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Plan could lead to reopening of King hospital

Email Picture Francine Orr / Los Angeles Times Family, friends, and activists gathered together in a prayer circle in front of the hospital in 2007.

A tentative agreement would allow the troubled Los Angeles County facility near Watts to resume inpatient and emergency services by 2012 in cooperation with UC. Hiring would start from scratch. By Garrett Therolf
March 12, 2009 Martin Luther King Jr. Hospital near Watts would reopen in three years with an emergency room and inpatient services under a tentative agreement that would substantially improve access to care in one of the most underserved areas of the nation, according to state and county officials.

Under the plan, worked out in negotiations among county officials, the University of California and representatives of the governor, the hospital would be operated by a new nonprofit entity governed by a board equally controlled by UC and the county.

The county would pay all the costs. The university would assume no financial risk but would provide physician services and take primary responsibility for restoring confidence in the facility's standards for patient care. The hospital would not use existing county employees, but would begin hiring from scratch.

Inpatient services at the hospital were shut down in August 2007 after years of repeated failures to provide adequate care, including errors involved in multiple deaths. The final case was that of a 43-year-old woman who was seen on a widely aired videotape writhing unattended on the floor of the emergency room lobby for 45 minutes.

The plan for the reopened hospital calls for 120 beds with an average daily census of 108 patients -- far fewer than the 233 beds the hospital once had. The proposal is silent on some crucial points. Among the most important is finding an outside contractor that would operate the facility day to day.

But the deal nonetheless appears to meet many of the demands for a new hospital that have topped the agenda for residents of the South Los Angeles area. The facility would offer a broad range of medical services and would once again be a teaching hospital.

"There are some very, very significant health needs, and this goes a long way to serving them," said Supervisor Mark Ridley-Thomas, whose district includes the Willowbrook hospital. "No matter where you live in the county, you need everything working. You cannot have that facility down."

County efforts to reopen King floundered until last May, when Supervisor Zev Yaroslavsky said the hospital's "last, best hope" would be a partnership with the UC system. Gov. Arnold Schwarzenegger took a personal interest in that proposal, holding a meeting on the topic in his Santa Monica office, and asked his health and human services secretary, Kim Belshe, to shepherd talks.

When Ridley-Thomas took office in January, he made clear that his No. 1 priority was the hospital's reopening. Not by accident, the tentative deal for King was announced on the supervisor's 101st day in office as his staff works to highlight his progress.

Schwarzenegger said in a statement to The Times, "The people of South Los Angeles deserve access to needed, quality medical services, and this proposed plan provides an important framework for addressing this community's healthcare needs."

Ridley-Thomas' colleagues on the Board of Supervisors issued positive statements about the proposal even as they underlined the reality that the public review period is just beginning and details remain scant.

The county board and the UC Board of Regents would both have to approve the deal for it to take effect. Some funding elements would require changes by the state Legislature.

"There is no perfect structure, but we did it the county way for 30 years and it didn't work. This is a different approach," Yaroslavsky said. King was opened as a county hospital in 1978 as the fruit of an effort that began in the aftermath of the Watts riots 13 years earlier.

Since the closure of King's inpatient services, state and county officials have poured more than $100 million into surrounding hospitals in an attempt to address the resulting vacuum. But the South Los Angeles area remains among the most medically disadvantaged communities in the nation.

For every 1,000 people in the area, there is less than one hospital bed. The national average is three beds for every 1,000 people.

More people die of lung cancer, stroke, diabetes and heart disease in the area than in any other place in L.A. County. Diabetes rates are 44% higher than elsewhere in the county, hypertension rates are 24% higher, HIV/AIDS rates are 38% higher and asthma rates are 11% higher.

The reopening plan specifies that the county's existing Civil Service rules not apply to the new hospital. Critics of King's failings in the past have said those rules hindered efforts to remove bad doctors, nurses and other employees. The workers would probably be unionized, but no union has been promised the chance to organize them, Ridley-Thomas said.

Outpatient services would continue to be county-run and subject to Civil Service rules, a provision that county unions demanded. A plan lacking that element would have been "dead on arrival," said Ridley-Thomas, who benefited from millions of dollars in union support during his hard-fought election last year. "We want to have a solution that is embraced broadly," he said.

The teaching aspect of the hospital would involve 250 medical residency slots. Many of them would probably go to UC students, because that possibility has been one of the county's chief tactics in attracting UC participation. The board of the new nonprofit entity would determine the role of Charles Drew University of Medicine and Science, the only historically black medical school west of the Mississippi River, which partnered with King for decades.

"I would hope that there would be some conversations to see how Drew could play a part in reformulating the hospital," said the Rev. Frederick O. Murph of the 1,500-member Brookins Community African Methodist Episcopal Church. "It certainly is going to have an effect on whether there is going to be community buy-in. It's one thing to sit in the back room and carve a deal, and it is another for the community to buy in and support it."

Ridley-Thomas said he hoped the reconfigured hospital would make room for retail space that would provide new jobs for nearby communities. He said he was consulting outside land use experts to determine how to do that.

The search for a contractor to operate the hospital could be the biggest remaining stumbling block. County officials have searched fruitlessly for such an operator since 2007.

"All of this hinges on finding a private operator to actually open the hospital. That's the black box. That's the biggie," said Robert Ross, president of the California Endowment, a foundation working to expand access to healthcare.

Jim Lott of the Hospital Assn. of Southern California said he was optimistic that the new governance structure would attract a faith-based operator with a mission to work in underserved communities. He said he was not worried that the county did not release financing details Wednesday, noting that many federal and state funding streams are still unsettled.

County Chief Executive William T Fujioka, a key negotiator of the deal, said: "We believe we have a financial model that works or we wouldn't be bringing it to the Board of Supervisors and the Board of Regents. Additionally, the county has a legal obligation to provide indigent care."

Sherry Lansing, a UC regent who chairs the board's health services committee said she was eager to review details of the proposal. "I know how committed the university is to serving underserved communities," she said.

garrett.therolf@latimes.com