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HOSPITALS; King/Drew–putting a failure in context. Part 1

Today’s fourth of five pieces in the LA Times on King/Drew medical center is called How whole departments fail a hospital’s patients and it’s probably the most horrific of the series so far. It starts with the widely reported case of the nurse who turned off the alarms in the ICU and goes onto the pharmacy where one tech worked unsupervised and another stole prescription drugs in bulk to sell out of his garage, to the orthopedic unit where the two most senior physicians were eventually forced out because of gross irregularities that appears to be outright fraud, and even to the family practice resident who preyed sexually on patients and eventually murdered one. Previous articles in this series have followed doctors around and found that they appeared more or less when they like, but were clocked in for time they were not at work, and showed that the funding for the hospitals and its associated residency programs has been far more than for comparable public hospitals in California.

To put it mildly, this hospital has failed in its mission. But there is one thing that is barely mentioned in the article and it’s the extremely contentious issue of race. King/Drew was formed out of result of the Watts riots in the 1960s, and was designed to be the pinnacle of inner city health care. This hidden implication is that the race issue really matters, with the implication that this would have never been allowed to happen at a predominantly white suburban hospital. Beyond that the tone of the LA Times articles seems to me to reflect another view, which is that poor, urban minorities are unable to run a hospital properly. This is never expressed clearly in these articles but it seems to be hinted at in the background. Conversely the first article in the series quotes a black physician squarely accusing the LA County Board of Supervisors of racism for treating the hospital unfairly:

"We see something that we fought really hard for," said Dr. Herbert Avery, 71, an obstetrician who helped plan the hospital and served briefly on its staff. "And now it’s being driven down under the ground under the guise that the people out there … they’re black and Mexican and they’re too stupid to run a hospital and a medical school."

It’s obviously beyond the scope of THCB to get into the weeds of what’s wrong at King/Drew and make suggestions as to how to fix it, but given that most of my readers will be as appalled as the LA Times readers about what’s going on there, I want to give a little context as to why it’s so difficult to change the culture. I don’t think that race per se is at the basis of the problem, whether it’s issues between blacks and latinos (as has often been cited at King/Drew) or whites and minorities. It seems to me that an obsession with race seems to be missing some vital points about American society that are ending up reflected in things like the failure of King/Drew.

These group under three predominant areas. 1) the scale of inner-city poverty and its impact on health care. 2) the relationship between community and authority. 3) The management of a large scale health care systems in a world of electoral machines.

More on this in Part 2.

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