The Disaster at LA's King/Drew Medical Center: Part II
By: Charles Ornstein and Tracy Weber and Steve Hymon
Los Angeles Times | Monday, December 13, 2004
Medical Staff Absent
On Friday morning, Aug. 13, 2004, patients filed into King/Drew's orthopedic clinic seeking treatment for their broken bones and aching joints.
Help was not to be had.
The medical staff — doctors, doctor trainees and physician assistants — was inexplicably absent. It took three hours or more to find fill-in doctors, county auditors later found.
That Friday the 13th was merely the beginning of a bad weekend for King/Drew. Later that day, officials were forced to close the emergency room to ambulances until Monday morning because nearly half the nurses on some shifts had either called in sick or failed to show up.
Every hospital must contend with the national nursing shortage — and King/Drew's shortfall, given the county's relatively low pay and its ongoing problems, may be worse than most. More than 35% of its nursing positions are vacant.
But the hospital also is thrown into chaos when nurses, doctors and others on the payroll simply don't come to work.
The consequences are costly, not just in terms of overtime, but also in sick pay and use of temporary workers. King/Drew spent $14.7 million on temps last year, more than a third of that on nurses. Harbor-UCLA spent $3.1 million, although it relied on its own nurses to fill in when necessary.
These expenses are well known to the county health department. Its second-in-charge, Fred Leaf, routinely signs off on disciplinary letters, including allegations of absenteeism.
A review of such letters, which become public when employees appeal their discipline, shows that King/Drew workers often are given chance after chance to mend their ways.
Sherri Echols, a nursing assistant, was warned three times about her attendance problems in 2002 and 2003. She was finally suspended in April for 30 days after missing more than 18 weeks of work without permission over those two years, said a disciplinary letter in her county Civil Service Commission file.
"The act of being employed in itself requires you to report to work," an administrator counseled Echols in the letter.
Echols denied the allegations in her appeal of the discipline.
Some employees, such as nurse Elaine Pitts, go for years totting up warnings.
In 1999, after her second suspension for absenteeism, Pitts was told she was allowed just one unscheduled absence a month. She was absent or sick for about two months out of the next 10, finally losing her job in June 2000, records show.
"Unnecessary expenditure of this sort is totally unacceptable," an administrator wrote in her termination letter, "particularly in this time of limiting resources for patient care."
Pitts lost her chance to appeal when she was absent for her own hearing.
In an interview, she conceded that she had missed work, but said she was juggling life as an exhausted single mother with a boss who wasn't sympathetic.
"I'm not going to lie," said Pitts, who now works elsewhere but says she wishes she were still at King/Drew. "There were times I'd come into the lobby and see [the supervisor], and I'd leave and call in sick."
Some employees provide unusual excuses.
Ultrasound technician Donald Ray Hall was absent more than seven weeks during his first eight months on the job. His explanations included "car trouble, jail," according to Civil Service records.
After repeated warnings, he was fired in 2000.
Civil Service records show that one financial services worker provided this justification for repeated absences in 2002: "temporary insanity."
Violence and Neglect
Another cost, less easily tallied, results from employees who show up but don't do their jobs.
A nursing supervisor found nurse Nopawan Mahasuwan "asleep in a lounge chair, mouth open, snoring and drooling," in February 2000, according to an internal hospital memo.
Supervisor Liberty Pascual said she watched Mahasuwan sleep for at least three minutes before trying to wake her.
Mahasuwan, however, said she was watching a monitor — not sleeping. And, she added, Pascual didn't simply nudge her, but delivered a smack that caused pain and swelling, according to the memo.
It was yet another disagreement among staff members that had escalated to threats or violence, according to internal reports and Civil Service records.
King/Drew employees have been suspended for such infractions as shouting expletives at their colleagues and threatening to "fix" their bosses or make them "pay." A custodian is appealing a 20-day suspension for allegedly pulling a putty knife on his boss.
During their shifts in June 2002, a nurse and an aide got into a scuffle, grabbing and scratching each other's necks.
"This is not really a big issue," said nursing attendant Beverly Norman in a written statement after the incident.
Hospital officials disagreed, finding that Norman's conduct "may have caused patients, visitors and other staff to incorrectly believe that staff at this medical center are unprofessional," her disciplinary letter said.
Visitors may come to that conclusion on their own.
In hallways and offices, employees hawk bootleg DVDs, peanuts and other products, leading one doctor's wife to compare the hospital to a giant swap meet.
"It wasn't like they were trying to hide it," said Leaf, the health department's chief operating officer, who was brought in a year ago to oversee operations at King/Drew. "They didn't have an expectation … that it might have been inappropriate."
