Suffering from years of neglect and mismanagement, the termination of the medical center’s doctor-training program has wider implications surrounding the production of minority physicians and the overall health of the local community.
By David Pluviose
To this day, the widespread racial disparities that prompted the August 1965 riots in the Watts community of South Los Angeles frame many of the discussions about race in America. The death and destruction wrought during that five-day upheaval, along with the findings of the December 1965 McCone report that the lack of adequate health care facilities was a contributing factor to the civil unrest, prompted city and state officials to put in motion plans to build a medical school and teaching hospital in the Watts community.
The opening of the Charles R. Drew University of Medicine and Science in 1970, followed by the Martin Luther King Jr./Drew Medical Center in 1972, led to critical milestones in the recovery of the community. The thousands of minority doctors produced by Drew helped heal the social wounds that had been ripped open during the riots.
But all has not been well at the teaching hospital. A Pulitzer Prize-winning Los Angeles Times exposé in 2004 revealed widespread neglect and mismanagement that the university administrators had swept under the rug for years. Ultimately, Los Angeles County terminated MLK/Drew’s doctor-training program late last year after the hospital failed a make-or-break federal inspection. This prompted the Centers for Medicare and Medicaid Services, or CMS, to pull its vital $200 million in funding for the hospital. Drew University President Susan Kelly, brought in last year to turn around the troubled institution, fears the resulting health care crisis will revive the civil unrest that prompted the riots more than 30 years ago.“There were lots of discussions in this community in 1963 and 1964, before the Watts riots, because everyone knew that there were very few beds, very few doctors,” says Kelly. “But it took the Watts riots, 32 deaths and 1,000 people injured and millions of dollars worth of property damage before anyone sat up and said, ‘I think they mean it; I think it’s true.’ Today, you’ve got a predominately Latino community, and if you understand the Latino community, it is more fragmented politically. I don’t know that you will get riots, but you may get increasing gang warfare.”
Lark Galloway-Gilliam, executive director of the Los Angeles-based Community Health Councils, says the displacement of the 251 residents is going to exacerbate lingering health care disparities, as the number of doctors available to treat South Los Angeles patients has fallen precipitously.
“The number of physicians, the number of beds, the rate of health disparities is so significantly off the scale here than anywhere else,” she says, adding that the Watts community has long relied on MLK/Drew.
Los Angeles County is now trying to contract with private physician groups to fill the void, but persuading private practice doctors to open up shop in the crime- and poverty-plagued neighborhood is an uphill battle.
According to Gilliam, Drew produces 25 percent of California’s minority physicians, so shutting down its doctor-training program will seriously deplete the pool of California physicians equipped to deal with the sometimes harsh realities of urban life.
“We always talk about cultural and linguistic competency, and people tend to think of that strictly in terms of language access,” she says. “But the physicians at Drew were trained to work with this population, to understand some of the unique characteristics, behaviors, nuances … we are losing that knowledge and sensitivity to the needs of this community.”
Michael Wilson, spokesperson for Los Angeles County’s Department of Health Services, concedes that the city is in a health care crisis. But he says terminating MLK/Drew’s resident program was necessary to keep the hospital open. It will now be managed by the UCLA-Harbor Medical Center and be renamed the Martin Luther King Jr.-Harbor Hospital. Wilson says keeping the hospital open was vital, as other local hospitals have closed their emergency rooms, worsening the crisis.
“The department was faced with a set of circumstances when the hospital failed its inspection, and from the very beginning has really remained committed. The emergency room has remained open. We treat the same volume of emergency patients,” he says. “We just had a major ER close here, Memorial in Inglewood, a few months ago. It’s a crisis all over.”
A Sad State of AffairsThe question remains: Why was MLK/Drew allowed to stay in such deplorable shape for years before the government stepped in? A number of patient deaths at the hospital over the years had been attributed to neglect and incompetence by hospital staffers. And by all accounts, county and hospital administrators were given numerous chances by CMS to make necessary changes.
