Lawyers Tell of Swift Fixes at King/Drew

Responding to a blistering federal report on conditions at Martin Luther King Jr./Drew Medical Center, lawyers for the public hospital insisted Friday that it had taken “swift and decisive action” to correct a host of problems that may have contributed to the deaths of several patients in the past year.

The Willowbrook hospital, owned by Los Angeles County, responded to the report by the U.S. Centers for Medicare and Medicaid Services in an effort to avoid the loss of roughly $200 million in federal funds, about half its annual budget.

The audit, obtained by The Times this week, found that hospital administrators had demonstrated an “inability to provide quality nursing care to meet the needs of their patients.”

In a lengthy response completed Friday night and released by the Los Angeles County Department of Health Services, lawyers for King/Drew said the county had revamped the hospital’s management, increased nursing staff levels, instituted new training programs and otherwise attempted to correct numerous, serious problems.

“King/Drew has taken a multitude of prompt and comprehensive actions,” said a letter attached to the hospital’s response.

County Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, said she was cautiously optimistic that the recent, highly publicized setbacks at the hospital would provide the impetus for the county to turn things around.

“I think that the attention has been brought to such an extent, and it’s such a crisis, that there’s going to be tremendous cooperation to try to solve the problem,” she said in an interview.

Burke said she recognized, however, that there would be resistance to change, especially to firing people.

“But,” she said, “it’s a time when you have to move forward and do what’s necessary.”

As Burke and other supervisors are quick to admit, however, it is not the first time that the county has promised to fix problems at the hospital, which has a long history of critical reviews and management shakeups.

The federal report noted that hospital officials had failed to fix dangerous lapses in care last year after promising to do so.

The report described the hospital’s failures in graphic, clinical detail, including three instances of patients who died after being left unattended for hours by medical staff. One 20-year-old man, suffering from gangrene of the intestines, died in a pool of his own vomit after being virtually ignored for 18 hours after his arrival at the hospital by ambulance.

In all, government inspectors have identified five patients at the Willowbrook hospital who died last year after serious lapses in care.

According to the report, nurses told inspectors that they were ordered to downplay the severity of patients’ conditions to get around rules requiring more nursing care for the sickest people.

The federal findings could lead to criminal charges against nurses or their superiors.

Moreover, Susan Brank, a spokeswoman for the state Board of Registered Nursing, said Friday that her agency would be investigating the nurses implicated in the federal report. For confidentiality reasons, she said she could not say whether the investigation had begun.

The county’s response represented the latest effort to resolve entrenched problems at the public hospital. King/Drew is one of the few providers of healthcare in a broad swath of South Los Angeles that is home to the county’s poorest residents.

The county hospital is affiliated with the private Charles R. Drew University of Medicine and Science, which recently lost accreditation in two of the doctor training programs it runs at King/Drew.

The federal Medicaid agency can either approve or reject the county’s response to its review. If the agency rejects the response, it could either give the county more time or set a date to cut off federal funds.

It would be highly unusual for the agency to follow through with a funding cutoff -- but a federal official said Thursday that the findings in the report are unusual in their severity.

If the county’s response is accepted, the agency may still return and hold an unannounced inspection to determine whether the county is adhering to its corrective plan.

Burke said she believed that conditions at the hospital had improved in recent weeks. Senior county health officials have effectively taken over management of the hospital and have brought in a consulting firm to overhaul nursing operations.

Two nurses at King/Drew also said Friday that there had been a significant improvement since the consulting firm, the Camden Group, took over nursing management Dec. 20.

The nurses said, however, that the staff at the hospital was taken aback by the criticism in the federal report.

“From my perspective, it’s pretty painful to read and it’s pretty painful to hear such comments about our nursing staff,” said Estelle Martin, a registered nurse who has worked at the hospital for 12 years. “I feel bad for the families and the patients,” she added, “because I wouldn’t want my family members to go through those things.”

The federal report was based on visits and interviews conducted in December and early January. In one visit, on Dec. 23, three days after the nursing management change, the inspectors found that nurses who were assigned to watch cardiac monitors did not know how to read them.

Martin and another nurse, Alan Noel, acknowledged that patient care at the hospital had slipped to unacceptable levels, but blamed the decline on severe staffing shortages. Noel said a single nurse might be left in charge of as many as 14 patients, more than double a normal load.

Under such conditions, he said, patients were often neglected and it became impossible to administer decent care.

“You have 14 patients and one patient crashes, you have to spend all your time with that patient,” Noel said.

Since the change in nursing management, he said, more nurses have been on duty, although there are still too few nurses working the night shift.

But like Martin, he said morale had taken a sharp blow with the release of the federal report.

“We were just starting to make new progress.... They’re trying to implement change, and then we got hit again. Every time we go forward, we get pushed back a couple of steps.”

Martin said she remained optimistic that the hospital could deliver quality care. She also insisted that the recent reports about King/Drew had tarred many good nurses and doctors with the failures of a few.

“A lot of us still have the enthusiasm and maybe the spine it takes to fight back and say, ‘I’m not compromising the care I provide to my patients no matter what management’s problems are,’ ” she said.

Others, she said, “are so downtrodden and exhausted from fighting every day for staffing that they just take what’s given to them and do the best that they can with it.”

Times staff writers Charles Ornstein and Daren Briscoe contributed to this report.