Some patients and their families say medical care has not been the priority.
Maria Mayorga, who spent two days at King/Drew after breaking her ankle in a car accident last December, said the nurses and aides "would just ignore you."
"You could hear them all chatting in the hall. They would be talking about parties, movies, about getting together…. I was upset. I'm sitting there on the [bed] potty. If I could have moved myself, I would have, but I needed the help."
Sometimes the neglect leads to death. Government inspectors found that serious nursing lapses contributed to five patients' deaths last year. And this October, a man died after his nurse missed signs on a cardiac monitor that his heart was failing, county health officials have alleged.
Until recently, however, few King/Drew employees lost their jobs for poor performance. And the county Civil Service system ensures that fired workers have numerous avenues of appeal.
"If they had an employee in there that didn't work, they just moved them to the side and brought in someone else," said David Runke, a County-USC administrator brought in to help fix King/Drew in the fall of 2003. "You have a lot of people, but you don't necessarily have a lot of productivity."
One of the Elite
Dr. George Locke is a member of King/Drew's ruling class.
When he pulls his 2002 Mercedes-Benz coupe into his reserved spot at the hospital, he routinely stands beside it until a female assistant arrives to carry some of his belongings inside. On his way out, someone is on hand to tote them back.
When political leaders, such as Rep. Maxine Waters (D-Los Angeles), arrive at King/Drew, Locke often is there to greet them with a hug.
As neurosciences chief, Locke made a total of more than $1 million over the last two fiscal years. That includes his hospital salary and a stipend he receives from King/Drew's affiliated medical school, records show.
Top county officials can't say what Locke does for all the money he earns.
At an August board meeting, Supervisor Mike Antonovich questioned the hundreds of thousands in "taxpayer money" that Locke received and whether he had earned it. The county health director, Dr. Thomas Garthwaite, had no firm answers, saying his department was looking into the matter.
During a review of the county's own records, however, The Times found that Locke took part in only 15 of the 501 surgeries performed by his department in the four years ending in December 2003.
Last year, Locke, who oversees both neurosurgery and neurology, participated in three operations, hospital records show. His second-in-command, neurosurgery chief Dr. Samuel Biggers, performed seven.
By comparison, Dr. Martin Holland, neurosurgery chief at San Francisco General, said in an interview that he did about 100 surgeries last year.
Though Locke's neurosurgery staff is larger than Holland's, it performs about half as many operations.
Holland has co-written eight medical journal articles in the last two years. Locke was an author on four in the last 14, according to the National Library of Medicine.
Yet Locke, 70, earned about twice as much as Holland.
"That's a lot of money per case," Holland said. "I wish I made that much."
Locke declined to comment. But his attorney, Lawrence Silver, wrote in a letter to The Times that Locke earned "significantly" less than he would in the private sector.
Moreover, Silver disputed the hospital's accounting of the number of surgeries Locke had performed and the national library's tally of the articles he had written. The lawyer did not provide what he considered the correct figures.
" … It would not be a criticism of Dr. Locke even if the numbers showed that he did no surgeries at all," Silver wrote.
"His job performance is not measured based upon his publications, but rather on his dedicated performance of his job as a physician and administrator."
Locke's signed time cards seem to reflect that dedication.
He sometimes has recorded one marathon workday after another, indicating he has spent the whole day at the hospital and the whole night on paid standby call, available by phone for advice.
On Nov. 17, 2003, for example, his time card showed that he had worked 12 hours at the hospital and 12 hours on standby. Actually, he arrived at the hospital about 10:30 a.m. and left about 4 1/2 hours later.
On July 26 this year, Locke's time card showed him working 12 hours and being on call an additional 14, for an impossible total of 26 hours. He was at the hospital for 6 1/2 hours.
On both days, as well as others, a Times reporter observed his arrival and departure.
Attorney Silver said his client didn't have to be at the hospital to work. " … The practice of medicine knows no time cards," he wrote. "This is not an employment where the cobbler works at his bench and cannot perform his tasks unless he is at the place of business."
King/Drew's medical director, Roger Peeks, said county rules require doctors to work at the hospital.
Unless he's on call, "the hours he puts down on his county time card, he should be actually here on premises," Peeks said.
When asked about the hours Locke keeps, health director Garthwaite shook his head and said, "I'm not going to defend George Locke."
The county's inability to explain expenditures at King/Drew extends well beyond Locke.
Spending More, Getting Less
Every year, the hospital doles out millions in county money — $13.7 million last year alone — to the university across the street.
