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First they came for the communists,
but I was not a communist, so I did not speak out. Then they came for the socialists
and the trade unionists, but I was neither, so I did not speak out. Then they
came for the Jews, but I was not a Jew, so I did not speak out. And when they
came for me, there was no one left to speak out for me.
– Pastor Martin Niemoeller.
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|So You Want Government Health Care? - Thursday, August 16, 2007
King Hospital Closes
So You Want Government Health Care?
David C. Stolinsky, MD
If you don’t live in the Los Angeles area, you may not have heard of Martin Luther King Hospital. But soon it won’t matter – it’s closing. The closure of this much-needed hospital gives us a lesson on how not to provide health care.
The hospital opens.
After the Watts riots of 1965, Los Angeles officials finally listened to complaints of the black community, including lack of a nearby public hospital. A new hospital was built in South Central Los Angeles, which then was largely African American.
In 1972 the hospital opened with 537 beds and active outpatient clinics. The emergency department was upgraded to a trauma center and was extremely busy. So many gunshot wounds were treated that before the outbreak of the Middle East war, the Army sent doctors there to get experience with battlefield-type trauma.
The hospital changes its name.
For centuries the name “hospital” denoted a place where doctors and nurses dedicated their lives to caring for the sick and injured. But somehow that noble ideal no longer is considered “intellectual,” so many hospitals were renamed to emphasize teaching rather than patient care. Though I spent my professional life in clinical teaching, I found this change problematic. I worried that devaluing patient care was not a positive sign.
The place where I spent most of my time used to be called Los Angeles County General Hospital, but it was renamed Los Angeles County-University of Southern California Medical Center. Harbor General Hospital was renamed Harbor-UCLA Medical Center. The obvious course was to affiliate King Hospital with one of our two medical schools, USC or UCLA.
But the African American power structure that ran King did not want to become what they viewed as subservient to largely white medical schools. So the Charles R. Drew University of Medicine and Science was established. Drew was a black physician who was a pioneer in blood transfusion. The new name was King-Drew Medical Center. No one can blame people for wanting their “own thing.” But with two top medical schools in town, did we really need a third?
In retrospect this was the first step downhill. Instead of affiliating the hospital with a medical school, a new school was created for the avowed purpose of assuring black students a place in health-care education. But the actual purpose was to assure that the black power structure retained control. There is nothing wrong with this goal – if it could be achieved while retaining excellence. But that’s a big if. In real life, excellence and control are often conflicting goals. In real life, we may have to choose which we value more.
We may have to choose whether we want to control health care, or whether we want quality health care. If you doubt this, look at the waiting times for appointments with specialists or for elective surgery. The months-long waiting times at King are similar to the waiting times for all patients in Canada and Britain. Does that tell us something?
The hospital gets a nickname.
When I worked at LA County-USC Medical Center, patients – mainly African American – often expressed relief that they were there rather than at King, which they called “Killer King.” Paramedics reported that patients from South Central often asked to be taken to “Big County,” even though the trip was longer. This was a sign that the hospital was serving the black power structure, not the black community.
Patients reported incidents of bad medical and nursing care, but we had no way to verify these stories. Sometimes a sad tale appeared in the Los Angeles Times, but such reports were rare. I couldn’t tell whether the rarity of these reports was due to the rarity of cases of bad care, or to the Times’ fear of being politically incorrect.
Once the hospital was identified as the “black hospital,” any criticism could be seen as anti-black. We all dislike criticism, but we need it to help us recognize and solve problems. James Baldwin, the noted African American writer, said that when he was at a dinner party, he would make an intentionally absurd remark. If nobody corrected him, he knew he was in the presence of racists who expected less of him. The same principle applies here. Withholding criticism is a sign of condescension, not respect.
The hospital slides downhill.
As years passed, more stories of bad patient care surfaced, including medication errors and neglect resulting in deaths. But now these stories were supported by official inspections. All hospitals must be inspected every few years by the Joint Commission. Often these inspections are conducted together with state officials, who have the power to revoke a hospital’s license, and federal officials, who have the power to deny Medicare and Medicaid payments and bankrupt the hospital.
Time after time, deficiencies were reported. Time after time, hospital officials promised to correct these deficiencies. Time after time, they were not corrected. Time after time, the Board of Supervisors, which oversees all county institutions, made positive statements but did little. There are five supervisors, elected to oversee a county of 34,520 square miles and 10,332,000 people – the most populous county in the nation, exceeded by only eight states. The supervisors are thus quite powerful, but they are elected by district, so the supervisor overseeing King Hospital is black. The subtext of “race” underlies the problem.
The hospital’s demographics change.
With the continuing influx of Latino immigrants, legal and illegal, the population that King Hospital serves has shifted. The majority of patients are now Latino. The staff of the hospital has also shifted and is multiethnic, but there is a persistent impression that the power structure remains largely African American. The demographic shift makes it more acceptable to criticize the hospital. This fact is regrettable, but it is no less a fact.
The hospital changes its name again.
After years of threats, this year the federal government made its final threat to remove Medicare and Medicaid funds, without which the hospital would have to close. Decades too late, the hospital was placed under the umbrella of Harbor-UCLA Medical Center as a last-ditch effort. The hospital became King-Harbor Medical Center, but the change was largely cosmetic. Several residency training programs, which had been closed by order of the medical specialty boards, remained closed.
The hospital closes.
The final nail was driven into the coffin when Edith Rodriguez, a 43-year-old Latino woman, lay on the floor of the emergency department for at least 45 minutes, vomiting blood and writhing in pain. The nursing staff refused to help her or call a doctor, because (they said) they had already determined that she was not seriously ill. Meanwhile a janitor mopped up around her.
Her boyfriend twice called 911 for help, but the operator correctly pointed out that the woman was already in a hospital. Finally the boyfriend asked for help from hospital police officers. They found that the woman was wanted on a parole violation, so they helped her into a police car to take her to jail, where she finally would be seen by a doctor. But it was too late. The woman died of a perforated bowel. She received more sympathy from the cops than from the hospital staff.
Soon after, a final inspection again revealed serious deficiencies, and federal funds were withdrawn. The emergency department closed, and the rest of the hospital will close soon. Whether it will reopen in a new incarnation remains in doubt.
The newest of Los Angeles County’s public hospitals, and the one favored with the most money per patient, consistently failed to provide adequate care and is being forced to close. What can we learn from this sad story?
· New facilities and more money don’t guarantee high quality. All they guarantee is that the money will be spent on something.
· The politics of “race” can ruin anything.
· Withholding needed criticism demonstrates apathy, not kindness.
· We can have open borders, or we can have a welfare state, but we can’t have both. Even the richest nation can’t provide welfare benefits, education and health care to a limitless influx of immigrants.
· Deficiencies at King Hospital were pointed out and finally ended by a higher authority. But when the federal government runs things, there is no higher authority to correct abuses. That’s why we divide authority between the federal government, the states and the private sector – a wise plan.
· Government-run health care is at least as likely to be inadequate as is privately funded health care. When was the last time you heard of a patient writhing in pain on the floor for 45 minutes without being helped in a private hospital?
· When politicians promise health care for everyone, we have a right to ask, “What kind of care? The kind you get with your congressional health plan, or the kind Edith Rodriguez got?”
Dr. Stolinsky writes on political and social issues. He can be contacted at firstname.lastname@example.org.