King/Drew Now King-Harbor, but Woes Continue

We had previously posted (here, here and here) about the ongoing troubles at the medical center formerly known as King/Drew and since renamed Martin Luther King Jr - Harbor Hospital in Los Angeles, after the county hospital went from being flagship hospital for the Charles R Drew University of Medicine and Science to a part of Harbor-UCLA Medical Center. Long viewed as a symbol of progress for poor and minority patients in the city, it had fallen on very hard times, attributed to bad management that for a long time hid behind the banner of the hospital's reputation in the community.

The troubles continue. The hospital regained notoriety after a patient who was left to writhe in pain on the Emergency Department floor eventually died. As the Los Angeles Times recapped the story (re-ordered to make it chronological),

[Edith Isabel] Rodriguez a California native, was poor and uninsured. She reportedly had a history of narcotics use and lived with various relatives.

A security videotape showing the woman writhing for 45 minutes on the floor of the emergency room lobby....

[In response to] 911 calls from Rodriguez's boyfriend and a female bystander. One dispatcher curtly told the bystander that the situation was not an emergency; the other said there was nothing she could do because Rodriguez was already in a hospital.

[A] video show[ed]... her extended time on the floor and a janitor cleaning around her.

She died of a perforated bowel, which probably developed in the last 24 hours of her life, according to a coroner's report.

Meanwhile, the Times also reported that

In new signs of turmoil at Martin Luther King Jr.-Harbor Hospital, officials said Tuesday the chief medical officer had been replaced and more than 40% of licensed vocational nurses and nursing assistants recently failed initial skills tests.

The disclosures came as the Los Angeles County Board of Supervisors, grappling with federal findings that the hospital continues to endanger patients, bluntly discussed preparations for possible closure of the public facility.

The people more directly involved in the case of Ms Rodriguez were treated more leniently, also according to the Times,

Six staff members at Martin Luther King Jr.-Harbor Hospital — including a nurse and two nursing assistants — saw or walked past a dying woman writhing on the floor of the emergency room lobby last month but did not help her, according to a report made public Friday.

Their discipline: a letter outlining how they should behave in the future.

The six are in addition to two others whose roles have already been made public by The Times: a contract janitor who cleaned the floor around the woman as she vomited blood and a triage nurse who oversaw the whole episode and pointedly refused requests to intervene.

The janitor was counseled verbally; the triage nurse was placed on leave and later resigned, the report said.

What we said last year about what was then King-Drew still seems relevant. A few lessons from this sorry story: in health care, it is often the whole institution and its most vulnerable constituencies that suffer for the mistakes made by top managers; and that bad managers can hide for a long time behind institutions that enjoy a favorable reputation. And to make an addendum, although we have been writing a lot lately about the shenanigans of pharmaceutical management, mismanagement, conflicts of interest, and corruption seem to afflict the leadership of all kinds of health care organization.

ADDENDUM (21 June, 2007) - See this post on The Health Care blog on King-Harbor's plight.