HEALTHWATCH: King/Drew Hospital In Los Angeles
Bill Schenley
Deadly Errors And Politics Betray A Hospital's Promise
A Times investigation finds King/Drew far more dangerous than the
public knows. Community pride, timid county leadership stand in the
way of a remedy.
FROM: The Los Angeles Times ~
By Tracy Weber, Charles Ornstein and Mitchell Landsberg, staff writers
http://www.latimes.com/news/local/la-me-kdday1dec05,1,3315829.story?coll=la-headlines-california
On a warm July afternoon, an impish second-grader named Dunia Tasejo
was running home after buying ice cream on her South Los Angeles
street when a car sideswiped her. Knocked to the pavement, she
screamed for help, blood pouring from her mouth.
Her father bolted from the house to her side. An ambulance rushed her
to the nearest hospital: Martin Luther King Jr./Drew Medical Center.
For Elias and Sulma Tasejo, there was no greater terror than seeing
their 9-year-old daughter strapped to a gurney that day in 2000. But
once they arrived at King/Drew, fear gave way to relief.
Dunia's injuries were minor: some scrapes, some bruises and two broken
baby teeth. The teeth would have to be pulled.
"They told me to relax," Sulma recalled. "Everything was fine."
At least, it should have been.
What the Tasejos didn't know was that King/Drew, a 233-bed public
hospital in Willowbrook, just south of Watts, had a long history of
harming, or even killing, those it was meant to serve.
Over the last year, reports by journalists and regulators have offered
stark glimpses of failings at King/Drew: Nurses neglecting patients as
they lay dying. Staff failing to give patients crucial drugs or giving
them toxic ones by mistake. Guards using Taser stun guns on
psychiatric patients, despite an earlier warning to stop.
Over the same period, a team of Times reporters has been
systematically examining the hospital. They conducted hundreds of
interviews, studied years of malpractice cases and reviewed records of
the hospital and its regulators. They looked closely at individual
departments and physicians. And, to put their findings in perspective,
they consulted outside experts in hospitals and medical care.
The investigation reveals that King/Drew is much more dangerous than
the public has been told.
Among the findings:
- Errors and neglect by King/Drew's staff have repeatedly injured or
killed patients over more than a decade, a pattern that remains
largely unscrutinized and unchecked. Some lapses were never reported
to authorities - or even to the victims or their families. And some
people learned of the severity of the failings only by suing or, in
several instances, from Times reporters who sought them out to learn
about their care.
- Although King/Drew opened in 1972 with the promise that it would be
"the very best hospital in America," it is now, by various measures,
one of the very worst. It pays out more per patient for medical
malpractice than any of the state's 17 other public hospitals or the
six University of California medical centers.
- Entire departments are riddled with incompetence, internal strife
and, in some cases, criminality. Employees have pilfered and sometimes
sold the hospital's drugs; chronic absenteeism is rampant; assaults
between hospital workers are not uncommon. Despite King/Drew's
repeated promises to regulators, the problems have gone unfixed for
years.
- The hospital's failings do not stem from a lack of money, as its
supporters long have contended. King/Drew spends more per patient than
any of the three other general hospitals run by Los Angeles County.
Millions of dollars go to unusual workers' compensation claims and
abnormally high salaries for ranking doctors.
- The hospital's governing body, the county Board of Supervisors, has
been told repeatedly - often in writing - of needless deaths and
injuries at King/Drew. Recently the supervisors have made some
aggressive moves aimed at fixing the hospital. But for years, the
board shied away from decisive action in the face of community anger
and accusations of racism.
King/Drew, founded in the aftermath of the 1965 Watts riots, has stood
for more than three decades as a symbol of justice and political power
to many black people in South Los Angeles and beyond. In reality, if
not officially, the hospital was established by and for African
Americans; the majority of its staff always has been black.
"That hospital means hope to us," said Karimu McNeal, 52, an African
American woman treated successfully for colon cancer at King/Drew in
2002. "When you go into the hospital and you see people that look like
you and take care of you, it gives you hope for the whole race that
we're achieving and doing something."
Mixed with community pride is an undercurrent of concern about
King/Drew's standards. For about three decades it has been known by an
unflattering nickname, "Killer King." Patients have fled ambulances to
avoid it, according to paramedics and one ranking fire official. And
police officers say they have an understanding among themselves that,
if shot, they will not be taken there.
The Tasejos, immigrants from Guatemala, didn't know any of this the
day their daughter was hurt. All they knew was that she needed help.
In the seven hours after Dunia's arrival, the hospital would commit a
series of medical errors in treating her, each compounding the one
before.
By the middle of that night, the couple were standing outside the
pediatric intensive care unit, bewildered and increasingly frightened.
Alarms were ringing and doctors were running by. The Tasejos tried to
catch the eye of a physician who had reassured them earlier.
"He looked at me," Elias Tasejo recalled. "He kept walking."
Here is an account of Dunia's care, based on her medical records, a
state health department investigation, a medical expert consulted by
The Times and interviews with her family:
To keep her still during a precautionary CT scan, her 65-pound body
was pumped with enough drugs to sedate a grown man.
Paralyzed by the medications, she had to be hooked up to a ventilator
to help her breathe. Its settings were wrong; a blood test showed she
was being starved of oxygen.
The settings were adjusted to give her more. But inexplicably, an
emergency room doctor ordered a trainee physician to pull out Dunia's
breathing tube 20 minutes later. No one checked to see whether she
could breathe on her own.
For the next two hours, Dunia's nurses failed to monitor her vital
signs or breathing, records show. By the time she was transferred to
the pediatric intensive care unit, she was flailing from lack of
oxygen and calling, "Mama."
The medical resident who admitted her to the ICU was unable to operate
a machine to check her oxygen levels, and didn't seek help for at
least 15 minutes.
By then, Dunia's heart and lungs had stopped working. Doctors
resuscitated her, but later that day she was declared brain dead.
After two days, she was removed from life support.
"This child should not have died," said Dr. Lorry Frankel, chief of
pediatric intensive care at Stanford University's children's hospital,
who reviewed Dunia's records for The Times. "If she had been taken to
any pediatric center that had appropriate policies and procedures in
place . she would still be alive today."
Frankel described Dunia's care as "appalling" and "really pathetic."
After her death, a team of doctors took the Tasejos into a room and
promised to find out what had killed her.
Elias Tasejo said the associate medical director handed him a business
card. He kept it in his wallet for three years, thinking he might hear
back. He never did.
"Our daughter is dead," he said earlier this year, "and we have no
idea why."
Hospital defenders
What happened to Dunia, and others like her, rarely figures in the
public debate over King/Drew. Community activists, who fought so hard
for the hospital's creation, are far more consumed with the fear that
it could be closed.
When King/Drew is threatened, it is often Lillian Mobley - long the
hospital's most visible defender - who takes the microphone.
Last January, she stood facing about 200 people in an auditorium at
Grant AME Church in Watts. As cheers of adoration washed over her,
Mobley, a thin woman of regal bearing, thrust her chin forward in a
characteristically defiant pose.
Moments passed. When the last voice had been stilled, when every head
turned her way, only then did she speak.
"The hospital," she said gravely, leaning on a cane, "is being closed
piece by piece."
There were murmurs, shouts of dismay.
"We have to stand together to fight this battle," said Mobley, her
voice rising. "We have to rise every morning under God's will . to
save Martin Luther King."
That meeting, held to protest planned cutbacks at King/Drew, was one
of many such gatherings she has addressed over the years.
Strong-willed and fiercely protective, Mobley, 74, is at the forefront
of a coterie of African American leaders, most now in their 70s and
80s, who defend King/Drew with the same intensity that they once
devoted to the civil rights movement.
To them, it is part of the same struggle.
Some vividly recall how things used to be, when they had to find a
ride to the main county hospital some 15 miles away. It was a long
trip if you didn't have a car - and most people didn't. "Twenty-five
dollars sick" meant you were in bad enough shape to pay for a cab
across town.
Many remember the case of Leonard Deadwyler, a black man who in 1966
was rushing his pregnant wife from their home in Watts to County
General Hospital (today's County-USC) in Boyle Heights when police
stopped him for speeding. An officer approached his car and shot him
to death. The shooting was determined to have been an accident, but
many saw it as a racist killing.
They also remember how the voters of Los Angeles County, mostly white,
refused to pay for King/Drew's construction, forcing Supervisor
Kenneth Hahn to find money elsewhere. Even now, threats to trim the
hospital's budget revive fears that whites are trying to take it away.
"We see something that we fought really hard for," said Dr. Herbert
Avery, 71, an obstetrician who helped plan the hospital and served
briefly on its staff. "And now it's being driven down under the ground
under the guise that the people out there . they're black and Mexican
and they're too stupid to run a hospital and a medical school."
Mobley's group is small, and its members hold no elective office, yet
they are the curators of King/Drew's dream. They are often called
simply "the Community," reverently spoken, as with a capital C. It is
a status they have guarded ever more zealously as the neighborhoods
around them have become increasingly Latino.
"If you're going to work at King/Drew, you have to work with the
Community," said Dr. Thomas Yoshikawa, chairman of the internal
medicine department. "You just can't come in and say, 'I'm the new kid
on the block. I'm going to play the game my way.' No, you have to play
the game their way."
Defying them can draw charges of racism - even when the transgressor
is African American.
In the fall of 2003, members of Mobley's group paced the lawn in front
of the hospital, as one bellowed through a bullhorn: "Marcelle
Willock, you can't hide. We charge you with genocide."
Willock, who is black and Latina, is dean of the hospital's affiliated
medical school at the Charles R. Drew University of Medicine and
Science. The protesters contended that she had not done enough to
protect and support key programs.
While racial politics sometimes play out on its expansive front lawn,
inside the hospital, King/Drew's legacy is on display.
In the lobby are prominent portraits of King; his wife, Coretta; and
local political dignitaries posing beside former Presidents Clinton
and Johnson. A photograph of King being greeted by the late Supervisor
Hahn is hung in two places there and in at least six others around the
hospital.
Down winding hallways is one of the hospital's greatest points of
pride - a trauma unit with state-of-the-art equipment. More gunshot
wounds have been treated here in recent years than at any other
hospital in the county. Many in surrounding neighborhoods credit the
unit's surgeons with saving their lives or those of their sons and
daughters.
"There's a lot of violence in the world today, especially in this
community," said Lee Russell, 40, yanking up his shirt to display
rope-like scars from a November 2003 shooting and stabbing. He praised
the King/Drew doctors and nurses, saying that if the trauma center
hadn't been nearby, "I would be dead.. I'm their walking miracle."
Last month, the Board of Supervisors voted to close the trauma unit to
focus on fixing the rest of King/Drew, which like other county
hospitals treats patients regardless of insurance status. In
September, the board agreed to hire private turnaround consultants for
$13.2 million. The supervisors' actions were their strongest to date,
brought about only by threats to King/Drew's federal funding and
national accreditation.
The trauma unit's closure, especially, drew residents' ire. "Don't
disrespect or underestimate our community," read a banner hung last
month at a rally of more than 1,000 hospital supporters.
King/Drew has become the "proxy for an entire community's identity,"
said Los Angeles civil rights attorney Connie Rice, who is African
American.
That creates tension between those who see the hospital in strictly
medical terms and those who see it as an embodiment of their dreams
for racial self-determination.
"You're talking about the fact that the nurses weren't trained to use
monitors," Rice said, "and they're going back to '60s Watts."
Community of grief
Over the years, King/Drew has created another community, one bound by
a common grief.
Jereatha Thomas belongs to it. She rushed her 27-year-old daughter,
Demetria, to King/Drew in June 2003.
In the emergency room, printouts from three electrocardiograms stated
plainly that Demetria Thomas had suffered a massive heart attack. Two
labeled it "acute," the other "extensive."
No one acted on the findings for more than 10 hours, as doctors
pursued other theories. By the time a cardiologist pointed out the
obvious, it was too late, said two experts who reviewed her medical
records for The Times.
Two days later, shortly after being transferred to Harbor-UCLA Medical
Center for more specialized care, Demetria died.
Jereatha Thomas has never recovered. She moved out of the house she
shared with Demetria, unable to live with the memories. She works
three jobs until she's too tired to think.
"Since the time my daughter passed away, people have come up to me and
said, 'My aunt, my uncle, my friend died the same way,' " Thomas said.
"It was a lesson to be learned for me. I would never go back to King.
Never, ever."
Thomas decided to hold the hospital accountable in the only way she
knew how: She sued. Her case is pending.
Every hospital makes mistakes, some of them fatal. Filing a lawsuit is
one of the few recourses patients and their families have when
something goes wrong. But taken together, the malpractice cases
involving King/Drew portray a place where things often go wrong -
sometimes in the same way, over and over.
King/Drew spent $20.1 million on malpractice payouts during fiscal
years 1999 to 2003, an extraordinary sum for a public hospital its
size in California. Adjusting for the number of patients the hospital
saw, that figure is more than at any of the state's other public
hospitals or the University of California medical centers.
Even County-USC Medical Center, which is three times larger and not
without troubles of its own, spent less. (King/Drew's payouts cannot
be compared to those at public hospitals outside the state, because
California has strict limits on malpractice damages.)
The Tasejos' award was added to the tab this October, more than four
years after Dunia's death. Weary of the legal battle, the family
settled for $195,000.
