How King-Harbor has stayed alive

For 3 1/2 years, Martin Luther King Jr.-Harbor Hospital has survived on a steady diet of last chances and last-minute reprieves.

Since January 2004, the public hospital has flunked more than a dozen inspections, and four times has been cited for problems so severe that regulators deemed patients in “immediate jeopardy.”

Not once, however, has the government followed through on its threat to pull certification and the vital federal funding that comes with it.

“Let’s be honest,” said Dr. Dennis S. O’Leary, president of The Joint Commission, a hospital accrediting group, “if this were a hospital different from King/Drew, this would have been over a long time ago.”

He and other experts interviewed by The Times said the government would have moved much faster and more aggressively if King-Harbor, formerly known as King/Drew, didn’t have a unique history and special standing in the community.

The hospital was one of the few gains from the 1965 Watts riots and still is one of the few places poor people in South Los Angeles can turn to for acute care. African American politicians, in particular, have embraced its salvation.

Experts in patient safety said King-Harbor’s problems raise nearly as many questions about the conduct of the U.S. Centers for Medicare and Medicaid Services as about the hospital’s leadership.

“At some point, the threat has to be real or it’s not a threat,” said Dr. Robert Wachter, chief of the medical service at UC San Francisco Medical Center. “What they’ve done is set a low bar and an expectation of opportunity on top of opportunity, third chances on top of fourth chances.”

At this point, experts said, the federal inaction runs the risk of undermining regulators’ power, at least when it comes to King-Harbor.

“If you keep drawing a line in the sand and you keep erasing the line in the sand, at some point the hospital and the community and the politicians think you don’t mean it,” O’Leary said.

The Joint Commission pulled its accreditation -- considered a seal of approval in the industry and a benchmark for many insurers -- from King/Drew in February 2005. The hospital, in Willowbrook, south of Watts, has not gotten its accreditation back.

Last week, the Medicare agency again notified King-Harbor that it was putting emergency room patients in immediate jeopardy of harm or death. King-Harbor now has 23 days to correct the problems or lose its funding, a threat even Los Angeles County officials said they expect, once again, to avoid.

“Plans to address the findings are underway and many changes have already been put in place,” hospital Chief Executive Antionette Smith Epps wrote in a staff memo Thursday night. “This challenge must be met with total commitment to quality patient care.”

To be sure, it is rare for the federal government to withdraw funding from hospitals; it does so fewer than five times a year. The goal in most cases is to bring them into compliance. Hospitals usually either improve or voluntarily shut down.

But records show that officials have acted against other troubled hospitals much faster, sometimes after a small number of serious lapses.

In May 2004, federal officials withdrew funding from Angels Hospital, a small facility in Rancho Cucamonga, after four patients died from allegedly inadequate medical care. Inspectors accused the staff of calling 911 on several occasions because no doctors were present, relying on paramedics to treat patients in life-threatening situations. The state pulled the hospital’s license, leading to its closure.

In 2003 and again in 2005, the Medicare agency revoked funding from Vermont State Hospital, a psychiatric institution in Waterbury, Vt. The first time was after two patients committed suicide within weeks. The second time came after back-to-back escapes by patients.

But Leslie V. Norwalk, acting administrator of the U.S. Centers for Medicare and Medicaid Services, said her agency has granted hospitals more time in other instances when the agency sensed a community need and a commitment to improve.

She cited Greater Southeast Community Hospital in Washington, D.C., which managed to improve after troubles in 2002 and 2003 but is now at risk of closing because of poor performance and financial reasons. That hospital serves a poor, primarily minority community, just like King-Harbor.

Norwalk said significant changes have been made at King-Harbor in response to federal pressure -- including its recent downsizing from more than 200 beds to 42.

She also noted that the hospital had voluntarily agreed in March to stop billing Medicare and Medi-Cal until it could prove that it met basic standards. That way, the hospital would remain federally certified -- key to keeping staff and maintaining a dialogue with regulators.

“This is something that we take very seriously,” Norwalk said. “Every single time that there has been a deadline ... we have moved it [the pressure] up a notch.”

King/Drew for years had run-ins with federal and state regulators. Its troubles date to the 1970s, shortly after its opening.

