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Underfunding is a myth, but the squandering is real
Mon Dec 6, 7:55 AM ET Top Stories - Los Angeles Times
By Charles Ornstein, Tracy Weber and Steve Hymon Times Staff Writers
For years it has been a heartfelt cry: "This hospital desperately needs more money!"
Whenever Martin Luther King Jr./Drew Medical Center is criticized, as it often is, the response from supporters is the same. They say Los Angeles County leaders never wanted King/Drew built in the first place ? and have been trying to starve it ever since.
"You know damn well the county knows what we need," said "Sweet Alice" Harris, long revered for her charitable efforts in South Los Angeles' black and Latino neighborhoods. "My problem is: Why is it that they don't love the poor people and want to help them? We're the first to be cut and the last to be rewarded."
Amen to that, said Dr. Xylina Bean, who started at King/Drew in 1973, the year after it opened, and is now director of neonatology.
"We have a saying here which we all understand, 'The Lord giveth and the Lord taketh away,' and usually King hospital has always been on the taketh away list, OK?"
Spend any time at the county-run hospital near Watts and it's easy to reach the same conclusion: Patients linger unattended, walls are gouged with holes, mattresses are worn and stained, even ink cartridges are in short supply.
The numbers, however, tell a different story. Though widely believed, the notion that King/Drew is being shortchanged is false.
The medical center spent more per patient than 75% of the public and teaching hospitals in California, according to a 2002 state audit that looked at fiscal year 2000.
The difference is stark when King/Drew is measured against the three other general hospitals run by Los Angeles County.
It spent $492 more per patient daily than Olive View-UCLA Medical Center, $685 more than County-USC and $815 more than Harbor-UCLA in 2002-03, county figures show.
The hospital with the most comparable budget is Harbor-UCLA, a much bigger facility 10 miles away. Last year, Harbor-UCLA had nearly $372 million to work with, not much more than King/Drew's $342 million.
Harbor-UCLA, however, did far more with its money.
It treated 61% more people in its emergency room and admitted 91% more patients. And it performed certain complex procedures, such as open heart surgery and kidney transplants, that King/Drew did not ? drawing in patients who were sicker and more expensive to care for.
King/Drew's problem is not the amount of money it gets but the way the money is squandered, according to audits, financial records, legal filings and dozens of interviews.
As at most hospitals, its greatest cost is employees. But King/Drew, with a staff of nearly 2,500, spends inordinate sums on people who do little or no work. The rest of the hospital ? hardworking employees, patients and their families ? often make do or do without.
Here are some examples:
? In the last five years, King/Drew has spent nearly $34 million on employee injuries ? 53% more than Harbor-UCLA and more than any of the University of California medical centers, some of which are double or triple King/Drew's size. Employees make claims for such things as damage to their "psyche," assaults by their colleagues and a variety of freak accidents, according to a Times review of workers' compensation claims.
? Last year, King/Drew employees billed for 299,804 hours of overtime, costing the hospital nearly $9.9 million. That's 61% more than the sum spent by Harbor-UCLA, which has about 400 more workers. Fourteen King/Drew employees pulled in more than $50,000 each in overtime. At Harbor-UCLA, there was one.
? Some employees habitually fail to show up, logging weeks, even months, of unexcused absences each year. And those who do come to work often don't do their jobs, causing one consultant in 2002 to remark that they had "retired in place." Others are distracted or impaired. County Civil Service Commission filings tell of staff members grabbing and clawing each other's necks; inspection reports tell of patients literally dying of neglect.
? King/Drew pays its ranking doctors lavishly. Some draw twice what their counterparts make at other public hospitals ? often for doing less. Eighteen King/Drew physicians earned more than $250,000 in the last fiscal year, including their academic stipends. Harbor-UCLA had nine.
If King/Drew and county health officials had controlled this excess spending, the hospital could have used the money in other areas, or even put it back into county coffers.
The mismanagement of the hospital is no secret.
The county Board of Supervisors and the Department of Health Services it oversees have received decades of warnings. Since 2000, there have been dozens of audits, scores of disciplinary reports and hundreds of workers' compensation claims.
Yet even as the county has faced enormous pressures over the years to trim its health budget, the board has largely spared King/Drew. The slightest suspicion that a cut might be coming mobilizes activists who treasure the black-run hospital.
So the waste continues. And so does the perception among King/Drew supporters that their hospital is being maliciously underfunded.
At a town hall meeting in the fall of 2003, a King/Drew doctor angrily jabbed his forefinger in the air as he accused the county health director, who is white, of punishing the hospital.
"I've been here 31 years and watched this hospital be yanked and pulled ? shot and kicked," said Dr. Ernie Smith, an African American pediatric cardiologist who has since left King/Drew. "This is nothing more than racism and white supremacy."
Doctors, nurses and other staff members in the audience applauded, amid approving murmurs of "Mmm-hmm, all right."
Supervisor Yvonne Brathwaite Burke, who has represented the hospital's district for 12 years and is the sole African American board member, bristled at the charge.