Her father plans to build an altar at her grave in Guatemala,
enshrining the dress and shoes she wore that July day.
"I want to get the [legal] papers so I can put them in the tomb and
say, 'Look. It's over, honey,' " he said.
Malpractice awards are just one sign of trouble at King/Drew.
From 1999 to March 2004, the hospital was cited for violating
California health regulations more often than 97% of hospitals
statewide, according to a Times analysis of state data. It had more
violations than any of the county's three other general hospitals.
The two most prominent national accrediting groups rate King/Drew
among the nation's most troubled institutions.
It is the only hospital in America to have received the lowest
possible rating in its last two reviews from the Accreditation Council
for Graduate Medical Education. The group has ordered the closure of
three of King/ Drew's 18 doctor-training programs: surgery, radiology
and neonatology. A fourth, orthopedic surgery, may be phased out under
pressure from the council.
King/Drew is also one of only seven U.S. hospitals that the Joint
Commission on Accreditation of Healthcare Organizations has said
should lose overall accreditation this year. The group accredits 4,579
hospitals nationwide. King/Drew has appealed the decision, but if it
fails, it could be forced to close all its doctor-training programs
and lose nearly $15 million in private insurance contracts.
"This hospital," said Dr. Dennis O'Leary, the joint commission's
president, "has problems of orders of magnitude that are substantially
greater than almost all other hospitals in this country."
Even the top county health official finds King/Drew's failings hard to
fathom.
"I'm not sure who would imagine the depths of the problems," said Dr.
Thomas Garthwaite, director of the Department of Health Services. "I'm
not sure anybody has the life experiences to prepare themselves for
this."
It is only through brutal experience that some patients and their
families learn of the dangers at King/Drew.
Sherry Ridley, a 43-year-old airport security guard, underwent
elective surgery there for ovarian cysts in November 2002.
First a doctor in training stitched through her colon in error,
essentially blocking it, according to a surgical note in Ridley's
medical records. No one caught the mistake for two weeks as her
stomach painfully bloated. A second resident's belated repair job
failed.
Over the next couple of weeks, a senior surgeon opened the patient up
eight times, trying to scrub out a worsening infection. More medical
equipment sprouted from Ridley nearly every day; wires and hoses
protruded from her like tentacles. Swollen with fluid, she ballooned
from 187 to 321 pounds. Bands had to be looped around her abdomen to
hold her incision together.
Ridley, the mother of two sons and one of seven close-knit siblings,
died five days after Christmas.
"My sister went in there healthy," said Gail Gordon, her eldest
sister. "She went from a human being to a monster when she passed."
The number of patients harmed or killed at King/Drew is impossible to
tally.
The Times asked Michael Pine, a national health quality expert, to
compare complications and deaths at King/Drew with those at all other
hospitals in California. After reviewing six years of data collected
from hospitals by state health authorities, Pine said he was unable to
reach firm conclusions. King/Drew, he said, often left out information
about whether patients came in with complications or developed them at
the hospital.
"There are definite problems in the way they're reporting their data,"
said Pine, whose firm is based in Chicago.
Separately, The Times discovered cases in which medical errors were
reported neither to the county coroner nor the state health department
as required - let alone to uncomprehending families.
The circumstances of Barbara J. Robinson's death might never have been
known but for a last-minute call to the coroner's office from a
King/Drew surgeon who was not involved with her care.
In February 2002, doctors suspected that fluid was building up around
Robinson's heart, dangerously compressing it. But when they finally
sought an echocardiogram image to confirm their theory - 11 hours
after her arrival at the King/Drew emergency room - the only
technician available said he wasn't qualified to perform the
procedure, according to Robinson's medical records. Three hours later,
the patient began to slip away. Without an image of her heart for
guidance, a doctor seeking to drain fluid plunged a needle into her
chest.
Robinson, 46, died within hours. A doctor wrote on her preliminary
death certificate that she had died from natural causes.
After her body had already been embalmed, the King/Drew surgeon called
the coroner's office, suggesting that Robinson's doctor might have
made a fatal mistake.
An autopsy confirmed that the needle had struck her coronary artery,
spilling blood from her heart.
Cases like these sometimes pass unnoticed.
But many of King/Drew's mistakes are well known to the elected leaders
responsible for overseeing the hospital, a board so powerful its
members are called "the five little kings."
Vows of action
Spurred by media reports of lapses in patient care at King/Drew,
county Supervisor Yvonne Brathwaite Burke held a news conference to
announce "swift and decisive action."
"Due to a series of highly publicized problems, irregularities,
illegalities and tragic mistakes . the public's confidence in this
major county medical facility has been shaken," she said. "It is
unacceptable for anyone who depends on King hospital . to fear that
they won't get the level of care they expect and deserve."
It was time for "drastic action." The hospital, she said, needed a
"crisis management task force" and a major administrative shakeup. Her
colleagues on the board approved Burke's plan.
"This," said Supervisor Zev Yaroslavsky, "is a major step; it's a
beginning at MLK."
Those remarks might have been made this year. In fact, they were
delivered nearly nine years ago.
Many such pledges have been made in the years before and since. But
they have not produced meaningful change.
In 1989, the supervisors were jolted by a Times investigation into
King/Drew that described a series of botched cases. In one, an
18-year-old shooting victim survived even though her throat was
mistakenly slit by trauma surgeons.
The supervisors ordered an investigation and pushed for a top-level
task force. They also removed the hospital's administrator, provoking
a wave of community protest.
King/Drew drifted out of the spotlight - for a while. But notorious
cases arose periodically in subsequent years, grabbing public
attention and prompting more promises of reform.
In 1992, Nelson Yamamoto, a 26-year-old sheriff's deputy, was taken to
King/Drew with four gunshot wounds. Joking with nurses as he arrived,
he was dead two days later. The coroner said the deputy died of the
gunshot wounds. But the district attorney later faulted the care
provided by doctors, in particular a surgeon who administered a lethal
combination of heart drugs.
"We have no doubt that there are many competent, dedicated healthcare
professionals at Martin Luther King hospital," the district attorney's
report said. "But we cannot turn a blind eye to the facts as we have
found them."
The doctors involved in Yamamoto's care were never charged. The
incident, however, cemented some police officers' impressions that
King/Drew was not a safe place to go.
In 1994, Aleta Clemons, a 42-year-old woman who went to King/Drew for
a hysterectomy, was infused with blood that had tested positive for
the AIDS virus. But no one had bothered to check the test results.
In 1998, Blanca Maldonado, 52, drank a glass of tissue preservative, a
poisonous chemical mixture accidentally left on her hospital bed stand
by a doctor in training. She staggered to the closest nursing station,
pleaded for help and died a short time later.
Each of these cases led to promises by the Board of Supervisors that
King/Drew would be fixed.
A pattern emerged: A crisis would bring superficial reform, followed
by a short period of relative calm, soon to be followed by another
crisis.
"Members of the Board of Supervisors tiptoe around Martin Luther King
hospital," said political consultant Kerman Maddox, who is black.
"They have to pay attention when they're forced to pay attention, but
when they're not . they'd rather ignore it and hope it'll go away.
They'd rather not get in battles with people in the community, because
they would appear to be racially insensitive."
Few people have been in a better position to know what is going on at
King/Drew than the supervisors. They receive county, state and federal
reports spelling out the hospital's most severe patient care failings,
along with other documentation.
The supervisors also must sign off on malpractice payments of more
than $100,000 - two dozen from King/Drew in the last six years alone.
Confidential paperwork describes precisely what went wrong and how the
hospital plans to fix it.
Yet, again and again, the board has professed shock at the hospital's
tragedies.
Last year, when a series of crises erupted at King/Drew, the
supervisors - four of whom have been on the board more than a decade -
reacted much as they had before. They called for another task force,
which had virtually the same mission as the 1996 group and was even
staffed with some of the same people.
Top health department officials took control of King/Drew's
operations. And under their watch, the hospital was twice threatened
with the immediate loss of federal funding for, among other things,
repeatedly bungling medication orders.
When the supervisors announced plans early this year to scale back the
hospital's prized neonatal unit, community activists, led by Rep.
Maxine Waters (D-Los Angeles), geared for a fight.
Waters threatened at a protest meeting to climb "on top of [the] desk"
of health department officials. A short time later, the county backed
off, saying its proposal needed further study.
While the board vacillates, patients suffer.
A cry of despair
In July 1994, Dr. Wilbert Jordan drove to a gold-colored house,
trimmed with white, just a block from King/Drew.
Jordan had the sort of news he felt he could deliver only in person:
The hospital had given Aleta Clemons, a mother of three, HIV-tainted
blood. She might be infected with the deadly virus.
She seemed almost calm when he told her. It wasn't until he was
outside that he knew she understood.
"I will never forget the scream and the cry that she let out as I was
walking to my car," the doctor said. "It was chilling."
Jordan, a specialist in infectious diseases, said hospital officials
had tried to dissuade him from telling Clemons about the mistake. He
felt it was his duty.
Two weeks later she learned that she was, in fact, infected with HIV.
Clemons, now 53, hadn't planned on going to King/Drew at all. She was
supposed to have her hysterectomy at Harbor-UCLA. She'd even stored
her own blood there in advance, on a doctor's advice. But when she
began hemorrhaging unexpectedly, her sister took her to King/Drew
because it was closer.
"I begged her not to take me there," Clemons said. "But she said that
I would have bled to death."
In late 1995, Clemons took her questions and concerns about what
happened to Supervisor Burke. Jordan went with her.
Burke was full of promises, Clemons recalled, wanting to make sure she
had a job, a formal apology and a house of her own. Clemons said she
never got those things.
Burke said she did not recall meeting with Clemons. "At no time did I
say I would get her a house or a job," the supervisor said. "Whenever
she calls, we try to do whatever we can to assist."
Clemons did get a $450,000 legal settlement, paid out over more than a
decade, and the promise of free lifetime care - at King/Drew.
"This," Jordan observed, "is like having to live with the person that
raped you."
Even 10 years later, Clemons thinks about going to the Board of
Supervisors to remind it of Burke's other pledges.
"I tried to get up the courage, because I really want to talk to them
face to face," Clemons said. "Every time, I just get depressed. I
can't go."
In recent months, her health has deteriorated markedly. Her gait is no
longer steady. She takes 16 pills daily.
She lives in King/Drew's shadow. She can see it from the rear window
of her apartment.
"Every time I look at that hospital I think about what happened to
me," Clemons said. "That hospital took my life away from me."
Bill Schenley
Underfunding Is A Myth, But The Squandering Is Real
For a public hospital, King/Drew is flush. But it spends millions on
employees' odd injury claims, lavish doctor pay and workers who don't
show up.
FROM: The Los Angeles Times ~
By Charles Ornstein, Tracy Weber and Steve Hymon, staff writers
http://www.latimes.com/news/local/la-me-kdday2dec06,1,3774583.story?coll=la-home-headlines
For years it has been a heartfelt cry: "This hospital desperately
needs more money!"
Whenever Martin Luther King Jr./Drew Medical Center is criticized, as
it often is, the response from supporters is the same. They say Los
Angeles County leaders never wanted King/Drew built in the first
place — and have been trying to starve it ever since.
"You know damn well the county knows what we need," said "Sweet Alice"
Harris, long revered for her charitable efforts in South Los Angeles'
black and Latino neighborhoods. "My problem is: Why is it that they
don't love the poor people and want to help them? We're the first to
be cut and the last to be rewarded."
Amen to that, said Dr. Xylina Bean, who started at King/Drew in 1973,
the year after it opened, and is now director of neonatology.
"We have a saying here which we all understand, 'The Lord giveth and
the Lord taketh away,' and usually King hospital has always been on
the taketh away list, OK?"
Spend any time at the county-run hospital near Watts and it's easy to
reach the same conclusion: Patients linger unattended, walls are
gouged with holes, mattresses are worn and stained, even ink
cartridges are in short supply.
The numbers, however, tell a different story. Though widely believed,
the notion that King/Drew is being shortchanged is false.
The medical center spent more per patient than 75% of the public and
teaching hospitals in California, according to a 2002 state audit that
looked at fiscal year 2000.
The difference is stark when King/Drew is measured against the three
other general hospitals run by Los Angeles County.
It spent $492 more per patient daily than Olive View-UCLA Medical
Center, $685 more than County-USC and $815 more than Harbor-UCLA in
2002-03, county figures show.
The hospital with the most comparable budget is Harbor-UCLA, a much
bigger facility 10 miles away. Last year, Harbor-UCLA had nearly $372
million to work with, not much more than King/Drew's $342 million.
Harbor-UCLA, however, did far more with its money.
It treated 61% more people in its emergency room and admitted 91% more
patients. And it performed certain complex procedures, such as open
heart surgery and kidney transplants, that King/Drew did not — drawing
in patients who were sicker and more expensive to care for.
King/Drew's problem is not the amount of money it gets but the way the
money is squandered, according to audits, financial records, legal
filings and dozens of interviews.
As at most hospitals, its greatest cost is employees. But King/Drew,
with a staff of nearly 2,500, spends inordinate sums on people who do
little or no work. The rest of the hospital — hardworking employees,
patients and their families — often make do or do without.