The most recent problems began in January 2004, when inspectors found that nurses lied in charts about patients’ conditions, failed to give crucial medications prescribed by doctors and left seriously ill patients unattended for hours -- including three who died.

Since then, the hospital’s failings have been documented in hundreds of pages of inspection reports that cited numerous avoidable patient deaths, dozens of medication errors and the use of Taser stun guns to subdue out-of-control psychiatric patients. Three of those inspections resulted in findings that patients were in immediate jeopardy, triggering the threats to pull funding.

By August 2006, after saying King/Drew had been given enough chances, federal regulators conducted what they called a “make or break” inspection. It was supposed to decide once and for all whether the hospital would lose $200 million in federal funding, more than half its budget.

King/Drew failed.

The Medicare agency said it would pull funding effective Nov. 30, “in the interest of patient health and safety.”

But another reprieve was granted after county health officials said they would drastically reduce and reshape services. Oversight of the facility was handed to Harbor-UCLA Medical Center, a county hospital near Torrance with a far better reputation.

Inspectors were due back in March 2007, but the hospital said it was not ready and asked for another delay, until August.

In the meantime, inspectors last week found patients to be in immediate jeopardy. They made the finding after two incidents received media coverage: the case of a 43-year-old woman who died after writhing on the floor of the emergency room lobby for 45 minutes and that of a 38-year-old man who waited for four days with no treatment for a brain tumor.

Thomas Scully, a former administrator of the Medicare agency who left in late 2003, said hospitals like King/Drew present regulators with a thorny dilemma but are “an unpleasant fact of life.”

“It’s a Catch-22,” said Scully, who oversaw the agency’s handing of Greater Southeast. “You have to be as tough as you possibly can, but the person you have to think about is the next kid who has spinal meningitis or the pregnant woman going into labor.... If your next-door neighbor or your brother or your dad had a heart attack and got into an ambulance, would you want that hospital to be open?

“If there was another hospital next door or other community options, they would shut it down in a heartbeat,” Scully said.

Even more than having inpatient beds at an inner-city hospital, Scully said, the community needs an emergency room where patients can be screened and stabilized. King-Harbor’s is busy; it treated nearly 47,000 patients last year and is on track to treat a similar number this year. (Under state law, an emergency room cannot operate independently of a hospital.)

Dr. Hector Flores, who at one time chaired a King/Drew advisory board, said regulators are acutely aware that if King-Harbor closes, it could overwhelm other hospitals in the region.

Flores said he’s hoping for a state or federal takeover of King-Harbor -- which could require an act of Congress.

“It has had enough chances,” he said. “They just need to look at something radically different.”

charles.ornstein@latimes.com

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(BEGIN TEXT OF INFOBOX)

A troubled history

The U.S. Centers for Medicare and Medicaid Services has repeatedly found Martin Luther King Jr.-Harbor Hospital out of compliance with its minimum patient-care standards.

January 2004: Inspectors find that nurses lied about patients’ conditions in their medical charts, failed to give crucial medications prescribed by doctors and left seriously ill patients unattended for hours.

March 2004: The Medicare agency finds patients are in immediate jeopardy after the hospital failed to administer medication accurately, failed to investigate medication errors and lacked “general oversight” over pharmacy services.

June 2004: The Medicare agency finds patients are in immediate jeopardy because the hospital relied too heavily on county police to use Taser stun guns to subdue aggressive mental patients.

October 2004: Under pressure from the Medicare agency, Los Angeles County hires outside consultants to run King/Drew.

December 2004: The Medicare agency again finds patients in immediate jeopardy because of continued use of Tasers.

September 2006: King/Drew is informed that it had failed what was billed as a “make or break” inspection and would lose annual funding of about $200 million, more than half the hospital’s budget.

October 2006: Federal officials agree to delay pulling King/Drew’s funding. In turn, county officials agree to reduce the hospital to 42 beds from more than 200 and place it under the oversight of Harbor-UCLA Medical Center. The hospital’s name changes to King-Harbor Hospital.

March 2007: Federal officials agree to another extension, this time until August. The county says it will not bill Medicare or Medicaid for hospital services until then. Both sides agree that any patient-quality problems could lead to immediate decertification.

June 2007: The Medicare agency finds emergency room patients are in immediate jeopardy and gives King-Harbor 23 days to respond.

Source: Times research