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Here is a case study in the vital need for individuals in a high-crime rate area to take personal responsibility for their very next door neighbors as the ONLY way by which medical care can improve in their community. Think about it. Otherwise, your life is in danger if you drive through that area -- and not just from random gun shots! If that is a puzzle, read on.
We have, in the Watts part of Los Angeles, the highest crime rate, the highest drug use rate, the worst schools, the worst economic opportunity and the highest unemployment. In general this place is a mess. (We also have students being taught that ONLY the government or the police can do anything about this -- thus perpetuating the very immorality that now exists.)
The one main hospital in this section, the
Martin Luther King Hospital has been one of the most badly administered
hospitals in the country -- being close to being shut down for lack of official
"hospital accreditation." (Read the LA Slime attack
on Martin Luther -- in the name of investigative reporting -- this got them the
Pulitzer Prize!)
Yet, the ambulances are more busy in this section than many others -- hauling gun shot victims and drug overdose victims to the "nearest emergency room." If Martin Luther closed! Then those ambulances would travel to the very fancy UCLA or UC hospitals -- where the rich white folk go!
Now comes a front page article in the Wall Street Journal, warning you that if you happen to have a stroke while driving in an area where a hospital like the Martin Luther King hospital is the closest, you stand a very good chance of getting such poor medical treatment at their emergency room that you will die or become a vegetable.
Who can change this picture? Only the people IN Watts. You can help by contributing copies of the Book of Common Sense Moral Code into that area. If you are brave, you might even walk into that area and pass out copies. But, there will NOT be success in that area until the people who live there start asking for their own copies of this book and then passing them out to their neighbors.
Do you want to help?
LA Times Pulitzer Prize Winning Article On HOW BAD Martin Luther King Hospital Really Is
School Student's Essay on Crime in LA
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May 9, 2005 |
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Fatal Blockages
Outdated Ambulance Rules,
Inadequate ERs Make Dangerous Ailment Worse
Lessons From Trauma Centers
By THOMAS M. BURTON Christina Mei suffered a stroke just before noon on Sept. 2, 2001. Within eight minutes, an ambulance arrived. Her medical fate may have been sealed by where the ambulance took her. Ms. Mei's stroke, caused by a clot blocking blood flow to her brain, occurred while she was driving with her family south of San Francisco. Her car swerved, but she was able to pull over before slumping at the wheel. Paramedics saw the classic signs of a stroke: The 45-year-old driver couldn't speak or move the right side of her body.
Had Ms. Mei's stroke occurred a few miles to the south, she probably would have been taken to Stanford University Medical Center, one of the world's top stroke hospitals. There, a neurologist almost certainly would have seen her quickly and administered an intravenous drug to dissolve the clot. Stanford was 17 miles away, across a county line. But paramedics, following county ambulance rules that stress proximity, took her 13 miles north, to Kaiser Permanente's South San Francisco Medical Center. There, despite her sudden inability to talk or walk and her facial droop, an emergency-room doctor concluded she was suffering from depression and stress. It was six hours before a neurologist saw her, and she never got the intravenous clot-dissolving drug. In a legal action brought against Kaiser on Ms. Mei's behalf, an arbitrator found that her care had been negligent, and in some aspects "incomprehensible." Today, Ms. Mei can't dress herself and walks unsteadily, says her lawyer, Richard C. Bennett. The fingers on her right hand are curled closed, and she has had to give up her main avocations: calligraphy, ceramics and other types of art. Kaiser declined to comment beyond saying that it settled the case under confidential terms "based on some concerns raised in the litigation." ![[By the Numbers]](../images/P1-AC840_STROKE05082005183243.gif)
Stroke is the nation's No. 1 cause of disability and No. 3 cause of death, killing 164,000 people a year. But far too many stroke victims, like Ms. Mei, get inadequate care thanks to deficient medical training and outdated ambulance rules that don't send patients to the best stroke hospitals. Over the past decade, American medicine has learned how to save stroke patients' lives and keep them out of nursing homes. New techniques offer a better chance of complete recovery by dissolving blood clots and treating even more lethal strokes caused by burst blood vessels in the brain. But few patients receive this kind of treatment because most hospitals lack specialized staff and knowledge, stroke experts say. State and county rules generally require paramedics to take stroke patients to the nearest emergency room, regardless of that hospital's level of expertise with stroke. ![[Glender Shelton]](../images/HC-GF987_SheltonGlender05082005164941.gif)