Here are some examples:
- In the last five years, King/Drew has spent nearly $34 million on
employee injuries — 53% more than Harbor-UCLA and more than any of the
University of California medical centers, some of which are double or
triple King/Drew's size. Employees make claims for such things as
damage to their "psyche," assaults by their colleagues and a variety
of freak accidents, according to a Times review of workers'
compensation claims.
- Last year, King/Drew employees billed for 299,804 hours of overtime,
costing the hospital nearly $9.9 million. That's 61% more than the sum
spent by Harbor-UCLA, which has about 400 more workers. Fourteen
King/Drew employees pulled in more than $50,000 each in overtime. At
Harbor-UCLA, there was one.
- Some employees habitually fail to show up, logging weeks, even
months, of unexcused absences each year. And those who do come to work
often don't do their jobs, causing one consultant in 2002 to remark
that they had "retired in place." Others are distracted or impaired.
County Civil Service Commission filings tell of staff members grabbing
and clawing each other's necks; inspection reports tell of patients
literally dying of neglect.
- King/Drew pays its ranking doctors lavishly. Some draw twice what
their counterparts make at other public hospitals — often for doing
less. Eighteen King/Drew physicians earned more than $250,000 in the
last fiscal year, including their academic stipends. Harbor-UCLA had
nine.
If King/Drew and county health officials had controlled this excess
spending, the hospital could have used the money in other areas, or
even put it back into county coffers.
The mismanagement of the hospital is no secret.
The county Board of Supervisors and the Department of Health Services
it oversees have received decades of warnings. Since 2000, there have
been dozens of audits, scores of disciplinary reports and hundreds of
workers' compensation claims.
Yet even as the county has faced enormous pressures over the years to
trim its health budget, the board has largely spared King/Drew. The
slightest suspicion that a cut might be coming mobilizes activists who
treasure the black-run hospital.
So the waste continues. And so does the perception among King/Drew
supporters that their hospital is being maliciously underfunded.
At a town hall meeting in the fall of 2003, a King/Drew doctor angrily
jabbed his forefinger in the air as he accused the county health
director, who is white, of punishing the hospital.
"I've been here 31 years and watched this hospital be yanked and
pulled … shot and kicked," said Dr. Ernie Smith, an African American
pediatric cardiologist who has since left King/Drew. "This is nothing
more than racism and white supremacy."
Doctors, nurses and other staff members in the audience applauded,
amid approving murmurs of "Mmm-hmm, all right."
Supervisor Yvonne Brathwaite Burke, who has represented the hospital's
district for 12 years and is the sole African American board member,
bristled at the charge.
"We have spent money and money and money, far beyond what we've spent
anywhere else," she said. "Whenever anything goes wrong, they say, 'We
don't have enough people. We don't have enough money.' "
Dr. Bean and many other King/Drew supporters don't buy that argument.
"There is a credibility gap here," Bean said. "I will tell you, I
ain't got no excess nothing."
Employee Injury Claims
Vast sums at King/Drew go to workers injured in encounters with
seemingly harmless objects.
Take, for instance, the chair.
Employees have been tumbling from their seats at King/Drew almost
since it opened its doors. The hospital's oldest open workers'
compensation claim involves Franza Zachary, now 71, who sprained her
back falling from a chair in October 1975 — costing the hospital more
than $300,000 so far.
The bills for two other chair-fallers have topped $350,000 each,
county records show.
Between April 1994 and April 2004, employees filed 122 chair-fall
claims at King/Drew, more than double the number at Harbor-UCLA. And
King/Drew has spent $3.2 million -- and counting -- to pay for them.
"Sitting down. Eating lunch. [Chair] broke" was how licensed
vocational nurse Elizabeth Rugley described her mishap in a 1999
claim. "Fell to floor. Hit the floor. Landed on my buttock."
In the last nine years, records show, Rugley, now 51, has had three
other on-the-job accidents at King/Drew: a second chair misadventure
in which she slipped and banged her head on a wall, a tumble, and a
trip over an elevator entrance. As a result, according to her filings
with the state, she has strained her neck, wrenched her back and
injured her right shoulder.
To treat Rugley's last three injuries and pay her when she has been
unable to work, King/Drew has spent $364,435.
In an interview, Rugley said her doctor told her that a person was
prone to accidents after a back injury. "I'd rather be working and
healthy and not hurting," she said.
Phyllis Butler-Young's chair gave way at King/Drew in 1999, according
to her workers' compensation claim.
A year later, she said, she re-injured herself pushing and pulling
gurneys in her job as a licensed vocational nurse. And in 2001, during
training at a rehabilitation center, Butler-Young was "jolted" while
trapped in an elevator, according to records she filed with the state.
All told, her claims have cost King/Drew more than $100,000.
Butler-Young, now 42, said chair falls were "common" at King/Drew.
"They're old," she said of the chairs. "They claim they didn't have
any money, so they took chairs from County-USC … [that] had to be
welded back together."
The cost of King/Drew's various injury claims runs higher than that of
comparable hospitals.
Averaged over its entire staff, King/Drew spent $2,326 per employee on
workers' compensation in each of the last six years, more than all but
one of the 17 other California public or teaching hospitals for which
The Times could obtain similar records. The average for all the
surveyed hospitals was $1,342 per employee annually.
King/Drew was expected to pay more than $50,000 each on 385 active
claims as of August, according to county records. Harbor-UCLA had 210
claims projected to cost that much.
"My eyebrows start raising at the $50,000 mark," said Vickie Wells,
director of occupational safety for the public agency that runs San
Francisco General Hospital Medical Center. "Every claim where we spent
more than $50,000, there is something usually going on."
Los Angeles County regularly challenges workers' comp filings it
considers questionable, but it must pay if administrative law judges
rule in a worker's favor.
The high number and cost of claims at King/Drew may stem more from bad
morale than clumsiness or unsafe conditions, workers' compensation
specialists said.
"If you like your employer and you love what you're doing and you like
the environment you're in, you're much less likely to say, 'I hurt my
back or finger' or that 'I'm stressed out,' " said Priscilla Morse,
who handles workers' comp claims for San Mateo County.
King/Drew's claims show that its employees often don't seem to like
each other much — let alone their employer. Some of the filings cite
assaults and psychological wounds.
One cashier filed a claim in 1999 saying she was overwhelmed by
stress. The tipping point, she told her workers' comp psychiatrist,
was when her supervisor grew angry at not being asked to be one of the
cashier's bridesmaids. The cashier said her resulting anxiety
triggered headaches, chest pain and chronic fatigue.
A judge agreed, and King/Drew so far has paid more than $216,000 on
the claim.
Operating room nurse Santiago Blanco, injured six years ago, is still
collecting from the hospital as well.
He reported being slugged in the back by a female colleague while
tending to a semi-conscious patient having a leg operation. The punch,
delivered about 20 minutes into the surgery, threw him four feet from
the table, causing back and neck injuries, he said.
"I don't know what the patient's reaction was," Blanco, 47, said in an
interview. "I was on the floor."
His injuries have cost King/Drew $316,500 so far, and are expected to
ultimately cost it more than $500,000.
Blanco was off work for months. But he, at least, had a medical
excuse.
Medical Staff Absent
On Friday morning, Aug. 13, 2004, patients filed into King/Drew's
orthopedic clinic seeking treatment for their broken bones and aching
joints.
Help was not to be had.
The medical staff — doctors, doctor trainees and physician
assistants — was inexplicably absent. It took three hours or more to
find fill-in doctors, county auditors later found.
That Friday the 13th was merely the beginning of a bad weekend for
King/Drew. Later that day, officials were forced to close the
emergency room to ambulances until Monday morning because nearly half
the nurses on some shifts had either called in sick or failed to show
up.
Every hospital must contend with the national nursing shortage — and
King/Drew's shortfall, given the county's relatively low pay and its
ongoing problems, may be worse than most. More than 35% of its nursing
positions are vacant.
But the hospital also is thrown into chaos when nurses, doctors and
others on the payroll simply don't come to work.
The consequences are costly, not just in terms of overtime, but also
in sick pay and use of temporary workers. King/Drew spent $14.7
million on temps last year, more than a third of that on nurses.
Harbor-UCLA spent $3.1 million, although it relied on its own nurses
to fill in when necessary.
These expenses are well known to the county health department. Its
second-in-charge, Fred Leaf, routinely signs off on disciplinary
letters, including allegations of absenteeism.
A review of such letters, which become public when employees appeal
their discipline, shows that King/Drew workers often are given chance
after chance to mend their ways.
Sherri Echols, a nursing assistant, was warned three times about her
attendance problems in 2002 and 2003. She was finally suspended in
April for 30 days after missing more than 18 weeks of work without
permission over those two years, said a disciplinary letter in her
county Civil Service Commission file.
"The act of being employed in itself requires you to report to work,"
an administrator counseled Echols in the letter.
Echols denied the allegations in her appeal of the discipline.
Some employees, such as nurse Elaine Pitts, go for years totting up
warnings.
In 1999, after her second suspension for absenteeism, Pitts was told
she was allowed just one unscheduled absence a month. She was absent
or sick for about two months out of the next 10, finally losing her
job in June 2000, records show.
"Unnecessary expenditure of this sort is totally unacceptable," an
administrator wrote in her termination letter, "particularly in this
time of limiting resources for patient care."
Pitts lost her chance to appeal when she was absent for her own
hearing.
In an interview, she conceded that she had missed work, but said she
was juggling life as an exhausted single mother with a boss who wasn't
sympathetic.
"I'm not going to lie," said Pitts, who now works elsewhere but says
she wishes she were still at King/Drew. "There were times I'd come
into the lobby and see [the supervisor], and I'd leave and call in
sick."
Some employees provide unusual excuses.
Ultrasound technician Donald Ray Hall was absent more than seven weeks
during his first eight months on the job. His explanations included
"car trouble, jail," according to Civil Service records.
After repeated warnings, he was fired in 2000.
Civil Service records show that one financial services worker provided
this justification for repeated absences in 2002: "temporary
insanity."
Violence and Neglect
Another cost, less easily tallied, results from employees who show up
but don't do their jobs.
A nursing supervisor found nurse Nopawan Mahasuwan "asleep in a lounge
chair, mouth open, snoring and drooling," in February 2000, according
to an internal hospital memo.
Supervisor Liberty Pascual said she watched Mahasuwan sleep for at
least three minutes before trying to wake her.
Mahasuwan, however, said she was watching a monitor — not sleeping.
And, she added, Pascual didn't simply nudge her, but delivered a smack
that caused pain and swelling, according to the memo.
It was yet another disagreement among staff members that had escalated
to threats or violence, according to internal reports and Civil
Service records.
King/Drew employees have been suspended for such infractions as
shouting expletives at their colleagues and threatening to "fix" their
bosses or make them "pay." A custodian is appealing a 20-day
suspension for allegedly pulling a putty knife on his boss.
During their shifts in June 2002, a nurse and an aide got into a
scuffle, grabbing and scratching each other's necks.
"This is not really a big issue," said nursing attendant Beverly
Norman in a written statement after the incident.
Hospital officials disagreed, finding that Norman's conduct "may have
caused patients, visitors and other staff to incorrectly believe that
staff at this medical center are unprofessional," her disciplinary
letter said.
Visitors may come to that conclusion on their own.
In hallways and offices, employees hawk bootleg DVDs, peanuts and
other products, leading one doctor's wife to compare the hospital to a
giant swap meet.
"It wasn't like they were trying to hide it," said Leaf, the health
department's chief operating officer, who was brought in a year ago to
oversee operations at King/Drew. "They didn't have an expectation …
that it might have been inappropriate."
Some patients and their families say medical care has not been the
priority.
Maria Mayorga, who spent two days at King/Drew after breaking her
ankle in a car accident last December, said the nurses and aides
"would just ignore you."
"You could hear them all chatting in the hall. They would be talking
about parties, movies, about getting together…. I was upset. I'm
sitting there on the [bed] potty. If I could have moved myself, I
would have, but I needed the help."
Sometimes the neglect leads to death. Government inspectors found that
serious nursing lapses contributed to five patients' deaths last year.
And this October, a man died after his nurse missed signs on a cardiac
monitor that his heart was failing, county health officials have
alleged.
Until recently, however, few King/Drew employees lost their jobs for
poor performance. And the county Civil Service system ensures that
fired workers have numerous avenues of appeal.
"If they had an employee in there that didn't work, they just moved
them to the side and brought in someone else," said David Runke, a
County-USC administrator brought in to help fix King/Drew in the fall
of 2003. "You have a lot of people, but you don't necessarily have a
lot of productivity."
One of the Elite
Dr. George Locke is a member of King/Drew's ruling class.
When he pulls his 2002 Mercedes-Benz coupe into his reserved spot at
the hospital, he routinely stands beside it until a female assistant
arrives to carry some of his belongings inside. On his way out,
someone is on hand to tote them back.
When political leaders, such as Rep. Maxine Waters (D-Los Angeles),
arrive at King/Drew, Locke often is there to greet them with a hug.
As neurosciences chief, Locke made a total of more than $1 million
over the last two fiscal years. That includes his hospital salary and
a stipend he receives from King/Drew's affiliated medical school,
records show.
Top county officials can't say what Locke does for all the money he
earns.
At an August board meeting, Supervisor Mike Antonovich questioned the
hundreds of thousands in "taxpayer money" that Locke received and
whether he had earned it. The county health director, Dr. Thomas
Garthwaite, had no firm answers, saying his department was looking
into the matter.
