvements in the aging 1,018-bed facility. And hospital officials implemented a massive personnel shake-up, replacing, for example, the whole nursing administration, according to the hospital administrator, Terrence Hansen.

Plan of Correction

In Los Angeles, health services chief Robert Gates reported Tuesday in his plan of correction for King that he will step up efforts to fill vacancies at the hospital and that he has obtained “clearance” to hire other additional personnel such as a new assistant director of nursing. But he attached no price tag. Previously, he has stated that the hospital is drafting a $3.5-million request for new medical equipment.

State health inspectors spent two weeks at King in June spot-checking the hospital’s entire operation after an analysis of Medicare patient deaths nationwide ranked King in the bottom 50 of 5,577 hospitals surveyed across the country.

Among the major problems they cited in their report last month was a “consistent shortage of registered nurses” at King, resulting in unqualified nursing students and attendants providing “compromised” care to acutely ill patients.

They found nursing students caring for patients who were on ventilators and cardiac monitors and being fed intravenously. Unqualified nursing staff was also reported to have cared for post-partum women with dangerous fevers, and for a child with a gunshot wound. In many cases, nursing records showed no documentation that medication and treatments had been given patients as ordered by physicians.

In the plan of correction, Gates stated that new classes and training will be offered to nurses and that nursing management will be held accountable for supervising patient care and assigning qualified nursing staff to treat patients.

But he added: “Due to the severe nursing shortage, numerous vacancies exist and recruitment is difficult.”

Resolving the hospital’s nursing problems may be the toughest chore of all at King, many health care officials agreed.

“You certainly can’t hire a lot of nurses immediately,” said Kathy Barry at the Hospital Council of Southern California. “It takes up to six months to fill positions in an intensive care unit, for example.”

“The nurse staffing is the big problem,” said an official at the Joint Commission on Accreditation of Healthcare Organizations. “I don’t see how they’re going to crack that nut in three months.”

No Funds Actually Lost

He added, however, that he knows of no major public hospital in the country that has ever actually lost its public health care funding, though several have been threatened.

Morford said in this case that unless all problems are corrected by the deadline, the funds will be cut off.

“Usually, what happens,” said Morford of the HCFA, “is that you expose the facts of the situation and people say, ‘Geez, we’ve got to do something.’ People get into gear, and we’re hoping that will happen here (at King.)”

Among the hospital’s most serious shortfalls, inspectors found, was the repeated failure by King’s dietary staff to assess patients’ nutritional requirements. In his response, Gates did not deny problems in this area but pointed out that clinical dietitian staffing has been short because of unfilled vacancies. He said, “We are looking at alternatives for staffing--part-timers, job sharing, incentive pay, dietetic students, four-year college graduates with nutrition degrees.”

Infection Control Problems

In the area of infection control, the report also found numerous problems:

Urinals containing urine were found on so-called over-bed tables alongside food trays. Infectious waste containers and containers intended specifically for used needles were overfilled and uncovered.

Intravenous tubes were not labeled with the date when treatment was initiated, making it impossible to tell whether the tubes had been changed every 48 hours as required. And tubing used for connecting a patient to a ventilator was found draped over the patient’s bed five days after the tubing had been disconnected. The investigators found a suction tube nearby “completely coated with dark brown, dried sero-mucus material.” One piece of equipment was so “encrusted with filth” that the odor attracted investigators’ attention.

The “morgue refrigerated holding box” had not been cleaned and appeared to contain body fluid, the inspectors found. Those conditions raised the possibility of health risks for personnel getting samples from cadavers stored in the box, the investigators said.

Gates responded that renewed emphasis has been placed on the importance of good housekeeping and adherence to the hospital’s infection-control program. A pilot program, Gates said, has been set up to study the feasibility of having housekeeping staff report to nursing management to assure “the timely and appropriate removal of waste.”

Approves Hiring

Gates said that 18 housekeepers have been approved for immediate hiring.

As for the numerous pieces of medical equipment that health inspectors charged had not received timely maintenance checks, Gates said that he would authorize use of overtime and hiring of additional personnel to ensure that all equipment is properly serviced.

At the California Assn. of Public Hospitals, executive director Carol Emmott said of the task that King faces: “It’s a long trough they’re going to have to dig out of.”

“These (problems) are not the kinds of things you throw dollars at and they immediately bear fruit.”

She said the last hospital she can remember in California that faced such a predicament as King was San Francisco General Hospital.

“That is the last one where I can remember a major full-court press to meet a number of objections by regulatory agencies,” Emmott said.

‘Major Personnel Shuffle’

Diane Miller, senior assistant administrator at San Francisco General, recalled that when the hospital faced a loss of its public health care dollars in 1984, the county supervisors pumped more than $1 million into the institution. The hospital went through a “major personnel shuffle” in which the county health services chief lost jurisdiction over the hospital, the hospital’s chief operating officer retired and the nursing director was reassigned, along with all but one of her seven assistants.

“It took us a full year to turn the hospital around,” Miller said.