What to Do with “Killer” King Hospital?
As a pre-med student, I shouldn’t repeat such aspersions about an institution in which I might someday consider for enrollment or residency, but as a taxpayer, I can’t help but feel that KDMC has long passed the point of no return as a viable medical facility.
Let’s put the recent federal evaluation in teaching terms: they not only got an advance copy of the test, but were given the answer key, and a multitude of coaches to make sure they copied it down right. A failure under these conditions would lead an academic to conclude that the student better take up manual labor as a career.
The millions of dollars paid to Navigant, one of only two companies that perform hospital management consulting, could not turn around three decades of a culture of incompetence. Despite getting rid of a large number of staff, from administrators to scrubs, the company was unable to help the hospital to pass 15 inspections in the past two years.The last inspection was the final exam – and King failed 9 of the 23 categories, including nursing, pharmacy, governing staff, as well as infection control, surgical services, rehabilitation, oversight – the list goes on.
An interesting statistic is that about 98-percent of South Central mothers go elsewhere than King to give birth – they vote with their feet. The hospital is averaging about $5-million in annual payouts for medical malpractice since 2000. More than half the current nursing staff is temporary, or “floaters.” Most hospitals keep this percentage to no more than 20-percent, in order to provide acceptable patient care.
Navigant told the county when it took over interim management, that it had dealt previously with all of the problems a hospital could have, with other of its medical operation clients. But this was the first time it had confronted almost all possible problems in one single hospital. This is not to imply that there are not many dedicated workers at KDMC.
Over the decades, many of the hardest working, most competent staffers have complained to their supervisors, administrators and even the county supervisors regarding problems. Their reward has been ostracism and punishment, but they stayed because they believe in the original mission of the institution. Politics and accusations of racism have insulated the hospital from meaningful reform. Even this week, with the frantic search for a solution, these roadblocks continue, as evidenced by Monday night’s community meeting held by Congresswoman McDonald.
Would Catholic HealthCare West, or any other private non-profit be willing to take over management of the hospital under present conditions? Not likely. Any new provider would have to demand two conditions: that its costs would be covered, and that it would have a free hand in personnel. Let’s examine these two requirements.
The county civil service structure guarantees even the most incompetent worker a job based on seniority, after joining the union. Any displaced King employee would have the right to be transferred to another county hospital at the same pay grade. Recruiting new personnel, with the current reputation of KDMC, will be a challenge. The new provider will probably have to offer higher-than-normal pay and benefits for decent replacements.
The new operation would have to be guaranteed that it could at least break even, without having to drain its other operations of funds to support a loss, due to the high number of uninsured patients in Los Angeles – probably the highest percentage in the nation. King has typically 42,000 to 50,000 annual emergency room patients – a third of which are not covered (a fifth of those are illegal immigrants), who use local emergency rooms for their primary care.
Because Los Angeles is a “sanctuary city,” it attracts thousands of new arrivals every month. Thousands of Mexican residents, who don’t even desire to move here, are encouraged by their government to come to Los Angeles for acute medical procedures. They consider the worst American hospital to be better than the best Mexican facility.
One in six California hospitals have already closed due to unreimbursed treatment, and more will follow. Every time there is an emergency room closure, it puts additional demand on nearby facilities, and the dominoes continue to fall.
If Harbor UCLA Hospital takes over the license and Medicare certification of KDMC, the threatened loss of $200-million in federal funds might be avoided. But one has to ask why the trustees of the successful university medical center would want to tackle these problems. Another option would be to reduce King Drew to a local clinic, offering only the most essential services for the community.
Meanwhile, Los Angeles County has a two month deadline to avoid closing KDMC by coming up with a solution which nobody will appreciate.