During a review of the county's own records, however, The Times found
that Locke took part in only 15 of the 501 surgeries performed by his
department in the four years ending in December 2003.
Last year, Locke, who oversees both neurosurgery and neurology,
participated in three operations, hospital records show. His
second-in-command, neurosurgery chief Dr. Samuel Biggers, performed
seven.
By comparison, Dr. Martin Holland, neurosurgery chief at San Francisco
General, said in an interview that he did about 100 surgeries last
year.
Though Locke's neurosurgery staff is larger than Holland's, it
performs about half as many operations.
Holland has co-written eight medical journal articles in the last two
years. Locke was an author on four in the last 14, according to the
National Library of Medicine.
Yet Locke, 70, earned about twice as much as Holland.
"That's a lot of money per case," Holland said. "I wish I made that
much."
Locke declined to comment. But his attorney, Lawrence Silver, wrote in
a letter to The Times that Locke earned "significantly" less than he
would in the private sector.
Moreover, Silver disputed the hospital's accounting of the number of
surgeries Locke had performed and the national library's tally of the
articles he had written. The lawyer did not provide what he considered
the correct figures.
" … It would not be a criticism of Dr. Locke even if the numbers
showed that he did no surgeries at all," Silver wrote.
"His job performance is not measured based upon his publications, but
rather on his dedicated performance of his job as a physician and
administrator."
Locke's signed time cards seem to reflect that dedication.
He sometimes has recorded one marathon workday after another,
indicating he has spent the whole day at the hospital and the whole
night on paid standby call, available by phone for advice.
On Nov. 17, 2003, for example, his time card showed that he had worked
12 hours at the hospital and 12 hours on standby. Actually, he arrived
at the hospital about 10:30 a.m. and left about 4 1/2 hours later.
On July 26 this year, Locke's time card showed him working 12 hours
and being on call an additional 14, for an impossible total of 26
hours. He was at the hospital for 6 1/2 hours.
On both days, as well as others, a Times reporter observed his arrival
and departure.
Attorney Silver said his client didn't have to be at the hospital to
work. " … The practice of medicine knows no time cards," he wrote.
"This is not an employment where the cobbler works at his bench and
cannot perform his tasks unless he is at the place of business."
King/Drew's medical director, Roger Peeks, said county rules require
doctors to work at the hospital.
Unless he's on call, "the hours he puts down on his county time card,
he should be actually here on premises," Peeks said.
When asked about the hours Locke keeps, health director Garthwaite
shook his head and said, "I'm not going to defend George Locke."
The county's inability to explain expenditures at King/Drew extends
well beyond Locke.
Spending More, Getting Less
Every year, the hospital doles out millions in county money — $13.7
million last year alone — to the university across the street.
And every year, it's unclear whether King/Drew gets its money's worth.
The Charles R. Drew University of Medicine and Science, which was
founded about the same time as the hospital, is under contract to run
King/Drew's doctor training programs and provide some clinical staff.
But county auditors this summer couldn't figure out how many residents
Drew trained, how its doctors spent their time or where the millions
went. Records that were supposed to be kept by the hospital and the
school often couldn't be found, their report said.
One thing was clear, according to the auditors: King/Drew, once again,
was spending more than Harbor-UCLA and getting less.
Medical residents at both institutions earned the same salary, but
King/ Drew spent 57% more than Harbor-UCLA on stipends for medical
faculty and other academic support.
The extra money did not buy success.
It was under Drew University's watch that a national accrediting group
in the last two years revoked the hospital's right to train aspiring
surgeons, radiologists and neonatologists.
None of Harbor-UCLA's programs have been forced to close.
In a letter to the county auditor, a Drew University official said the
findings were inaccurate:
"The evidence clearly shows that services were performed, funds were
expended appropriately and the payments to Drew were proper."
Concerned about the shoddy accounting and poor academic results, some
county supervisors this year said they were fed up with Drew.
They courted, begged and even tried to shame the nationally prominent
medical schools at UCLA and USC into taking over.
But given the problems with the hospital and its training programs,
the two schools have mostly kept their distance.
"It's not like UCLA is saying, 'Oh, hallelujah, I'd love to do it,' or
USC is saying, 'Let me in on that deal,' " Supervisor Gloria Molina
said in August.
Weeks later, the county signed on with Drew University once more.
Advice Often Ignored
County leaders have received lots of advice on how to fix King/Drew,
from both their own auditors and outside consultants.
What they have not done, for the most part, is heed it.
About three years ago, health department officials turned to veteran
management consultant Leonard Fuller.
Fuller was blunt in his assessment. Some employees, he wrote, "feel
that they have little incentive to do more than 'the absolute minimum
to get by.' "
The hospital's very future is at risk if the financial disarray is not
addressed, he warned in his report.
Fuller said he presented his findings to Supervisor Burke. "Her
thoughts were, 'This is terrible. We've got to get down to the bottom
of it,' " he recalled.
To tackle that task, Garthwaite, then the new health director, wanted
to fill the vacant King/Drew administrator's post with an outsider, he
said. But he said Willie T. May, who was serving as King/Drew's
interim leader, had Burke's blessing.
"Let's just say we were encouraged to give Willie May a chance," he
said.
Burke said she did not object to May's appointment but did not lobby
for it.
In a November 2002 memo, the county's chief administrative officer
welcomed May as a "highly qualified" manager who "possesses the
special knowledge, skills and experience" to succeed at King/Drew.
By March 2004, the health department had begun the process of firing
May, saying the hospital had foundered on his watch. He had cancer and
retired rather than fight for his job.
May was the latest in a series of administrators to quit or be ushered
out, overwhelmed by King/Drew's many problems.
In October 2003, he testified in a deposition over budget cuts that he
had learned about crucial matters through the "rumor mill," which he
defined as "just general people talking in the hallways." (A 16%
budget reduction at King/ Drew was begun in 2003, but put on hold
midstream, in part because county officials couldn't figure out what
to cut.)
In the deposition, May also said he had fixed 11 major violations
cited by a hospital accrediting group two years earlier. He couldn't
name one.
May did not respond to telephone calls and a detailed letter
requesting comment.
Garthwaite recommitted himself to the task of turning around
King/Drew. He sent his own deputies to begin sorting through the
hospital's finances.
A year later, they are still stumped by basic questions about how
King/Drew spends it money.
Leaf, the health department's second-in-command, said it could be
another year before they had solid answers.
"I know the games that are played and the stalling tactics that go on"
at King/Drew, he said. "Even knowing that, it's just an unbelievable
morass. It really is."
Bill Schenley
One Doctor's Long Trail Of Dangerous Mistakes
Alarmed colleagues reported pathologist Dennis Hooper to King/Drew
officials, but he stayed on the job. Records detail sloppy work and
faulty diagnoses even before he was hired.
FROM: The Los Angeles Times ~
Tracy Weber and Charles Ornstein, staff writers
http://www.latimes.com/news/local/la-me-kdday3dec07,1,4233337.story?coll=la-headlines-california
Five pathologists slipped into the microscope lab at Martin Luther
King Jr./Drew Medical Center, steeling themselves to act after months
of deepening suspicion.
They'd seen enough. They were convinced that their newest colleague,
Dr. Dennis G. Hooper, was making dangerous mistakes. And on this
August afternoon in 2000, they were prepared to turn him in.
Dr. Brian Yee had caught the first hint of trouble in April.
Rechecking a 27-year-old man's blood work, he noticed that Hooper, a
pathologist with 16 years' experience, had missed signs of leukemia.
Over the summer of 2000, the pathologists believed, Hooper had
misdiagnosed at least four other patients.
One was Virginia Jackson, 75, known as "Mama Jackson" to her adoring
117th Street neighbors. In early July, Hooper had said she was
cancer-free — having failed to spot the malignant cells in her urine.
Six weeks later, another pathologist, Dr. Theresa Loya, found invasive
bladder cancer in a subsequent biopsy. The cancer would eventually
kill Jackson, a mother of 16 and grandmother of 39.
About the same time, Dr. Hezla Mohamed was asked to recheck another of
Hooper's cases. Hooper had seen "no area of malignancy" in the swollen
neck tissue of a 59-year-old man, medical records show. Mohamed
suspected that it was thyroid cancer — a finding that an outside lab
would later confirm.
At a certain point, "you start to wonder if the person knows what he's
doing," said Mohamed, now pathology chairwoman at the Los Angeles
County-owned hospital.
In the microscope lab that August day, Hooper's colleagues worked out
the details of a warning letter to the hospital's chief medical
officer and his associate.
The letter said Hooper, in his first six months on the job, had lost
specimens and at times cut tissue so sloppily that he could not make
an accurate diagnosis. It meticulously charted his alleged failings,
listing each by case number, and cautioned that his work "puts all of
us and the institution at risk for medical malpractice."
Soon afterward, Mohamed recalled, the pathologists met with the
hospital's medical leaders, who said they would investigate the
complaints and keep an eye on Hooper.
Further entreaties brought no response. Tension gave way to bitterness
as the colleagues realized that this was the hospital's final answer:
silence.
"Here you had five pathologists signing a letter listing cases and
telling administration in no uncertain terms that this pathologist has
competency problems, and there was no response," said Dr. Timothy
Dutra, who signed the letter.
Worse than that, he said, the hospital's medical leaders later denied
ever receiving the letter, "even though I know it was given to them on
three separate occasions."
Hooper continued working, whipping slides through his microscope with
a speed some colleagues considered irresponsible. The tall, paunchy
pathologist, once eager for their friendship, kept more to himself
now, listening to the music of Yanni on his headphones and saving his
charm for their boss, Dr. Irene Gleason-Jordan.
Even when confronted with mistakes, some co-workers recall, Hooper
seemed indifferent to the life-or-death importance of his job. Though
pathologists rarely see patients in person, they issue crucial
verdicts based on blood or tissue samples. Depending on a
pathologist's report, patients can return home to a normal life,
require surgery and other treatment, or face the reality that their
lives are ending.
Six months after the pathologists sent their letter, Johnnie Mae
Williams, then 40, went to the public hospital in Willowbrook, south
of Watts, for a seemingly minor gynecological exam. Hooper determined
that she had cancer of the uterine lining, and surgeons quickly gave
her a radical hysterectomy, taking out all of her reproductive organs.
Hooper was wrong.
He had seen cancer — but it wasn't hers. His findings, it was later
determined, were based on a slide from another patient, who had brain
cancer. In his report, Hooper raised the possibility that the slide
had somehow been mislabeled, but medical records show no evidence that
he investigated where the slide came from.
When Mohamed examined Williams' excised organs 2 1/2 weeks after her
surgery, she found no evidence of cancer, according to Williams'
medical records.
A uterine-cancer expert said that what Hooper saw on the slides should
have made him wary. The cancer that he diagnosed is uncommon in a
woman of Williams' age, and one cell type necessary for Hooper's
finding was absent, said Dr. Lora Hedrick Ellenson, a professor of
pathology at Cornell University's medical school, who reviewed
Williams' medical records for The Times.
"Everything about this case should have raised all kinds of red
flags," Ellenson said.
Mohamed informed at least five other doctors at King/Drew, including
several involved in Williams' care, that she did not have cancer, the
records show.
But no one told Williams.
She did not learn of the misdiagnosis until more than two years later,
when a Times reporter — unaware that she didn't know — sought her out
for an interview.
After the operation, "I felt like I wasn't even going to be a full
woman anymore," she said, her hands shaking.
The mother of three had wanted to have more children. But she'd taken
solace in being a cancer survivor, and she'd been grateful to
King/Drew. "Everyone kept calling it 'Killer King,' " she said. "I
used to say, 'No, that hospital saved my life.' "
Hooper, 55, has repeatedly declined to discuss the case and others
cited in this article.
His attorney, James Andrew Hinds Jr., wrote in a Nov. 5 letter to The
Times that the criticisms of Hooper amounted to "innuendo" and were
"without factual substantiation." In fact, he said, Hooper cleaned up
"an administrative mess at the hospital." Hinds also indicated that
the doctor was precluded from commenting because of patient
confidentiality rules.
As much as they scrutinized Hooper's performance at King/Drew, his
fellow pathologists knew little about his past. The same was true,
apparently, of hospital officials.
Had they looked into it more closely, they might not have hired him in
the first place.
An unseen cancer
When Roberta Nesbit got the results of her biopsy back from a San
Diego lab in 1995, she had reason to celebrate.
The mole on her groin was benign, according to Hooper, who was filling
in for another pathologist at the lab. She was cancer free.
Actually she wasn't. Over the next 15 months, the melanoma would grow
underneath her skin, becoming a massive tumor. She had a second
biopsy, which revealed not only that she did have cancer, but also
that it had spread to her lymph nodes.
Nesbit sued Hooper and the lab for malpractice.
In court papers, the pathologist's own attorneys conceded that even a
second-year medical trainee would have spotted the cancer in the mole.
But Hooper, they said, was not at fault: He must have looked at a
slide from another, healthy patient, mislabeled by a technician as
Nesbit's.
Nesbit's attorney, who dismissed Hooper's defense as specious,
negotiated a $450,000 settlement with the doctor in 1998.
Less than a year later, Nesbit was dead at 57.
"We're not talking about some trivial error here," said Nesbit's
lawyer, Richard Binder. "We're talking about something that cost
someone her life."
