QUALITY PUBLIC HOSPITAL CARE IN LOS ANGELES

This is a story of a hospital that is unimaginably bad. The excerpts below leave out case-studies that are horrifying. It might be tempting to dismiss it as a "black" hospital and remark that its standard of care is exactly what is to be expected of staff trained under affirmative action, but the point is that it continues to exist only because most of its patients have nowhere else to go. If medical choice were available to its patients (via a voucher scheme or any other scheme) it would have been deserted long ago. Only public funding allows it to exist.

King/Drew, a 233-bed public hospital in Willowbrook, just south of Watts, has 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.

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.)

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."....

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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