Stroke care is positioned roughly where trauma care was a quarter-century ago. By 1975, surgeons expert at treating victims of car crashes and other major accidents realized that taking severely injured patients to the nearest emergency room could mean death. So the surgeons led a push to make selected regional hospitals into specialized trauma centers and to overhaul ambulance protocols so that paramedics would speed the most severely injured to those centers. Now, in many areas of the U.S., accident victims go quickly to a trauma center, and trauma specialists say this change has saved lives and lessened disability. Eighty percent or more of the 700,000 strokes that Americans suffer annually are "ischemic," meaning they are caused by blockage of an artery feeding the brain, usually a blood clot. Most of the rest are "hemorrhagic" strokes, resulting from burst blood vessels in or near the brain. Although they have different causes, both result in brain tissue dying by the minute. Several factors have combined to prevent improvement in stroke care. In some areas, hospitals have resisted movement toward a system of specialized stroke centers because nondesignated institutions could lose business, according to neurologists who favor the changes. In addition, stroke treatment has lacked an organized lobby to galvanize popular and political interest in the ailment. Doctor Ignorance A big reason for the backwardness of much stroke treatment is that many doctors know little about it. Even emergency physicians and internists likely to see stroke victims tend to receive scant neurology training in their internships and residencies, according to stroke specialists. "Surprisingly, you could go through your entire internal-medicine rotation without training in neurology, and in emergency medicine it hasn't been emphasized," says James C. Grotta, director of the stroke program at the University of Texas Health Science Center at Houston. Many hospitals don't have a neurologist ready to deal with emergencies. As a result, strokes aren't treated urgently there, even though short delays increase chances of severe disability or death. Even if doctors do react quickly, recent research has shown that many aren't sure what treatment to provide. ![[Owen Samuels]](../images/Samuels_Owen-HC-GF98604172005181508.gif)
For example, a survey published in 2000 in the journal Stroke showed that 66% of hospitals in North Carolina lacked any protocol for treating stroke. About 82% couldn't rapidly identify patients with acute stroke. As with other life-threatening conditions, stroke patients are better off going where doctors have had a lot of practice addressing their ailment. A seven-year analysis of surgery in New York state in the 1990s showed that patients with ruptured blood vessels in the brain were more than twice as likely to die -- 16% versus 7% -- in hospitals doing few such operations, compared with those doing them regularly. A national study published last year in the Journal of Neurosurgery showed a similar disparity. Another major shortcoming of most stroke treatment, according to many neurologists, is the failure to use the genetically engineered clot-dissolving drug known as tPA. Short for tissue plasminogen activator, tPA, which is made by Genentech Inc., has been shown to be a powerful treatment that can lessen disability for many patients. A study published in 2004 in The Lancet, a prominent medical journal, showed that the chances of returning to normal are about three times greater among patients getting tPA in the first 90 minutes after suffering a stroke, even after accounting for tPA's potential side effect of cerebral bleeding that can cause death. But several recent medical-journal articles have found that nationally, only 2% to 3% of strokes caused by clots are treated with tPA, which has no competitor on the market. Some authors of studies supporting the use of tPA have had consultant or other financial relationships with Genentech. Skeptics of the drug point to these ties and stress tPA's side-effect danger. But among stroke neurologists, there is a strong consensus that the drug is effective. One reason why many patients don't receive tPA is that they arrive at the hospital more than three hours after a stroke, the time period during which intravenous tPA should be given. But many hospitals and doctors don't use tPA at all, even though it has been available in the U.S. since 1996. The dissolving agent's relatively high cost -- $2,000 or more per patient -- is a barrier. Medicare pays hospitals a flat reimbursement of about $5,700 for stroke treatment, regardless of whether tPA is used. Airport Emergency Glender Shelton of Houston had an ischemic stroke caused by a clot at Los Angeles International Airport on Dec. 30, 2003. In full view of other holiday travelers, Ms. Shelton, then 66, slumped over, and an ambulance was called. It was 4:45 p.m. ![[Gretchen Thiele]](../images/HC-GG034_ThieleGretchen04262005181122.gif)