Hooper moved on. By late 1997, he was filling in at a Reno medical
center operated by the U.S. Department of Veterans Affairs and tending
to private medical laboratories he had opened in California, Nevada
and Wyoming. (He eventually operated at least six, at various times.)
At the VA medical center, former co-workers remember him in rumpled
khakis, singing along with Elvis recordings during autopsies or
lamenting the ban on the diet drug combination fen-phen. He'd hurry
through dissections and slides, then make phone calls related to his
outside businesses, they say.
As at King/Drew, it wasn't long before the quality of his work came
into question.
In May 1998, a surgeon discovered that Hooper had failed to notice one
of two tumors in a section of colon she had taken out, according to VA
documents that The Times obtained through the federal Freedom of
Information Act. Another pathologist determined the growth to be
cancerous.
After a second physician expressed worries, Hooper was found to have
made at least two more serious errors, VA documents show.
Ultimately, hospital administrators opened an investigation and sent
slides from 346 of Hooper's cases to the nationally renowned Armed
Forces Institute of Pathology for a comprehensive review.
Of these cases, nearly a third contained mistakes. The institute found
that Hooper had made major errors in 10 cases and minor errors in 104
more. Major errors typically require remedies such as chemotherapy or
surgery.
According to a published study and two experts, the standard error
rate for major mistakes by a general pathologist such as Hooper is
less than 1% when all cases are reviewed.
Hooper's rate was nearly three times that.
His contract as a fill-in at the hospital was not renewed, VA
officials said.
"I would not hire him ever" again, said Dr. Paul Jensen, former chief
of pathology and laboratory medicine at the Reno facility. "Wouldn't
even consider it."
But the VA kept Hooper's litany of mistakes to itself — never alerting
the Nevada Board of Medical Examiners.
Dr. Thomas Barcia, the hospital chief of staff, said VA lawyers
advised him that Hooper's errors fell within acceptable industry
norms.
To this day, if another hospital called to inquire about Hooper, the
VA would give him a clean reference, Barcia said, adding that "the
data I have does not show he was a substandard pathologist."
In 1999, the year after the VA's investigation of Hooper, another arm
of the federal government sanctioned him for lapses in his private
Reno laboratory.
The Health Care Financing Administration determined that Hooper had
falsely claimed the lab was accredited by the College of American
Pathologists. In fact, he had never applied for such accreditation,
government records say.
The regulators also found that Hooper closed the lab to avoid an
inspection. The government banned him from owning or operating a
pathology lab anywhere in the United States for two years.
Even before these sanctions, some associates had serious doubts about
the quality of work at Hooper's labs.
One of them was James Champa, a Wyoming orthopedic surgeon and former
medical school friend.
"I realized something was wrong," he recalled, "when my male patient
got a positive pregnancy test from the lab Hooper ran here in
Jackson."
'On the fast track'
From an early age, Hooper sought to make his mark in the world of
science.
After high school, he left tiny Ely, the dusty east Nevada mining town
where his father was postmaster. While pursuing a PhD in microbiology,
Hooper attended medical school at the University of Nevada in Reno.
He told admiring classmates that he'd been asked by medical school
officials to teach microbiology, but felt it would be awkward to
instruct his peers.
"He was on the fast track," Champa recalled. "I was awed."
Hooper trained as a pathologist in the Navy and leaped over colleagues
to become chairman of the laboratory department at the Naval Medical
Center in San Diego.
Then, in 1994, his nearly 15-year naval career came to an abrupt, and
somewhat mysterious, end.
Hooper resigned after he was investigated for allegedly using
government resources improperly, according to his own testimony in a
2002 court hearing. The Navy would not discuss the inquiry.
Hooper rebounded quickly. He captivated friends and colleagues in the
mid-1990s with ideas for lucrative diagnostic and research labs.
They recall his saying that he was on the hunt for an HIV vaccine and
that he had a patent on his research. He planned to sell the idea to a
pharmaceutical giant.
But first he needed money. Many friends — and their families and their
friends — invested with Hooper, some handing over hundreds of
thousands of dollars.
Hooper, who had been active in his Lutheran church, came across "as a
person who is really dedicated to medicine and especially to HIV,"
said Father Frank Hoffmann, a Catholic hospital chaplain in San Diego
who invested $8,000 of his retirement money. "He looked honest,
sincere. With me he would always bring up the religious part."
Colleagues and other investors say Hooper appeared to be the
high-rolling businessman, entertaining them in casino suites and fancy
restaurants.
He would disarm them, they say, with funny asides punctuated with
high-pitched giggles.
He seemed to handle the pressures of business well, his associates
said, though they noticed that he chain-chewed Pepcid AC and Tums,
bought in bulk at Costco.
Before long, however, his enterprises crumbled. The promised profits
never materialized. And Hooper, once so solicitous, stopped returning
investors' calls.
Hal Forseth, a Montana obstetrician who interned with Hooper in the
Navy, recalled the pathologist's sending a brisk form letter saying
Forseth's investment had been lost: "Just, it tanked…. Adios, amigo.
That was hurtful. He was a friend."
Hooper filed for personal bankruptcy in 1999 — a year before King/Drew
hired him — listing 28 pages of creditors. Two groups of investors
sued, accusing him of swindling them out of nearly $1 million in all.
In court papers, he denied the allegations.
In one suit, investors alleged that Hooper had coaxed them into
funding labs and research destined to fail. They contended that he
knew his HIV vaccine didn't work and that, contrary to his claims, it
had not been patented.
"You're looking at him and you're thinking, 'This is the nice guy next
door who will help my mom across the street,' " said Dr. Thomas
O'Gara, a Reno family physician and medical school classmate of
Hooper.
O'Gara's family won $70,000 in a court judgment last year, but he said
they had yet to collect anything. With interest, the award had grown
to at least $95,000 as of October 2003, according to a court filing.
"He didn't just take me," O'Gara said. "He took my mother, my dad. He
took my brother."
The second suit, filed by eight other investors — including Father
Hoffmann — is pending.
Robert Mallon, a Yuma, Ariz., pathologist and former Navy colleague of
Hooper, said he hoped to recover at least some of the $167,000 he
invested.
"If we get a judgment against him, I'll follow him to his grave,"
Mallon said.
Red flag after red flag
The investor suits are among several items in public records that
document Hooper's legal and professional troubles in the years before
King/Drew put him on staff.
Evidence could also have been found at the Nevada medical board, to
which — as a doctor licensed in that state — he was required to report
the Nesbit settlement. Other information was in the U.S. government's
Laboratory Registry and in federal bankruptcy filings.
And these are just the public documents. More could have been gleaned
from private reference checks.
Los Angeles County health officials said King/Drew did a criminal
background check on Hooper and searched his malpractice record on a
national registry. County spokesman John Wallace said he could not
discuss the registry results because they are confidential. Hooper had
no criminal history, Wallace said.
It is unclear whether King/Drew knew of Hooper's federal lab sanctions
or the investor lawsuits, Wallace said. Physician applicants at the
hospital are not required to disclose bankruptcy filings or lawsuits
unrelated to malpractice.
But a hiring expert said a responsible hospital should make every
effort to learn if there had been any.
Any business should be wary of a bankrupt applicant who is being sued
by his partners, because he might be more concerned with his legal
woes than the job at hand, said William Greenblatt, chief executive of
Sterling Testing Systems, which performs background checks on hospital
job applicants and others.
"You would have to know that he had lawsuits," said Dr. David Shenton,
who added that he lost $15,000 in one of Hooper's ventures.
"You'd see some red flags, and then you'd call references," said
Shenton, who helps screen physician applicants at his Billings, Mont.,
hospital. "It just seems sort of odd that [King/Drew] didn't catch
it."
Impassioned campaign
In the pathology lab at King/Drew, Dr. Dutra knew only what he saw: a
colleague who shrugged off his mistakes — when he acknowledged them at
all.
"He would make these casual diagnoses that were wrong, and they didn't
seem to bother him," Dutra recalled.
While the other pathologists sank into bitter disappointment at
management's seeming indifference to their concerns, Dutra embarked on
an impassioned campaign. He made angry phone calls and wrote pleas to
county Supervisor Yvonne Brathwaite Burke's office, county auditors
and health department leaders and the Medical Board of California. He
listed new diagnoses by Hooper that he considered questionable,
including case numbers and dates.
He sometimes began his letters with sheepish apologies for his earlier
vehemence.
"The truth of the matter is that we're only seeing the tip of the
iceberg," Dutra wrote in May 2001 to Dr. Gail Anderson Jr., the health
department's acting medical director who oversaw King/Drew. "Who knows
how many other time bombs Dr. Hooper has out there, waiting to show up
sometime in the future with their misfortune?"
Dutra's frustration clouded his professionalism at times, he freely
acknowledges. One day he ranted against Hooper so loudly in the
pathology department hallway that Hooper called him later and, in
obscene terms, told him to "shut the … up," Dutra said.
County auditors, spurred in part by Dutra's effort, began asking
questions about Hooper in November 2000. Stymied by what they saw as
hospital officials' slow responses, they didn't complete their report
until September 2001.
Their conclusion: Dutra and his colleagues had been right all along.
Hospital leaders had known of Hooper's failings and done nothing.
The 16-page report faulted Dr. Edward Savage, the former medical
director to whom the pathologists had addressed their letter, and
Gleason-Jordan, the department's chairwoman, for brushing aside the
warnings.
The audit urged disciplinary action against Hooper. But by this time,
he was on disability leave, claiming harassment and stress, the audit
said. He formally left county service in July 2002. Hooper was never
disciplined, county officials recently confirmed.
Others faulted in the audit still contest its findings.
"They don't know what they're talking about," said Savage, who retired
under pressure but now works at the hospital part time. "We did
everything according to the rules."
Gleason-Jordan was replaced as chairwoman the month after the audit
was released, and she later retired.
In an interview, she defended Hooper's performance and accused her
former staff of lying.
Dr. Thomas Garthwaite, who became director of the county Department of
Health Services in early 2002, said the Hooper case was his first
signal that King/Drew suffered from grave medical and management
problems.
"I was just struck by the nature of the errors and by the relatively
casual way it was handled," he said recently. "It was very clear to me
we needed new leadership."
Garthwaite could not explain, however, why he did not act against
Hooper.
An independent expert who reviewed the audit, the pathologists' letter
of warning and other records for The Times said Hooper's ongoing
mistakes pointed to broad failures in leadership at the hospital.
"Certainly his bosses were not doing a good job in preventing these
errors," said Dr. Hector Battifora, former chairman of pathology at
City of Hope National Medical Center in Duarte. "When errors like this
happen and they are reported and nothing is done … that is absurd. And
the administration should have been aware of it, and they should have
done something about it."
Dutra distinctly remembers one administrator's response.
Anderson, the health department's acting medical director, chastised
Dutra in a letter for "releasing confidential, patient-specific
information" to the medical board and Burke's office.
In the final paragraph, however, Anderson briefly commended Dutra's
concern for patient safety.
Reexamining 2,000 diagnoses
Administrators finally did something about Hooper — after he was gone.
They paid Mohamed and another pathologist thousands of dollars to comb
through all his nearly 2,000 diagnoses.
Mohamed said she had not kept a precise tally of misread tests, but
had referred cases as she found them to the hospital's risk management
department. She said recently that she could remember just one
significant case beyond those the hospital already knew about.
According to court files, Maria Aparicio, now 66, learned after the
review that Hooper had missed her breast cancer two years earlier.
Aparicio, who required surgery and follow-up treatment, sued and
collected a $25,000 settlement from the hospital.
California authorities did not try to discipline Hooper until October
2003 — three years after the pathologists wrote their letter — when
the state medical board accused him of mishandling the care of six
King/Drew patients, including Williams, whose reproductive organs were
removed unnecessarily. He is contesting the board's accusation.
Dutra took no solace in his group's ultimate vindication by county
auditors. He left King/Drew in July 2003, disgusted, he said, with its
leadership. "Even when you win, you don't win anything," he said.
By the time the medical board filed its case, Hooper had left the
state.
Today, he is a staff pathologist at a large private hospital in San
Antonio.
"Dr. Hooper is a member in good standing of our medical staff here at
Baptist Health System," spokeswoman Karen May said. "And that's the
information we're prepared to release."
Bill Schenley
How Whole Departments Fail A Hospital’s Patients
A culture of mismangement pervades nursing, orthopedic surgery,
residents’ training and the pharmacy. Individual shortcomings often
make matters worse.
FROM: The Los Angeles Times ~
By Charles Ornstein and Tracy Weber, staff writers
http://www.latimes.com/news/local/la-me-kdday4dec07,1,4626554.story?coll=la-headlines-california
Brenda Nelson hurried though the doors of Martin Luther King Jr./Drew
Medical Center in October, toting a container of gumbo soup for her
son, Mario. She expected him home soon.
To her surprise, she was told that Mario, 28, was in intensive care.
There, a security guard repeatedly refused to let her in. When she
finally was allowed through an hour later, nobody told her what she
would find.
Mario was dead, his eyes and mouth open.
"I screamed and hollered," she said recently, her hands trembling. "I
tried to pull my baby out of the bed."
Then she closed his eyes.
A nurse told Nelson that Mario — the family's chief party planner and
cook, and a onetime church choir director — had suffered from AIDS,
something she hadn't known. The immediate cause of death was
respiratory failure brought on by pneumonia.