"We have spent money and money and money, far beyond what we've spent anywhere else," she said. "Whenever anything goes wrong, they say, 'We don't have enough people. We don't have enough money.' "
Dr. Bean and many other King/Drew supporters don't buy that argument.
"There is a credibility gap here," Bean said. "I will tell you, I ain't got no excess nothing."
Employee Injury Claims
Vast sums at King/Drew go to workers injured in encounters with seemingly harmless objects.
Take, for instance, the chair.
Employees have been tumbling from their seats at King/Drew almost since it opened its doors. The hospital's oldest open workers' compensation claim involves Franza Zachary, now 71, who sprained her back falling from a chair in October 1975 ? costing the hospital more than $300,000 so far.
The bills for two other chair-fallers have topped $350,000 each, county records show.
Between April 1994 and April 2004, employees filed 122 chair-fall claims at King/Drew, more than double the number at Harbor-UCLA. And King/Drew has spent $3.2 million -- and counting -- to pay for them.
"Sitting down. Eating lunch. [Chair] broke" was how licensed vocational nurse Elizabeth Rugley described her mishap in a 1999 claim. "Fell to floor. Hit the floor. Landed on my buttock."
In the last nine years, records show, Rugley, now 51, has had three other on-the-job accidents at King/Drew: a second chair misadventure in which she slipped and banged her head on a wall, a tumble, and a trip over an elevator entrance. As a result, according to her filings with the state, she has strained her neck, wrenched her back and injured her right shoulder.
To treat Rugley's last three injuries and pay her when she has been unable to work, King/Drew has spent $364,435.
In an interview, Rugley said her doctor told her that a person was prone to accidents after a back injury. "I'd rather be working and healthy and not hurting," she said.
Phyllis Butler-Young's chair gave way at King/Drew in 1999, according to her workers' compensation claim.
A year later, she said, she re-injured herself pushing and pulling gurneys in her job as a licensed vocational nurse. And in 2001, during training at a rehabilitation center, Butler-Young was "jolted" while trapped in an elevator, according to records she filed with the state.
All told, her claims have cost King/Drew more than $100,000.
Butler-Young, now 42, said chair falls were "common" at King/Drew.
"They're old," she said of the chairs. "They claim they didn't have any money, so they took chairs from County-USC ? [that] had to be welded back together."
The cost of King/Drew's various injury claims runs higher than that of comparable hospitals.
Averaged over its entire staff, King/Drew spent $2,326 per employee on workers' compensation in each of the last six years, more than all but one of the 17 other California public or teaching hospitals for which The Times could obtain similar records. The average for all the surveyed hospitals was $1,342 per employee annually.
King/Drew was expected to pay more than $50,000 each on 385 active claims as of August, according to county records. Harbor-UCLA had 210 claims projected to cost that much.
"My eyebrows start raising at the $50,000 mark," said Vickie Wells, director of occupational safety for the public agency that runs San Francisco General Hospital Medical Center. "Every claim where we spent more than $50,000, there is something usually going on."
Los Angeles County regularly challenges workers' comp filings it considers questionable, but it must pay if administrative law judges rule in a worker's favor.
The high number and cost of claims at King/Drew may stem more from bad morale than clumsiness or unsafe conditions, workers' compensation specialists said.
"If you like your employer and you love what you're doing and you like the environment you're in, you're much less likely to say, 'I hurt my back or finger' or that 'I'm stressed out,' " said Priscilla Morse, who handles workers' comp claims for San Mateo County.
King/Drew's claims show that its employees often don't seem to like each other much ? let alone their employer. Some of the filings cite assaults and psychological wounds.
One cashier filed a claim in 1999 saying she was overwhelmed by stress. The tipping point, she told her workers' comp psychiatrist, was when her supervisor grew angry at not being asked to be one of the cashier's bridesmaids. The cashier said her resulting anxiety triggered headaches, chest pain and chronic fatigue.
A judge agreed, and King/Drew so far has paid more than $216,000 on the claim.
Operating room nurse Santiago Blanco, injured six years ago, is still collecting from the hospital as well.
He reported being slugged in the back by a female colleague while tending to a semi-conscious patient having a leg operation. The punch, delivered about 20 minutes into the surgery, threw him four feet from the table, causing back and neck injuries, he said.
"I don't know what the patient's reaction was," Blanco, 47, said in an interview. "I was on the floor."
His injuries have cost King/Drew $316,500 so far, and are expected to ultimately cost it more than $500,000.
Blanco was off work for months. But he, at least, had a medical excuse.
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 (news, bio, voting record) (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."
(BEGIN TEXT OF INFOBOX)
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
About the series
Deep trouble: A hospital inspired by the civil rights movement fails ? sometimes kills ? those it was meant to serve.
The myth of poverty: King/Drew is not underfunded. It is mismanaged.
Unheeded warnings: How one pathologist got hired and remained on staff despite misdiagnoses and legal woes.
Broad failure: Beyond individual workers' shortcomings, whole departments are in disarray.
Timidity at the top: The county Board of Supervisors shies away from reform, paralyzed by community protest and racial politics.
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