Troubled Los Angeles ER Closes after Failed Inspection

Posted: Tuesday, August 14, 2007
Updated: July 8th, 2008 05:26 PM EDT
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Troubled Los Angeles ER Closes after Failed Inspection






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LOS ANGELES --

County supervisors want Martin Luther King Jr.-Harbor Hospital reopened within one year, and they directed health officials Monday to find a private operator within three months to ensure medical care is available to the mostly low-income residents near the facility.

The medical center failed its latest inspection by the U.S. Centers for Medicare and Medicaid Services, meaning it will lose $200 million in federal funding -- more than half of its annual budget. The hospital's emergency room closed on Friday, and inpatient services will be phased out over the next two weeks, with the facility being reduced to an urgent care center.

Various county officials said last week they want the hospital eventually reopened -- most likely under private management -- although health department officials said that likely could not happen for at least 15 months.

But the county Board of Supervisors, in a special meeting called to discuss the hospital's future, said they want a full-fledged medical center operating again in the area within 12 months.

"The county is not walking away from that facility," Supervisor Zev Yaroslavsky said.

The board wants county Chief Executive Officer William Fujioka and Department of Health Services Officials to come up with an outline of requirements for a possible private operator by tomorrow.

"We must commit to looking at every option to reopen a hospital under a private operator or under county auspices as soon as possible," Bruce Chernof, county health director, told the board.

The board also said that any plan to transfer current hospital staffers to other county medical facilities must be approved by the board. It was not immediately known how many of the hospital's 1,635 full-time employees would be moved to other county-run facilities.

"We can't allow what has happened and the kind of poison that we've had at Martin Luther King Hospital to poison the rest of our health care system," Supervisor Gloria Molina said.

Several community activists gathered at the hospital today to demand that the county reopen the emergency room immediately.

"It's going to be a medical Katrina of the highest order if the state and the Board of Supervisors and those that care about quality care don't step in and provide the leadership," said Earl Ofari Hutchinson of the Los Angeles Urban Policy Roundtable.

MLK-Harbor provided care to 50,000 emergency room patients last year.

Eliminating emergency-room and in-patient services will have a major impact on seven private hospitals -- California Hospital Medical Center; Centinela Freeman Regional Medical Center; Downey Regional Medical Center; Kaiser Permanente Bellflower; Memorial Hospital of Gardena; St. Francis Medical Center; and White Memorial Medical Center.

In the meantime, an urgent care center will remain at MLK-Harbor, and likely will handle more than 180,000 annual visits, according to county health officials. Urgent care will be provided at the hospital 16 hours a day.

The hospital's two full-time, on-site Advanced Life Support ambulances will remain at the urgent care center and the Department of Health Services will maintain its three newly refurbished surgical suites and surgical team, with plans to increase the outpatient-surgery program.

CMS said the hospital failed the most recent inspection in eight of 23 categories -- governing body, patients' rights, quality assessment/performance improvement, nursing services, pharmaceutical services, physical environment, infection control and emergency services.

In a letter to hospital CEO Antionette Smith Epps, CMS officials said serious failures included:

  • A lack of supervision for ER patients who are a danger to themselves or others
  • Patients placed at serious risk of exposure to tuberculosis
  • Staff unable to locate critical equipment and medications on the pediatric emergency cart, and unable to correctly calculate dosages for medication administered to pediatric patients
  • Staff failed to analyze pharmacy data adequately for medication errors
  • Last summer, CMS officials determined the hospital did not meet nine of the government's 23 conditions for federal funding. To avoid losing federal funding over that finding, the county Board of Supervisors downsized the hospital and placed it under the management of Harbor-UCLA Medical Center personnel.

    Clinical specialties, including high-risk obstetrics, neonatology, pediatrics, neurosurgery, cardio-thoracic surgery, ophthalmology and dental, were moved to Harbor-UCLA, leaving the revamped MLK-Harbor with an emergency room and 48 beds for in-patient services.

    The county-run hospital was built to serve the county's poor and uninsured in the aftermath of the 1965 Watts riots.

    The long-troubled hospital repeatedly has been the subject of news stories chronicling breakdowns in care. It recently came under fire over the death of Edith Isabel Rodriguez, who was ignored by emergency room staff as she writhed in pain, ultimately succumbing to a perforated bowel.

    Another MLK-Harbor patient, Juan Ponce, languished for four days in the emergency room with a brain tumor without getting help. Eventually, family members took him elsewhere.


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