In his letter to MLK/Drew administrator Antoinette Smith Epps, CMS certification official Steven D. Chickering noted that in the 32 months leading up to the termination of the hospital’s Medicare contract, CMS “conducted no fewer than 15 surveys that repeatedly identified events in and practices by the hospital that were found to have severely compromised patient health and safety.” He also says in the letter that CMS “took extraordinary measures and allocated exceptional federal resources” to help correct the substandard care at MLK/Drew, to no avail.
Among the problems, CMS concluded during an inspection that one of the hospital wards had “no appropriately trained and competent staff” watching the heart monitors of cardiac patients, although it had previously been reported that “patients died when nurses at King/Drew failed to heed heart monitor warnings.” The final inspection revealed numerous other shortcomings, including dangerously unsupervised pain medication dosing by nurses and the widespread use of dirty, blood-stained medical diagnostic tools, which put patients at unnecessary risk.
These lapses were well-known by many administrators at MLK/Drew and Drew University for years, says Kelly. But despite two unfavorable accreditation reviews, they chose to ignore the problems.
“That was the culture. … You don’t fix it if you pretend it’s not happening,” Kelly says.
The circumstances of MLK/Drew’s downfall give rise to sensitive questions about administrative failings at a number of majority-Black institutions. In many cases, the institutions have received more warnings and more chances than traditionally White institutions under similar situations could expect.“There’s a lot of discussion here around the culture of the hospital,” Gilliam says. “There’s a very broad stroke that’s applied to any institution for which there is African-American leadership, and many of our institutions are coming under attack. I think that there’s more than meets the eye.
“It’s a lot more complicated than we want to make it, and when we start throwing around words like ‘culture,’ there’s a whole litany in our history, such as ‘African-Americans are lazy’ — it’s easy for people to go to that. I’m not one who subscribes to that. If anything, I think we need to perhaps dissect and understand what these institutions are working with and not working with.”
Gilliam says many of the issues facing MLK/Drew are no different from those faced at other hospitals, pointing out that tight funds have forced the closure of other institutions that aren’t “Black-run.” The secrecy about mistakes made by physicians is a problem everywhere, she says, and the lack of accountability among doctors is a problem with the profession, not just at MLK/Drew.
James Lott, executive vice president for policy development and communications at the Hospital Association of Southern California, says MLK/Drew’s numerous failures were the result of a culture that consistently passed the buck on accountability. Lott says this lack of accountability allowed MLK/Drew to degrade to the point of widespread dysfunction, prompting the UCLA takeover. Despite being located in a major urban community with numerous health care needs, “The hospital now is operating as a small community hospital,” he says. “It’s a different day over there.”
“The demographics of the service area will always present hospitals serving that community with a financial challenge because the preponderance of the pay mix will be in the uninsured, Medicaid side of the ledger,” Lott continues. “More than half of the care they provide is Medicaid and uninsured. That’s going to be the case regardless of what type of hospital is put there unless the demographics of the community changes.”
A New DirectionKelly’s vision for the future of Drew University has its critics in the Black Los Angeles community. When the Australian native was hired to lead the university, Black residents reacted angrily, with some charging that state and local authorities were systematically purging the university’s Black legacy. Kelly, however, is adamant that Drew has to become even more diverse if it is to survive. As South Los Angeles becomes increasingly Hispanic, that means bringing in more Hispanic students, professors and administrators. She also has her eye on reaching out to the area’s Japanese, Korean and Polynesian communities. Kelly says such diversification will be vital as the university rebuilds and eventually regains a doctor-training program.
“Why is South Los Angeles so Latino now?” she asks. “It’s because African-Americans rose through their jobs and their earning power and now live in much nicer housing in Carson and Florence. That’s exactly what you’d want, isn’t it?”
Many Blacks in Watts see that times and demographics have changed, and they “don’t really want to hang onto the poverty. They don’t want to hang onto the health disparities,” she says. “If we build a strong university that is a model of diversity — always with Black groups, always with a strong number of Black doctors and Black administrators and Black supporters — if you move to the other side in the positive sense, you’re designing your own future.”
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