For whom the bell tolls, it tolls for thee – King/Harbor Hospital

By now the closure of King/Harbor Hospital’s Emergency Room after the failed “make or break” CMS inspection has made the rounds of the newspapers, radio talk shows and various news outlets. I was one of the many King/Drew Medical Center supporters who both fought for and knew that the hospital could be “fixed” if the correct steps were taken. However, as the months passed and endless reports were issued I quickly concluded that under the current “save the hospital” plan being implemented that failure was the only possible scenario.

My knowledge and expertise was based on over 35 years as a nurse at the bedside, in nursing/hospital management and as a nursing educator. The County hired two different consulting firms, one that was billed as a consulting firm (The Camden Group) with nursing expertise and the other (Navigant) billed as being skilled at hospital turn-arounds. A little due diligence and research on my part provided me with information that contradicted the PR being spewed by Dr. Garthwaite, (head of Department of Health Services at the time). However, the Board didn’t have to rely on my word or even my proof, they only had to read the reports from the CMS and even the local paper to discern that the so-called nursing consultants were not making the grade. Under Camden’s watch we had the stunning failure of surgical instruments not being counted at the end of surgeries. Not long afterwards CMS issued their now infamous memo, which forced the County to enter into an agreement to pay for a management firm to oversee the day-to-day hospital operations. This MOU gave us Navigant Consulting and their 1000+ problems of KDMC report. It was about this same time that Garthwaite made his recommendation to close the trauma center, explaining that this would help “decompress” the hospital’s other service areas and thereby assuring a greater chance to pass the much needed CMS inspection. No one should forget that the Los Angeles County District Attorney found that the Board of Supervisors had violated the Brown Act by holding a closed-door session prior to announcing the decision to close the Trauma Center; however he never released the tapes of that session and I believe that this is still being litigated.

Navigant took over the day-to-day operations with a guarantee of a full time staff and promises that they were the “right” folks to do the job. And it was long afterward that we discovered that full time attention meant something more like Tuesday through Thursday; and forget have a Chief Nursing Officer (CNO) on 24 hour call since their CNO flew back to spend her weekends in her home in one of the Carolinas. She was later replaced with a CNO who lived much closer only requiring her to travel to New Mexico for her weekends. After at least one contract extension and a couple of financial augmentations Navigant finally concluded their overhaul of King/Drew with the placement of Ms. Antoinette Epps-Smith as the hospital’s Chief Executive Officer. There was a small opportunity for the County to rid itself of Navigant and replace them with another firm. Supervisor Antonovich managed to get the Board to consider FTI Cambio, unfortunately Ms. Epps sang the praises of Navigant (I wonder why) and we continued on with a firm that had been with us through several failed JCAHO and CMS inspections.

When CMS came for its next inspection the failure was so great as to caused the County to promise to down size and reorganize the hospital, placing it under the “umbrella”
of its sister hospital Harbor-UCLA. In the real world Ms. Epps would have tender her resignation or the DHS would have asked for her resignation, but of course this is Los Angeles County where people get promotions, praises, and raises when they fail. So Ms. Epps received a standing ovation from the community she failed and praises from the Board of Supervisors. It was about this point in time when Chernof and Epps became successful in clamping an almost complete lockdown on information about all things King/Harbor. Employees (nurses, physicians and staff alike) seemed fearful of sharing any information with anyone – but that didn’t stop the failures from occurring.

The most notable was the death of Ms. Rodriguez, a woman who had sought help from the hospital instead found an unresponsive and uncaring staff. Even after being left to writhe on the ER floor for 45 minutes, and it has been reported that numerous staff, including at least one RN, ignored her cries of pain that is until the hospital safety police came to arrest her, her boyfriend agreed when an officer informed him that she would get care at the County USC jail ward – imagine his desperation that allowing her to be arrested on the promise that it could possibly get her the medical care that King/Harbor personnel were unwilling or unable to give her. Unfortunately this intervention came too late. As she was being wheeled out to the patrol car she collapsed and all attempts to rescuitate her failed.

Shortly afterwards the State of California Department of Health and Human Services issued a notice that the state planned to revoke the hospital’s license. And this was followed by the failure of King/Harbor to pass the last critical CMS inspection and the loss of 200 million dollars in crucial federal dollars. The County immediately closed the ER and is in the process of closing the hospital leaving an urgent care clinic in the footprint of this once 200+-bed hospital.

Do the citizens of South Central need a hospital with an Emergency Room, without a doubt! Do I believe King/Drew Medical Center could have been brought up to minimum national standards, you betcha! There are those who blame the Board and indeed they deserve their share of blame for the failure – these failures occurred at several critical junctures and in my opinion they were:

1. Not firing the Camden Group when it was apparent they were being unsuccessful and once they “completed the job” and it was discovered that the work product appeared less than exemplar the County never sought legal remedy.
2. Not firing Dr. Garthwaite for his gross misunderstanding of the problem, which led to the mandated MOU agreement with CMS, which of course saddled us with Navigant.
3. Not replacing Navigant with Cambio or another firm when the opportunity presented itself.
4. The hiring of Ms. Epps, who was advertised as having presented an excellent resume did not appear to have ever been solely responsible for such a momentous task.
5. Not firing Ms. Epps when King/Drew failed its first “make or break” CMS inspection, which then caused for the drastic downsizing and reorganization of King/Drew and it being renamed King/Harbor.

You may wonder why such measures, because the failures that we saw at King/Harbor were never new ones but the repetition of many of the same ones that caused the original jeopardy. The consultants and DHS staff alleged that much of the King/Harbor staff appeared unwilling to accept change and there were even vague allegations of “sabotage” such as employees being given new policy to adhere to only to pretend that they had never received such policies. But most importantly the incident involving Ms. Rodriguez illustrates a staff so demoralized and demotivated that they were unable to respond to someone writhing in pain on the floor right before their eyes. When a staff reaches this point there is little that can be done to reinvigorate it and often the only remedy is closure.

So what does the future hold for beleaguered King/Harbor Hospital? Well, if we are to believe the Board of Supervisors they plan to find a private firm that will assume the operations of the hospital. It won’t be an easy task to find a private firm to assume the operations of this hospital, if we are fortunate enough to find such a firm then, I believe, to ensure the greatest possibility of success the County will, no must, relinquish a great deal of authority thus allowing the private firm a wide latitude of autonomy to make the necessary changes that will not only restore the hospital’s federal funding, but also stave off the loss of the hospital’s licensure to the State. And it’s not just the County that has to be willing to give up some control, all stakeholders are going to have to give up some of their “interests” (something that never really happened the last time around) and allow the firm to do what must be done. This of course is all dependent on the premise that the private firm is competent in its function and that they have a strong commitment to providing service to the community of South Central and by extension all of Los Angeles.

Just for added background on August 2, 2004 I submitted a civilian complaint to the Los Angeles County Civil Grand Jury, vis a vis the board of Supervisors lack of appropriate knowledge to oversee the health care of Los Angeles County and ask that they recommend a health care authority. The civil grand jury investigated and recommended the creation of a health authority. It would appear that, as usual, the Supervisors decided to let things be as is and now we know where that course has led. See grand civil 2004 findings and recommendations.

And for those who believe that CMS was overly harsh in its critique or evaluation of King/Harbor I encourage you to read the complete CMS report, which can be found at http://bos.co.la.ca.us/Categories/Agenda/cms1_071137.htm and select CMS Report, or you can download the report directly at http://lacounty.info/bos/sop/supdocs/34095.pdf. Read the report and then draw you own conclusions . . .