And every year, it's unclear whether King/Drew gets its money's worth.
The Charles R. Drew University of Medicine and Science, which was founded about the same time as the hospital, is under contract to run King/Drew's doctor training programs and provide some clinical staff.
But county auditors this summer couldn't figure out how many residents Drew trained, how its doctors spent their time or where the millions went. Records that were supposed to be kept by the hospital and the school often couldn't be found, their report said.
One thing was clear, according to the auditors: King/Drew, once again, was spending more than Harbor-UCLA and getting less.
Medical residents at both institutions earned the same salary, but King/ Drew spent 57% more than Harbor-UCLA on stipends for medical faculty and other academic support.
The extra money did not buy success.
It was under Drew University's watch that a national accrediting group in the last two years revoked the hospital's right to train aspiring surgeons, radiologists and neonatologists.
None of Harbor-UCLA's programs have been forced to close.
In a letter to the county auditor, a Drew University official said the findings were inaccurate:
"The evidence clearly shows that services were performed, funds were expended appropriately and the payments to Drew were proper."
Concerned about the shoddy accounting and poor academic results, some county supervisors this year said they were fed up with Drew.
They courted, begged and even tried to shame the nationally prominent medical schools at UCLA and USC into taking over.
But given the problems with the hospital and its training programs, the two schools have mostly kept their distance.
"It's not like UCLA is saying, 'Oh, hallelujah, I'd love to do it,' or USC is saying, 'Let me in on that deal,' " Supervisor Gloria Molina said in August.
Weeks later, the county signed on with Drew University once more.
Advice Often Ignored
County leaders have received lots of advice on how to fix King/Drew, from both their own auditors and outside consultants.
What they have not done, for the most part, is heed it.
About three years ago, health department officials turned to veteran management consultant Leonard Fuller.
Fuller was blunt in his assessment. Some employees, he wrote, "feel that they have little incentive to do more than 'the absolute minimum to get by.' "
The hospital's very future is at risk if the financial disarray is not addressed, he warned in his report.
Fuller said he presented his findings to Supervisor Burke. "Her thoughts were, 'This is terrible. We've got to get down to the bottom of it,' " he recalled.
To tackle that task, Garthwaite, then the new health director, wanted to fill the vacant King/Drew administrator's post with an outsider, he said. But he said Willie T. May, who was serving as King/Drew's interim leader, had Burke's blessing.
"Let's just say we were encouraged to give Willie May a chance," he said.
Burke said she did not object to May's appointment but did not lobby for it.
In a November 2002 memo, the county's chief administrative officer welcomed May as a "highly qualified" manager who "possesses the special knowledge, skills and experience" to succeed at King/Drew.
By March 2004, the health department had begun the process of firing May, saying the hospital had foundered on his watch. He had cancer and retired rather than fight for his job.
May was the latest in a series of administrators to quit or be ushered out, overwhelmed by King/Drew's many problems.
In October 2003, he testified in a deposition over budget cuts that he had learned about crucial matters through the "rumor mill," which he defined as "just general people talking in the hallways." (A 16% budget reduction at King/ Drew was begun in 2003, but put on hold midstream, in part because county officials couldn't figure out what to cut.)
In the deposition, May also said he had fixed 11 major violations cited by a hospital accrediting group two years earlier. He couldn't name one.
May did not respond to telephone calls and a detailed letter requesting comment.
Garthwaite recommitted himself to the task of turning around King/Drew. He sent his own deputies to begin sorting through the hospital's finances.
A year later, they are still stumped by basic questions about how King/Drew spends it money.
Leaf, the health department's second-in-command, said it could be another year before they had solid answers.
"I know the games that are played and the stalling tactics that go on" at King/Drew, he said. "Even knowing that, it's just an unbelievable morass. It really is."
Harbor-UCLA Medical Center serves a community with demographics similar to those of Martin Luther King Jr./Drew Medical Center. Here is a statistical comparison:
Harbor-UCLA treats more patients:
ER visits in fiscal 2004
Patient admissions in fiscal 2004
Yet King/Drew spends more money:
Overall cost per patient in fiscal 2003
Malpractice claims from 1999-2003
Workers' comp from 2000-04
Overtime in fiscal 2004
Sources: Los Angeles County Department of Health Services, Los Angeles County Emergency Medical Services Agency, Times research
We have implemented a new commenting system. To use it you must login/register with disqus. Registering is simple and can be done while posting this comment itself. Please contact gzenone [at] horowitzfreedomcenter.org if you have any difficulties.
blog comments powered by