County Health Chief Is Rebuked

Los Angeles County supervisors sharply rebuked their health department chief during a rancorous public debate Tuesday and ordered him to physically move his office to Martin Luther King Jr./Drew Medical Center.

“Park yourself there,� Supervisor Gloria Molina directed Dr. Thomas Garthwaite during one of many heated exchanges at the weekly board meeting. “Take your schedule. Tear it up and spend every moment that you’re working for us working on solving the crisis.�

The Board of Supervisors directed Garthwaite to hire even more outside doctors and nurses to roam the hallways to protect patients from the types of medical mishaps that have plagued the public hospital for the last 21 months. Board members also turned on one another in their frustration over the hospital’s persistent troubles.

At one point, Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew, loudly proclaimed that she would not allow the hospital to shut down, no matter how bad its problems.

She reminded her colleagues that there weren’t many options for healthcare in the Watts area before King/Drew’s opening in 1972 and that there weren’t many now.

“I’ll tell you this: That hospital will be closed over my dead body,� Burke said. “I want to be clear on that.�

Molina, the board chairwoman, interrupted, “That is not a good statement.�

“That is a true statement,� Burke replied.

When his turn came, Supervisor Zev Yaroslavsky said: “The only dead bodies I’m concerned about are the dead bodies that we’re seeing here.�

At another point, Molina said, “If my mother needed to be hospitalized, and this is where they were taking her, I would get there as quick as possible and get her the hell out of there.�

Tuesday’s tense wrangling over King/Drew came the day after the Department of Health Services informed the board of two more problematic deaths at the hospital. A week earlier, health officials reported three other such deaths to the board.

All five followed mistakes by King/Drew’s nurses and doctors, county officials said.

In addition to directing Garthwaite to spend his days at the hospital, the board told the health department to:

• Immediately begin hiring outside intensive-care doctors to monitor the treatment of patients.

• Recruit expert nurses to serve as “foot patrols� in King/Drew’s wards to ensure that bedside nurses were properly caring for their patients.

• Require that every invasive procedure and diagnostic test done by doctor trainees at King/Drew be directly supervised by a senior physician. Virtually all the recent deaths involved poor oversight of medical residents.

As evidence of their rising — and frequently expressed — sense of helplessness, the supervisors took these three proposed solutions from a speaker addressing the board: Jim Lott, executive vice president of the Hospital Assn. of Southern California.

“I can’t tell you how effective that sounds for me!� Molina said as soon as Lott had listed his ideas. She directed staff to immediately add them to a pending motion.

The board also directed the department to examine whether the county should sever its contract with the Charles R. Drew University of Medicine and Science, which it pays to train doctors at the hospital.

Molina and her colleagues questioned whether the millions they were paying to fix King/Drew’s problems were being well spent.

Under pressure from federal regulators, the county hired a turnaround firm last fall to overhaul the hospital. Navigant Consulting Inc. is receiving $13.2 million under its yearlong contract.

The firm has already indicated that it will need millions more and probably a one-year contract extension to complete the job.

King/Drew has come under virtually nonstop scrutiny for nearly two years because of a series of medical problems. In February, a national accrediting group revoked its seal of approval, and federal regulators have several times threatened to cut off its money.

The U.S. Centers for Medicare and Medicaid Services is reviewing the most recent deaths, regional administrator Jeff Flick said Tuesday. He added that his agency was still preparing a detailed report about major problems identified in an October review, findings that were expected to be released months ago.

After largely supporting health director Garthwaite in recent months, the supervisors showed scant patience with him or the hospital staff Tuesday.

In his defense, Garthwaite said the department had taken disciplinary actions against hundreds of King/Drew employees. He also took credit for proposing the closure of the busy trauma center last fall to take pressure off the rest of the hospital.

But Garthwaite acknowledged that in hindsight he should have responded more aggressively when problems first came to light.

“If I had to do it over again, I would send more people in quicker,� he told the board.

Garthwaite, who took over in February 2002, has not made it a secret that he is seeking another job, which supervisors say is further detracting from his ability to help the hospital.

Supervisor Mike Antonovich has criticized Garthwaite for his frequent out-of-town travel and asked the county auditor to look into whether Garthwaite has improperly taken payments for speaking engagements.

Supervisors said they had trouble trusting any policies Garthwaite put in place because so many had gone unheeded in the past.

“We could pass rules all day long, and we have people — whether they be nurses, whether they be attending physicians, whether they be chairs of departments — who ignore us every single moment of the day,� Molina said. “They ignore us. They ignore the community. They ignore their own ethical responsibility to patient care.�

During the public-comment portion of the meeting, several speakers criticized The Times for its high-profile coverage of King/Drew and the board for reacting to news articles about lapses at the hospital. Others turned the supervisors’ own words against them.

Lark Galloway-Gilliam, executive director of the nonprofit Community Health Councils, said Garthwaite and his deputies had already patrolled King/Drew’s halls with little success.

“Maybe you need to be there walking the floor,� she told the supervisors. “Maybe you need to be there telling the staff what you expect from them.�

Galloway-Gilliam urged the board not to abandon its plans to fix the hospital.

“You are not on the outside looking in,� she said. “We are looking to you and saying, ‘What’s going on? Make it work, whatever it takes.’ �

Union representative Kathy Ochoa chided the board for breathlessly seizing on the idea of having an outside intensive-care specialist monitor treatment at the hospital, when Navigant had already proposed that in a 1,000-page January report.

“Remember?� asked Ochoa, an official with the Service Employees International Union, Local 660. “I read the 1,000 pages. I urge you to do the same. You’ve already paid for that piece of advice. Why aren’t we moving on it?�

In a separate action Tuesday, the board approved a $150,000 settlement with the mother of a 20-year-old man who died at King/Drew in March 2003 after his abdominal pain was misdiagnosed.

Oluchi McDonald’s death was featured in The Times’ December series that detailed decades of troubles at King/Drew.