By 5:55 p.m., she arrived at what now is called Centinela Freeman Regional Medical Center, four miles away in Marina del Rey. Hospital records show that doctors thought Ms. Shelton had suffered an "acute stroke." But she didn't get a CT scan, a recommended initial step, until 9 p.m. By then, she was already outside the three-hour window for safely administering intravenous tPA. Records also say she didn't receive the drug "due to unavailability of a neurologist until after the patient had been outside the three-hour time window." Ms. Shelton's daughter, Sandi Shaw, was until recently nurse-manager of the prestigious stroke unit at the University of Texas Health Science Center at Houston. Ms. Shaw says that at her unit, her mother would have had a CT scan within five minutes of arriving, and tPA probably would have been administered 30 or 35 minutes after that. Today, according to her daughter. Ms. Shelton often can't come up with words or relatives' names, can't take care of her finances, and can't follow certain basic commands in neurological tests. Kent Shoji, an emergency-room doctor at Centinela Freeman who handled Ms. Shelton's case, says, "She was a possible candidate for tPA," but a CT scan was required first. "The order was put in for a CT scan," Dr. Shoji says. "I can't answer why it took so long." A Centinela Freeman spokeswoman says, "We did not have 24/7 coverage with our CT scan, and we had to call a technician to come in. That's pretty common with a community hospital." The hospital has since been acquired by a larger health system and now does have 24-hour CT capability. 'Parochial Interests' A hospital-accrediting group has begun designating hospitals as stroke centers, but that is only part of what is needed, stroke experts assert. They say hospitals typically have to come together to create local political momentum to change state or county rules so that ambulances actually take stroke patients to stroke centers, not the nearest ER. New York, Maryland and Massachusetts are moving toward creating stroke-care systems, and Florida recently passed a law creating stroke centers. But in many places, short-term economic interests impede change, some doctors say. ![[Chuck Toeniskoetter]](../images/HC-GG035_ToenisketterChuck04262005165607.gif)
"There are still very parochial interests by hospitals and physicians to keep patients locally even if they're not equipped to handle them," says neurosurgeon Robert A. Solomon of New York-Presbyterian Hospital/Columbia. "Hospitals don't want to give up patients." The University of California at San Diego runs one of the leading stroke hospitals in the country. It and others in the area that are well prepared to treat stroke patients have sought for a decade to set up a regional system, but there has been little progress, says Patrick D. Lyden, UCSD's chief of neurology. "Some hospitals are resisting losing stroke business," he says. "We have the same political crap as in most communities. Paramedics still take people to the local ER." Among the opponents of the stroke-center concept during the 1990s was Richard Stennes, then ER director at Paradise Valley Hospital south of San Diego. In various public debates, Dr. Stennes recalls, he argued that many apparent stroke patients would be siphoned away from community hospitals even if they didn't turn out to have strokes. Also, he argued that tPA might cause more injury than it prevents. And then there was the economic issue: "Those hospitals without all the equipment and stroke experts," he says, "would be concerned about all the patients going to a stroke center and taking the patients away from us." Dr. Stennes has since retired. "All hospitals and clinicians try to deliver the right care to patients, especially those with urgent medical needs," says Nancy E. Foster, vice president for quality of the American Hospital Association, which represents both large and small hospitals. "Community hospitals may be equally good at delivering stroke care, and it would be important for patients to know how well prepared their local hospital is." Stroke experts aren't proposing that every hospital needs to specialize in stroke care but instead that in every population center there should be at least one that does. In Atlanta, Emory University's neuro-intensive care unit illustrates the special skills that make for top care. Owen B. Samuels, director of the unit, estimates that 20% to 30% of patients it treats received poor initial medical care before arriving at Emory, jeopardizing their futures or even lives. Brain hemorrhages, for example, are commonly misdiagnosed, even in patients who repeatedly showed up at emergency rooms with unusually severe headaches, Dr. Samuels says. The Emory unit has 30 staff members, including two neuro-critical care doctors and five nurse practitioners. A team is on duty 24 hours a day. The unit handles about two dozen patients most days, keeping the staff busy. On the ward, nearly all patients are unconscious or sedated, so it's eerily silent. Patients generally need to rest their brains as they recover from stroke or surgery. ![[Vance Bowers]](../images/HC-GG033_BowersVance04262005180219.gif)
After a hemorrhagic stroke, blood pressure in the cranium builds as blood continues to seep out of the ruptured vessel. Pressure can be deadly, cutting off oxygen to the brain. Or escaped blood can cause a "vasospasm," days after the original stroke, in which the brain reacts violently to seeped-out blood. In the worst case, the brain herniates, or squeezes out the base of the skull, causing death. To avoid this, nurses at Emory constantly monitor brain pressure and temperatures. They put in drain lines. They infuse medicines to dehydrate, depressurize and stop bleeding. Since Emory launched the neuro-intensive unit seven years ago, 42% of patients with hemorrhagic strokes have become well enough to go home, compared with 27% before. Fewer need rehabilitation -- 31% versus 40% -- and the death rate is down. Damica Townsend-Head, 33, gave