What Nelson was not told, until The Times reported it five days later,
was that the nurse assigned to keep constant watch over Mario had not.
She had silenced the alarm on his vital-signs monitor, then failed to
notice his heartbeat fading, according to the nurse's suspension
letter filed in her Civil Service records.
Nor was Nelson told that the nurse had allegedly falsified her son's
medical chart. According to Los Angeles County health officials, the
nurse indicated that she found Mario stable at 6 p.m. — more than an
hour after he had died.
"She took it in her hands to play God," said Nelson, who has sued the
county, which owns King/Drew.
Mario's death was no isolated incident. Three King/Drew patients, all
hooked up to monitors, died last year after nurses failed to notice
their declining vital signs, state and federal inspectors found.
The nursing department is often considered the heart of a hospital;
its failings alone can incapacitate the entire institution. The
frequency of lapses in King/Drew's nursing department suggests a
systemic problem, one that goes beyond mere individual shortcomings.
In fact, a Times investigation found that such deep failings extend
well beyond nursing, to at least three other areas.
Mistakes and neglect at times have debilitated King/Drew's pharmacy
and doctor-training programs, which affect nearly every patient
admitted. And the newspaper found the small but essential department
of orthopedic surgery to be crippled by employee misbehavior —
absenteeism, profiteering, even the commission of felonies in off
hours.
The fault, hospital experts say, lies with the institution's overall
leadership.
Unless leaders can identify and fix what is broken, a hospital cannot
operate safely, said Dr. Donald Berwick, president of the Boston-based
Institute for Healthcare Improvement. Otherwise, he said, it's like
insisting, "My car is fine except for the brakes."
Until recently, the Los Angeles County Board of Supervisors,
King/Drew's governing body, has balked at wholesale repairs. Over the
years, as the evidence has piled up in audits, malpractice cases,
internal memos and reports from regulators, the board has largely
stood by, seemingly paralyzed.
"Fundamentally, someone has to step up to the plate and lead the
people out of the morass that they're in," said Dr. Kenneth W. Kizer,
president of the National Quality Forum, a nonprofit group seeking to
improve healthcare.
Orthopedic surgery
Orthopedic surgeons are the carpenters of medicine, called in to
repair limbs shattered by bullets or snapped in car wrecks. They tend
to the aching joints of the elderly and the torn ligaments of the
weekend warriors.
At King/Drew, they also quite often get into trouble.
It starts at the top.
Dr. Clarence Woods, department chief until his removal this fall, was
twice faulted by county auditors for having little or no control over
his staff — including surgeons and physician assistants who often
worked only when they wanted to.
Dr. William T. Long, the only other full-time orthopedic surgeon,
recently resigned after being threatened with dismissal for allegedly
falsifying his time cards and referring insured King/Drew patients to
his private practice at Centinela Hospital Medical Center in
Inglewood. Auditors found him performing surgeries and seeing private
patients at Centinela on at least five Fridays this year when his time
card indicated he was at King/Drew.
Long said the county dropped its allegations against him before he
resigned. "I was not found to be at fault for anything when I left
there," he said.
Department of Health Services officials said they could not comment on
personnel matters.
Dr. James K. Brannon, a high-profile surgeon and medical entrepreneur,
is under investigation by county auditors for alleged conflicts of
interest.
Although he works just part time at King/Drew, the doctor has ordered
nearly $1 million in medical equipment for surgeries there from a
company he co-owns. The disposable items, used for bone grafts, are
far more expensive than the reusable devices employed by most
hospitals, orthopedic surgery experts told The Times.
Brannon has denied wrongdoing, saying he ordered his company's
equipment with the full approval of the county.
The department's surgeon-training program is so rife with troubles
that the county plans to phase it out at the urging of the national
accrediting group for physician-training programs.
In a recent letter to the hospital, the Accreditation Council for
Graduate Medical Education said King/Drew's orthopedic surgery
residents were badly selected and poorly trained.
Residents dissatisfied with the program told accreditors that they
were reluctant to complain because they felt intimidated by program
leaders.
The department has other problems. The performance of physician
assistants, who treat patients and prescribe medications under a
doctor's guidance, is "terrible," said a report the accreditation
council sent to King/Drew last summer. "These individuals are seen as
unreliable and undependable, frequently absent and often
discourteous."
A county audit came to similar conclusions last year. In fact,
then-department chief Woods told auditors, King/Drew's own human
resources department had determined that physician assistants were
"running amok."
Assistant Karen Theophile was reprimanded in 1999 for not responding
when paged, in 2000 for not being available when on call, in 2001 for
not following directions and in 2002 for skipping work without
permission. Last year, auditors said they were unable to verify when
she worked because of her "inconsistent use of the time clock."
Theophile declined to comment.
"What we have is a group of employees who don't come to work," Long
said at a meeting of physician assistants in April 2002, according to
the meeting's minutes. "Can't think of a single day when a PA has been
on time."
Woods told county auditors in 2003 that he'd rather step down as chief
than figure out a solution. Supervising physician assistants, he
complained, "is like supervising children."
The failings of PAs extend beyond absenteeism.
For 5 1/2 months in 2002, physician assistant Andrew Josiah spent his
nights working at King/Drew and his days at the halfway house where he
was serving out a sentence for felony child abuse.
Josiah was convicted of trying to choke his 12-year-old son and then
dunking his head under water.
Woods knew all about it: By his own account, he signed the form
allowing Josiah to participate in the work-release program. The
hospital did not dismiss Josiah until July, six months after a state
licensing agency had put him on five years' probation.
Josiah did not return telephone calls seeking comment.
Woods acknowledged that he had been slow to discipline employees and
naive to help Josiah. But he said the orthopedic surgery department
served patients well under his watch.
"We were productive," he said. "I think anybody you talk to could
attest to that — that we were the hardest working of the departments
there."
Residency program
In July 1999, Dr. Penelope Velasco, then 28, began training at
King/Drew to become an obstetrician/gynecologist.
By last year, the final one of her residency, she had been involved in
three malpractice suits.
In her first year, she was the primary surgeon during the caesarean
delivery of Lauryn Johnson, who suffered brain damage. In a lawsuit,
the baby's mother alleged that doctors performed the procedure too
late. The county settled the case for $2.5 million in July 2003.
In her second year, Velasco was unable to deliver a large baby who
temporarily became stuck in the birth canal, according to a subsequent
lawsuit. The baby's arm was left unusable. (Velasco was then working
at Riverside County Regional Medical Center as part of a training
rotation that King/Drew had arranged.)
The case against her and others was settled in September for $375,000,
according to the plaintiff's lawyer.
In her final year, Velasco performed elective surgery on 43-year-old
Sherry Ridley. During an operation to remove ovarian cysts, Velasco
stitched through Ridley's colon in error, according to Ridley's
medical records. Doctors did not notice the error for 12 days. Ridley
was ultimately overcome with infection and died.
Her family's lawsuit is pending.
Medical residents such as Velasco are expected to make mistakes,
experts say. But experienced physicians are expected to catch them.
More than anything, Velasco's troubles highlight potentially dangerous
lapses in the supervision of King/Drew's doctor-training programs,
founded more than three decades ago to turn out talented physicians to
serve the nation's impoverished minority communities.
"The gynecology resident and attending surgeons in this case clearly
did not recognize what they were doing or had done," said Dr. Thomas
Gouge, director of surgical residency at New York University Hospital,
who reviewed Ridley's medical records for The Times. "They thought
that their stitches were fine."
Velasco said in an interview that she had received good supervision
during her residency and properly cared for patients. She said she was
aware of no evidence that she had stitched through Ridley's colon.
In any physician-training program, she said, "things will happen. It's
just the nature of medicine, the nature of life."
In the last two years, oversight of residents at King/Drew has been
deemed so lax that the national Accreditation Council for Graduate
Medical Education ordered the hospital and its affiliated medical
school to close three of 18 training programs — in surgery, radiology
and neonatology.
Despite these sanctions, some residents continue to work with little
or no supervision. Just last month, a resident left a 20-inch-long
metal guide-wire inside a patient while trying to insert a catheter
into his leg. The error was not discovered until 13 days later, when
the wire was spotted precariously close to his heart on a routine
X-ray, county health officials reported in a memo to the Board of
Supervisors .
Walter Strong, vice president for university relations at Charles R.
Drew University of Medicine and Science, defended the residency
programs' overall quality, saying they are moving "in a positive
direction." Ten have been fully accredited since January, including
one that had previously been on probation.
Many current and former King/Drew trainees say they learned a great
deal from the variety of injuries they saw at the medical center.
"You can't buy the experience that I got at King," said Dr. Mary-Anne
Purtill, a 1997 surgery graduate who directs the trauma center at the
Medical College of Ohio in Toledo.
But King/Drew, by the county's own admission, often does not attract
top-tier minority residency candidates. And many residents, after
their training, fare worse than their peers on national specialty
examinations.
King/Drew's academic problems can be compounded by its tolerance of
disturbing behavior.
In 1999, for instance, the hospital hired Dr. Warren C. Lemons as a
resident in its family medicine program despite documented academic
problems. He had been forced to repeat his first year of a pediatric
residency in North Carolina and then left — by mutual agreement with
officials — without finishing the program.
At King/Drew, said a former staff psychologist responsible for
evaluating residents, Lemons displayed such odd and defensive behavior
that she kept notes about him on her daily calendar and reported him
to her superiors.
Lemons remained at King/Drew until 2001, when he was dismissed because
he failed to get a medical license from the state of California as
required.
In February, Lemons returned — unofficially. Security guards caught
him barricaded in an unused hospital room, with a former King/Drew
patient, setting up videotaping equipment. The former patient, a deaf
and mute man, was zipping up his pants, and Lemons had his old
hospital ID, baby oil and soft restraints in his possession. Both men
were allowed to leave.
Months later, Lemons was arrested on suspicion of killing the man
during a sexual encounter in a Calexico hotel room. In a search,
police said, they found the dead man's King/Drew medical records and
140 videotapes, including some graphic images of naked male patients.
The police investigation is still underway, and Lemons has not been
criminally charged. His attorney has said Lemons did nothing wrong.
Pharmacy
In February 2003, federal agents raided the home of a low-level
pharmacy clerk, Eric Townsend, seizing 38,700 prescription pills he
had stolen from King/Drew and was selling from his garage.
Among the stash, agents found tablets to control depression,
schizophrenia, heartburn and high blood pressure, according to
Townsend's plea agreement. An informant told authorities he'd been
buying in bulk from the clerk for more than three years. The pills
seized in the raid, and 4,000 others acquired during a previous
undercover buy, were valued at about $150,000, authorities said.
Townsend was sentenced to five months in federal prison and ordered to
pay $30,000 in restitution to King/Drew.
The hospital's pharmacy director, Amy Gutierrez, acknowledged in an
interview that she hadn't been aware the drugs were missing until she
was contacted by the state Board of Pharmacy, months after Townsend's
sentencing. She said the department tightened security as a result.
This was one of many significant failures in the department in the
last decade. It has been hobbled by haphazard supervision, staff
misconduct and venomous infighting, according to interviews, lawsuits
and county records. Employees have sued and counter-sued one another,
and even summoned county police to quell disputes.
What suffers is the department's core mission: delivering the right
drugs at the right time to patients.
In March, for example, federal inspectors confirmed a Times report
that a 46-year-old meningitis patient had been mistakenly given a
potent anti-cancer drug for four days. The drug, Gleevec, is used to
treat a form of leukemia.
The patient, William Watson, continued to fall victim to medication
errors — even after the first mistakes were caught. Inspectors found
that nurses and pharmacists had failed to give him 25 doses of
medications ordered by doctors. Making matters worse, they had given
him 12 extra doses of one drug and one injection of an anti-psychotic
medication that was never ordered.
During their investigation, the inspectors — pulling files randomly —
discovered that pharmacists and nurses had mishandled the drug
treatment of nine other patients.
A stroke patient had to wait nearly five hours for a drug to help
prevent heart attacks and recurrent strokes, the inspectors' report
said.
At one point, pharmacists refused to fill the patient's medication
order because a doctor had misspelled the drug's name. Later, an
inspector watched as two pharmacists within half an hour of each other
picked up the prescription, looked at it, then walked away without
arranging for its delivery. It is unclear whether the patient suffered
harm as a result.
In the August 2001 edition of Tech Talk, the pharmacy department's
short-lived newsletter, pharmacy technician Derrick Evans warned of an
"alarming" number of medication errors.
"It's important that we don't forget who loses out if we do not do our
jobs to the best of our ability," he reminded his colleagues. "The
patients."
Current and former employees describe their bosses as misguided,
unqualified or, in at least one case, asleep. One pharmacy technician
recalled nervously filling prescriptions while the night pharmacist
pushed two chairs together, donned his slippers and slept through his
shift.
"He didn't check my calculations. He didn't check to see what I put in
my [IV] bags," said Cassandra Ellis-Woodson, a former King/Drew
pharmacy technician who quit in 2002. "There was just so much stuff at
that place.... You couldn't focus on patient care."
County health leaders have said at various times in the last year —
even after the cancer-drug mix-up — that the pharmacy is one of the
better-functioning areas at King/Drew.
And Gutierrez, who has led the department for 10 years, said she was
not to blame for any problems. She has tried to set high standards for
employees, she said, and that's why some don't like her. Also, she
said, the department struggles with a staffing shortage, which forces
the use of temporary workers.
Gutierrez said all hospital pharmacies make mistakes. "The answer to a
medication error is not always to point a finger at the bad apple,"
she said. "You look at the system, and you look at a way to improve
the system so it doesn't recur."
But with some pharmacists at King/Drew, mistakes happen again and
again.
One pharmacist from a temporary agency, Zenaida Joaquin, was
reprimanded at least three times for mistakes in the hospital's
outpatient pharmacy in 2002 and 2003, according to county hospital
records.
She allowed a patient to receive two vials of medication that were
prescribed to another patient with the same last name. She gave a
different patient three medications prescribed for someone else. And
she gave a third patient twice the ordered dose of Valium.
Joaquin said the outpatient pharmacy processed hundreds of orders a
day and did not have enough staff.
"I feel like I'm being made a scapegoat," she said. "There were others
who committed mistakes also."
Nursing
Rona and Cynthia Millage were shocked to learn about the death of
Mario Nelson, the AIDS patient whose nurse had failed to notice his
heart faltering in October.
To them, it seemed the hospital had learned nothing at all from the
death of their mother, Robbie Bilbrew, 16 months earlier.
She too had been hooked to a cardiac monitor. Her condition too had
declined without anyone's noticing. Her nurse, too, had fabricated
chart entries in advance, a state investigation found.
The nurse, Elsa Ruiz, left the hospital the morning of Bilbrew's death
in July 2003, never to return. Ultimately she was fired for abandoning
her post.
Contacted by The Times, Ruiz declined to comment. She did, however,
admit to the state nursing board that she had repeatedly falsified
medical records and misrepresented events in the case, the board said
in a written accusation against her. The board's action is pending.
Rona Millage said her mother, a 52-year-old former teacher's aide, was
in a hospital unit dedicated to patients who needed extra nursing
care. Yet she slipped away, alone and unnoticed.
"What was that nurse doing for all that time?" Millage asked. "Didn't
she care?"
It's a question the families of other patients, even some of the
hospital's own doctors, have asked as well. Some nurses at King/Drew,
they say, have lost — or never had — the sort of compassion and
commitment that draws people to the profession.
Hospital inspection reports, legal filings and personnel records
detail behavior by King/Drew nurses that seems not only callous, but
inconceivable—even allowing for the pressures at a hospital with an
especially severe nursing shortage.
On several occasions in 1999, nurse Yvonne Cathey allegedly ordered a
janitor's aide to mix up intravenous medications for critically ill
patients in the trauma intensive care unit. According to Civil Service
records, the aide's job description restricted her to "only the most
unskilled duties" and required her only to recognize "a limited number
of two- and three-syllable words."
This year, the state nursing board stripped Cathey of her license
despite her denial of wrongdoing.
Between 1999 and March 2004, state inspectors cited only five of
California's 450 hospitals more often than King/Drew for violating
nursing standards.
Sometimes, according to inspection records, patients have languished
unattended by one nurse after another. A patient with gangrene of the
leg, kidney failure and a temperature of just above 90 degrees
shivered for 19 1/2 hours — until his death — without a special
air-heated blanket ordered by a doctor, said a 2004 federal inspection
report that did not name the patient.
Nurse after nurse reportedly noted the patient's low temperature but
ignored the directive, supplying only a light blanket.
Other times, the same nurse was involved in more than one serious
medical lapse.
Wilma Walker, who allegedly failed to notice Mario Nelson's declining
vital signs in October, had been suspended in April for giving the
anti-cancer drug to meningitis patient Watson, according to county
records.
Walker has appealed her latest discipline to the Civil Service
Commission, denying the allegations.
Watson said the failings in his care were more than medically
harmful — they were dehumanizing. Made incontinent by his medications,
he recalled mopping up his urine with his hospital gown. The stench
had become too much to bear.
"It's not really a great place to be when you're really sick," he
said.
Cynthia Millage said the nurses and aides didn't take time for even
the most basic needs of her mother. Millage had to teach herself to
clean her mother's bedsores, even her breathing tube.
"It'd get all clogged and stuff," she said. "We had to do everything."
In nursing, some dangerous practices were allowed — and even
encouraged -- by the bosses. For instance, senior nursing managers
urged front-line nurses to minimize the severity of patients'
illnesses, a June county audit showed, because patients rated sicker
would require more nursing care.
The publicized troubles at King/Drew—and an long contract dispute with
the county's nurses union—made hiring difficult and added to the
burden of those already on staff.
Despite challenges that can make each shift grueling, many King/Drew
nurses say they do their best to provide high-quality care. "We can't
turn the patients away," said Ida Steverson, a surgical nurse, of the
poor people King/Drew serves. "They can't just get up and go to
Cedars-Sinai" Medical Center near Beverly Hills.
Some staffers remain on the job, however, despite poor training and
outright ineptitude. Earlier this year, a consulting group tested
King/Drew's nurses and determined that at least one in five could not
pass competency tests.
Nursing expert Jean Ann Seago, who reviewed King/Drew's nursing
citations for The Times, said she'd seen rampant problems before with
one hospital unit or one rogue nurse, but never throughout an
institution.
"If it's sort of the general culture of the whole hospital, oh my
God," said Seago, director of the UC San Francisco nursing
administration program. "Somebody needs to get a grip on the
situation."
"This is an example of what happens when you just let things go on and
on," she said.
Bill Schenley
Why Supervisors Let Deadly Problems Slide
Fearful of provoking black protests, they shied away from imposing
tough remedies on inept administrators. 'We have failed the
community,' one board veteran acknowledges
FROM: The Los Angeles Times ~
By Mitchell Landsberg, staff writer
http://www.latimes.com/news/local/la-me-kdday5dec09,1,5150845.story?coll=la-headlines-california
(w/photos)
On the sultry evening of Aug. 11, 1965, a 21-year-old black man named
Marquette Frye was pulled over by the California Highway Patrol at
116th Street and Avalon Boulevard for driving drunk.
A crowd gathered. Frye resisted arrest. A patrolman struck him in the
face with a nightstick.
It was as if the blow knocked loose the cornerstone of a dam.
What poured forth was a torrent of rage, propelled through the streets
of Watts and South Los Angeles by the conviction that African
Americans had lived too long with the contempt of a white-run
society — denied respect, along with decent housing, education and
medical care.
That flood of anger led directly to the creation of Martin Luther King
Jr./Drew Medical Center, which opened in 1972. And the power of that
feeling, rooted both in centuries of black struggle and in pride and
hope for a better tomorrow, has always been as much a part of the
hospital as IV drips and surgical gloves.
From the beginning, King/Drew was to be something special — a hospital
that reflected African American achievement and power, a model for
urban hospitals nationwide.
But within three years, it had become clear that, for all the
aspirations the hospital represented, it was falling far short. At
times, instead of healing its patients — almost all of them black and
Latino — it was killing and maiming them.
The Los Angeles County Board of Supervisors, which owns and runs the
hospital, was left with a political and moral dilemma:
It could take tough, decisive action, which would surely bring
protests and pickets. Or it could take the path of least resistance —
issue ineffective reprimands, commission studies, fire an
administrator or two — and hope the problems would go away.
The political price of inaction was small. Members of the Board of
Supervisors rarely face serious electoral challenges, and the people
being harmed were not politically powerful or well-connected.
So, given the choice — the distress of racial politics on the one
side, the likelihood of more needless deaths on the other — the board
chose to risk the latter.
And the problems didn't go away. If anything, they got worse.
In the last year, the hospital slid into such crisis that the
supervisors took the strongest, and least popular steps ever to fix
King/Drew, closing the trauma unit and hiring an outside consulting
firm to manage the hospital for a year.
As they did so, the supervisors were forced to admit that it had taken
years of neglect — their neglect — for the hospital to reach such
straits.
"We should be embarrassed, all of us collectively," Supervisor Gloria
Molina acknowledged at a recent meeting, "because we have failed the
community." .
It was a remarkable admission from someone who sits on what is, by
some measures, the most powerful local political body in the United
States.
The 'five little kings'
Collectively, the five supervisors — Molina, Michael Antonovich,
Yvonne Brathwaite Burke, Don Knabe and Zev Yaroslavsky — represent
more constituents than all but eight U.S. governors. They spend twice
as much money annually as the combined governments of El Salvador,
Nicaragua, Honduras and Costa Rica.
They are both the executive and legislative branch of county
government, which gives them broad powers with few checks and
balances.
Yet for all their power, the "five little kings," as they have been
called, have been unable or unwilling to provide consistently decent
healthcare to some of the neediest, least powerful people they
represent.
A Times investigation published over the last four days has detailed
how King/Drew, by a variety of yardsticks, has become one of the worst
hospitals in California and, in some respects, the nation. The record
is replete with botched surgeries, misdiagnoses and fatal neglect by
nurses.
There is no shortage of people who could share the blame.
There have been bureaucrats too timid to tell their superiors the
truth. Hospital administrators who downplayed problems. Department
heads who tolerated lax discipline. State legislators and members of
Congress who stood in the way of change. Regulators and accreditors
who balked at sanctions. An affiliated medical school, the private
Charles R. Drew University of Medicine and Science, that failed to
provide the expertise and prestige that UCLA and USC offer other
county hospitals.
But the county board, more than anyone, had the power to shape
King/Drew, for good or ill.
The supervisors have generally responded to the alarm bells at
King/Drew weakly or not at all. . They have expressed shock at each
fresh disclosure of problems at the hospital, and and offered
piecemeal reforms that didn't work or didn't last.
"We have not had the information that there were these kinds of
problems," Burke said last December, when federal inspectors charged
that the hospital was shirking the fundamentals of good patient care.
Why, asked Yaroslavsky, weren't the supervisors told that "the place
is going to hell in a handbasket?"
The evidence suggests that they were told — repeatedly.
No major malpractice claim at King/Drew can be settled without the
supervisors' approval. Some of the claims at King/Drew, said Molina,
were so"astounding" she could "hardly believe it."
They were just one tipoff to the hospital's failings.
Regulators and consultants sent reports. Whistle-blowers complained.
Employees sent petitions. Newspapers wrote exposes. Mistreated
patients and their families told their stories.
All that information, and more, was available to the supervisors.
But the mistakes continued and, over the years, bodies piled up. Some
died in horrifying ways: poisoned by accident, paralyzed by drug
overdoses, abandoned in their own vomit.
The reasons for the supervisors' failure are as complex as the county
itself. Race has been an issue, but so have incompetent or neglectful
workers and bureaucrats — and a rigid Civil Service system that
hampers efforts to fire them.
"Most fundamentally," said Assemblyman Mark Ridley-Thomas (D-Los
Angeles), whose district includes neighborhoods served by the
hospital, "it's a failure of resolve to address the issue creatively
and forthrightly."
There's also an issue of turf. By long tradition, the board hands over
responsibility for county institutions to the supervisor in whose
district they lie.
In the 32-year history of King/Drew, only two supervisors have
represented the 2nd District: Kenneth Hahn, a revered powerbroker; and
Burke, a committed conciliator.
Both were players in King/Drew's saga from the beginning; both failed
to make it the hospital it was meant to be.
Behind riots, deep grievances
Months after the Watts riots, Gov. Pat Brown convened a commission
chaired by former CIA Director John McCone to investigate the
causes.The obvious trigger was the Frye arrest. But the grievances
reached much deeper.
The McCone Commission concluded that African Americans in Los Angeles
had been denied a fair share of public services, prominently including
healthcare. There was no accredited hospital in Watts or surrounding
communities; the nearest public hospitals were far away and hard to
reach by public transportation.
The McCone report galvanized Kenny Hahn, then in his prime on the
Board of Supervisors. First elected in 1952, he was a natural-born
politician.
A white man, he cultivated a devoted following, even after his heavily
white district turned heavily black. It was a following that would,
decades later, help elect his son, James K. Hahn, as mayor, and his
daughter, Janice, to the City Council.
Had a lesser politician been supervisor, King/Drew would not have been
built. County voters turned down a bond issue to pay for it, many
reasoning that it was like rewarding Watts residents for rioting. A
majority of his fellow supervisors were skeptical, if not outright
opposed. Hahn's daughter still loves to tell how her father cut short
a Hawaiian vacation and herded his family back home when he got wind
of a board vote to scuttle the hospital.
"A man," he grumbled, "should be entitled to a legitimate vacation.
This is a sneaky way to do business, when a man's back is turned."
Ultimately, Hahn cajoled the state Legislature into funding the
hospital. He orchestrated its opening, and watched with pride as
young, idealistic African Americans set out to run it.
"It broke down racism like you wouldn't believe," said Dr. Melvin
Fleming, an early hospital administrator. Like every other top
administrator at the hospital since it opened, he is African American.
Before King/Drew, he said, "we were excluded from any kind of
experience at running a hospital in Los Angeles County because of
racism."
Until he left office in 1992, Hahn remained King/Drew's patron. He met
regularly with hospital officials. King/Drew's community advocates
knew they could always reach him by phone.
"Kenny Hahn ... was our savior; he was our leader," said Dr. Richard
Allen Williams, a cardiologist who was involved from the start. Hahn,
he added, was "willing to come at any time, any hour, under any
circumstances, to make sure that Martin Luther King hospital had what
it needed."
What Hahn couldn't do was guarantee that the hospital would succeed.
By 1975, only three years after it opened, The Times was reporting
that "horror stories implying neglect and incompetence, especially by
nursing personnel, are heard regularly" at King/Drew.
In 1977, a disgruntled nurse wrote Hahn anonymously to complain that
the hospital was dirty, patients were "sent around in circles,"
doctors scheduled to be working were not on the premises and some
employees worked drunk or under the influence of drugs, some of them
stolen from the hospital pharmacy.
All this, the nurse wrote, had led to the nickname "Killer King,"
which dogs the hospital to this day.
County officials made few substantial changes until 1989, when a story
in The Times described a systemic breakdown of care at King/Drew,
where "a disproportionate number of patients are dying."
Hahn demanded an investigation, which led to the dismissal of the
medical center's administrator. The hospital hired more nurses and
established a team to monitor nursing care.
The fixes didn't hold.
Antonovich, the longest-serving of the current supervisors, spent more
than a decade on the board with Hahn. While acknowledging his own role
in King/Drew's failures, he said his former colleague, who died in
1997, five years after retiring, left a mixed legacy there.
"Kenny was very protective of the hospital, because of his leadership
in getting the hospital built," Antonovich said. "Where he erred was
in not demanding the same high-level degree of management and
accountability at that hospital as the other county hospitals have
had."
A balancing act for Burke
By the time Yvonne Brathwaite Burke was elected in 1992, King/Drew
seemed to be in perpetual trouble.
The shooting of Sheriff's Deputy Nelson Yamamoto had occurred months
before she was sworn in. Yamamoto was saved by King/Drew emergency
surgeons, only to die 42 hours later. The coroner said the deputy died
of the gunshot wounds. The district attorney faulted doctors, although
no charges were filed.
In the face of such challenges, Burke seemed to bring ample talent and
experience to the job.
She had been a pathfinder as a black woman in politics, her every job
seeming to break new ground. As a young real estate lawyer, she had
been a staff attorney to the McCone Commission, drawing attention for
her astute handling of politically sensitive matters. In 1976, not
long after she became the first sitting member of Congress to have a
baby, U.S. News & World Report ran an interview with her under the
headline: "A Woman President 'Any Day Now.' "
As supervisor, Burke waded into the politics of King/Drew, initially
defending the hospital in the Yamamoto case. A year after her
election, she expressed confidence that there was "no intentional
maltreatment or gross negligence" in his death.
But as details emerged suggesting the deputy had been killed by poorly
administered heart drugs, she reversed herself, saying in July 1995
that the death, along with six other suspicious ones, was "terribly
indicting."
The incident foreshadowed the difficulties Burke would face —
navigating between a community that demanded protection for the
hospital, and outside forces demanding reform.
That December, Burke called for an immediate, sweeping reorganization
at King/Drew. Antonovich praised her for "biting the bullet on this
very difficult situation."
Burke got her "swift and decisive action," much as Hahn had in 1989: a
new nursing director, a team of nursing consultants, a "medical
management surveillance team" to keep an eye on doctors, new chiefs
for key medical departments — and a new administrator.
Yet a year later, in 1997, Burke called for a new investigation, this
time in response to reports that a 3-year-old had received a
transfusion of the wrong blood type.
So it went, one problem following another.
"I have to be very honest," Burke said recently. "I have existed from
crisis to crisis over this whole 12 years."
As the crises have multiplied in the last year, she has expressed
increasing exasperation, but has not proposed any comprehensive plan
to fix things.
On a warm Monday in September, she sat alongside her four colleagues
in a cramped, dimly lit conference room in the downtown Hall of
Administration, facing a bank of cameras and vowing to heed the advice
of the county health director, Dr. Thomas Garthwaite, to shut down
King/Drew's trauma unit.
Garthwaite said the closure would "decompress" the hospital by sending
patients with serious, traumatic injuries to other hospitals. The
supervisors had agreed in secret meetings — later deemed violations of
the state's open-meetings law — to give it a try.
Now they were announcing their intentions in public.
Burke wasn't happy. But she agreed: "We have to do what we have to
do."
The announcement met with an outcry, not only from the usual community
activists and political leaders, but from paramedics and police
officers who argued that the decision would cost lives by delaying the
time it took for some patients to get care. The decision, and the way
it was reached, also inflamed long-standing suspicions that the board
was bent on closing the entire hospital.
Four days later, Burke backed down.
The matter, she said, needed more study.
This time, her fellow supervisors didn't follow her lead. They voted 4
to 0 last month to close the trauma center, with Burke
abstaining.Although Burke was praised by some for her change of heart,
others said it fit an unfortunate pattern.
"That isn't leadership," complained The Wave, a weekly newspaper that
circulates in areas served by King/Drew. "It's going in whatever
direction the winds of public opinion blow."
Burke is known as an able negotiator and conciliator — qualities that
have generally served her well as a supervisor. Larry Aubry, founder
of the fledgling Community Oversight Committee, a watchdog group that
keeps an eye on political leaders in South-Central Los Angeles,
described Burke — not disparagingly — as "an avowed, self-described
centrist."
"In other words," he continued, "she's a moderate. And I'm suggesting
that no moderate is going to turn this thing around."
Fiercely protective activists
Burke's moderation stands in marked contrast to many of the voices
heard in the King/Drew debate.
The supervisor herself has said the inflammatory rhetoric from
community activists and political leaders has made it hard for her to
support reforms at the hospital
Speaking in October 2003 about the hospital's administrators, she
said: "Personally, I think I should have pushed for many of these
people to be replaced, but any time anything is done, the community
has become totally upset."
Since its founding, King/Drew has been fiercely protected by a group
of African American activists who have forged close ties to many of
the doctors and administrators at the hospital and rallied behind them
when county officials demanded change.
Health department chief Garthwaite said he understood why members of
the community had reacted as they did.
"I think it's a terribly regrettable statement in our society that no
one cared about the healthcare of the citizens of South Los Angeles
until there was a riot," he said. "What does that say? The only way to
get attention is to be loud and to be political."
The loudest, most political voice on King/Drew in the last year hasn't
been Burke's but that of Rep. Maxine Waters (D-Los Angeles), who has
rallied community opposition to much of what the supervisors have
tried to do at the hospital.
When the supervisors met to discuss the proposed trauma center closure
last month, Waters organized a demonstration, roused political
leaders, including the Rev. Jesse Jackson, and then virtually hijacked
the board's session by grabbing the microphone and staging a one-woman
tour de force.
It enhanced her reputation with many in the community, who saw
her —unlike Burke — as someone willing to use every weapon in the
activist's arsenal to fight for her constituency.
But some have accused Waters — and others — of being knee-jerk
King/Drew defenders.
"Why weren't they out in front of the hospital with placards ...
demanding that the hospital serve the community the way Cedars-[Sinai]
serves its community?" asked Joe Hicks, a longtime civil rights
leader, referring to the prominent medical center in West Los Angeles.
"Why are they now standing in the way of reform?"
Fear of being called racist
At the heart of the rhetoric surrounding the hospital has been the
issue few politicians want to confront: race.
Some in the core group of hospital activists have made race a central
element. . Members of the Board of Supervisors and other critics have
been reluctant to take on problems partly for fear of being branded
racists.
"Asking about King/Drew really was like touching the third rail," said
. Connie Rice, a prominent civil rights lawyer who is African
American. "You would get such a voracious and vicious, racially
accusatory backlash that no one would touch it."
As a public hospital, King/Drew cannot be a black institution — at
least not officially. But in practice, it and its affiliated medical
school have been black since their inception.
"It's the most symbolic and substantive institution in the black
community," said state Assemblyman Mervyn Dymally, who has been
involved with the hospital throughout its history. "It is probably the
only major institution in which we have a sense of ownership.
King/Drew is ours.... It's a product of our sweat and tears."
Most King/Drew employees — including many doctors — are black, as are
the vast majority of administrators. Given all that, some community
activists consider criticism of the hospital to be racist.
Several county supervisors said they had received racist hate mail
over the years whenever they had spoken out about problems at
King/Drew.
"They're just really, really, nasty, nasty letters," said Molina, a
Latina who has been accused — falsely, she says — of wanting to change
the name of the hospital to "Benito Juarez Medical Center," after the
19th century Mexican statesman and national hero.
"There are some political leaders who look at everything through a
racial context," Antonovich said. "But when you have political leaders
using the race card to prop up inferior medical standards and inferior
management, they are doing a disservice to the community."
When supervisors talk about race-based criticism, one voice they cite
is that of Ernie Smith, ombudsman for the Black Community Health Task
Force, an influential grass-roots organization that is an advocate for
African American interests at the hospital.
An engaging man with a PhD in comparative culture from UC Irvine,
Smith (no relation to Dr. Ernie Smith, a pediatric cardiologist quoted
earlier in this series) is passionate and knowledgeable about the
hospital, but couches his arguments in racially bombastic language.
He has warned ominously about a Latino takeover of the hospital. In
his lexicon, Garthwaite, the white physician who heads the county
health department, is the "grand wizard," an allusion to the Ku Klux
Klan. Police are "pigs" and "Rottweilers." King/Drew's African
American administrators are establishment pawns, "old hog-maw and
sauce-eatin' Negroes."
Many people associated with the hospital insist that race is no longer
a significant issue there, or that it is beside the point.
"It's a hospital that's named after Dr. King, but it treats anyone who
comes in the door," said former Assemblyman Roderick Wright.
Dr. Xylina Bean, who heads the neonatal division at King/Drew, argues
that the hospital and its patients have been the victims of class
prejudice as much as racism.
"It's based more in a concept that poor people do not deserve, just
because they're poor, the same level of quality of care that the rest
of the world requires," Bean said earlier this year at a community
meeting. "You can call it racism if you want to, because it does tend
to reflect upon specific people who just happen to be African American
or just happen to be Hispanic."
Different dynamic for Latinos
King/Drew was built at a pivotal time in Los Angeles history, just as
African Americans were coming into their own as a powerful political
force.
At the same time, the city's Latino population was starting to surge
as immigrants flowed north from Mexico and Central America. AfLatinos
now constitute a majority of residents in the area surrounding
King/Drew, and a plurality of the hospital's patients.
Despite their greater numbers, Latinos have tended to keep quiet — at
least publicly — about King/Drew, even when they believe the hospital
has ill served them. They have not agitated for change, in the
supervisors' chambers or in the streets.
One likely reason is that many in the community served by King/Drew
are illegal immigrants leery of drawing attention to themselves.
"The fear factor is a big barrier to these people getting involved,"
said Arturo Ybarra, a political organizer who has spent more than 13
years trying to rouse Latinos to take a more assertive role in
King/Drew. "They play it low key."
Also, many immigrants come from countries where poor health care is a
fact of life. King/Drew may be better than any hospital they have
known.
"Back in our country, you are used to this," said Jaime Calderon, 42,
who grew up in rural El Salvador before immigrating to the U.S. "You
go to the hospital there, and they're supposed to operate on your
right leg and instead they operate on the left."
Calderon's older brother died at King/Drew in 2002 after a botched
liver biopsy.
There may be another dynamic at work. Among Latinos, the hospital does
not hold the outsized significance it does for many African Americans.
"It's another county hospital to them," said Molina. "It isn't 'their'
hospital."
This is true at the most fundamental levels. To begin with, many
Latinos say they face a language barrier at King/Drew that makes it
seem alien and forbidding.
"I don't communicate well with the staff at the hospital," said
Rebecca Hernandez, who emigrated from Mexico 14 years ago and lives in
Watts with her husband and four children. She speaks only Spanish.
"They give me written instructions," she said, "but they're all in
English. I throw away all the papers because I don't understand them."
Although some King/Drew employees do speak both English and Spanish,
they aren't always available.
Latinos aren't the only ones who lack a sense of ownership. Many
younger black people take the hospital and its conditions for granted,
much as someone might accept a long line at the post office.
"A county hospital," said Steven Brown, 36, as he propelled his
wheelchair down King/Drew's sidewalk, "is like a county jail. It's
always going to be full, but they take care of everybody."
This may be King/Drew's most insidious enemy — the burden of low
expectations.
Both gratitude and shame
Marcia Kpodo's experience with King/Drew is neither the best nor the
worst. It speaks to an uneasy ambivalence that many served by
King/Drew feel. Kpodo hurried to the hospital one day in January after
she learned that her niece, visiting from Philadelphia, had been
rushed to King/Drew with acute appendicitis.
Kpodo arrived to find her 25-year-old niece in agony, still waiting
for treatment in the emergency room. She pleaded with the staff to
remove the appendix before it burst. She spoke with an administrator
and finally begged for help from Rep. Waters, who happened to be
touring the hospital.
Waters asked the attending physician to treat Kpodo's niece as soon as
possible.
Nothing worked. "They told me their hands were tied, because they
didn't have an operating room at the time," Kpodo said later.
Not until nearly 12 hours after her niece's arrival did surgeons
operate, successfully removing the appendix.
The next day, Kpodo appeared at a community rally led by Waters on
behalf of the medical center.
"I'm eternally grateful to King/Drew," Kpodo told the cheering crowd
of King/Drew activists.
Later, Kpodo acknowledged her anger at the delay her niece endured —
but she didn't blame the hospital.
Rather, she faulted a medical system that seemed to penalize the less
fortunate.
"America," she said, "should be ashamed."