the Emory team a scare. After surgery last fall for a hemorrhagic stroke, her brain swelling was "really out of control," Dr. Samuels says, raising questions about whether she would survive. The staff put a "cooling catheter" into a blood vessel, which allowed the circulation of ice water to bring down the temperature in her blood and brain. They intentionally dehydrated her brain to lower pressure. A month later, she woke up and recovered with minimal disability. She still walks with a cane and tires easily, but her speech is normal and she hopes to return soon to work. "I consider her what we're in business for," Dr. Samuels says. Public Awareness The public's low awareness of stroke symptoms -- and the need to respond immediately -- can also hinder proper care. Ischemic strokes, those caused by clots or other artery blockage, cause symptoms such as muscle weakness or paralysis on one side, slurred speech, facial droop, severe dizziness, unstable gait and vision loss. People with this kind of stroke are sometimes mistaken for being drunk. In addition to intense head pain, a hemorrhagic stroke often leads to nausea, vomiting or loss of balance or consciousness. Still, many people with some of these symptoms merely go to bed in hopes of improving overnight, doctors say. Instead, they should go immediately to a hospital and demand a CT scan as a first diagnostic step. The well-funded American Heart Association, established in 1924, has made many people aware of heart attack symptoms and thereby saved many lives. In contrast, the American Stroke Association was started only in 1998 as a subsidiary of the heart association. The stroke association spent $162 million last year out of the heart association's $561 million overall budget. Justin Zivin, another University of California at San Diego stroke expert, says the stroke association "is a terribly ineffective bunch. When it comes to actual public education, I haven't seen anything." The stroke association counters that it is buying television and radio ads promoting awareness, similar to ones produced in 2003 and 2004. The group also sponsors research and education, including an annual international stroke-medicine conference. It's not just the general public that fails to recognize stroke symptoms. Often, emergency-room doctors and nurses don't, either. Gretchen Thiele of suburban Detroit began having horrible headaches last May, for the first time in her life. "She wasn't one to complain, but she said, 'I can't even lift my head off the pillow,' " recalls her daughter, Erika Mazero. Ms. Thiele, 57, nearly passed out from the pain one night and suffered blurred vision. When the pain recurred in the morning, she went to the emergency room at nearby St. Joseph's Mercy of Macomb Hospital. Ms. Mazero says that during the six hours her mother spent there, she was given a CT scan, but not a spinal tap, which could definitively have shown she had a leaking brain aneurysm, meaning a ballooned and weakened artery in her brain. After the CT, Ms. Thiele was given a muscle relaxant and pain medicine and sent home, her daughter says. Two months later, the blood vessel burst. Neurosurgeons at William Beaumont Hospital in Royal Oak, Mich., did emergency surgery, but Ms. Thiele suffered massive bleeding and died. Ali Bydon, one of the neurosurgeons at Beaumont, says a CT scan often is inadequate and that her condition could have been detected earlier with a spinal tap, also called a lumbar puncture. "Had she had a lumbar puncture and perhaps an operation earlier, it might have saved her life," says Dr. Bydon. "In general, a person who tells you, 'I usually don't get headaches, and this is the worst headache of my life,' is something that should alarm you." In addition, he says Ms. Thiele "absolutely" was experiencing smaller-scale bleeding in May that foreshadowed a more serious rupture. If doctors identify this kind of bleeding early, he says, chances of death are "minimal." But when a rupture occurs, he says, "25% of patients never make it to the hospital, 25% die in the hospital and 25% are severely disabled." A St. Joseph's hospital spokeswoman says the hospital has "very aggressive standards for treatment, and we met this standard," declining to elaborate. Determined Nurse Paramedics did the right thing after Chuck Toeniskoetter's stroke, but only because of some extraordinary intervention. Mr. Toeniskoetter, then 55, was on a ski trip Dec. 23, 2000, at Bear Valley, near Los Angeles. He had just finished a run at 3:30 p.m. when, in the snowmobile shop, he began slurring his words and nearly fell over. Kathy Snyder, the nurse in the ski area's first-aid room, quickly diagnosed stroke. She called a helicopter and an ambulance. Ms. Snyder says she knew the closest hospital with a stroke team was Sutter Roseville Medical Center in Roseville, Calif. The helicopter pilot was planning to take Mr. Toeniskoetter to a closer ER, but Ms. Snyder says she stood on the helicopter runners, demanding the patient go to Sutter. The pilot eventually relented. Mr. Toeniskoetter went to Sutter, where he promptly received tPA. Today, he has no disability and is back running a real estate-development business in the San Jose area. "Trauma patients go to trauma centers, not the nearest hospital," he says. "Stroke victims, too, require a real specialized sort of care." One-third of all strokes are suffered by people under 60, and hemorrhagic strokes in particular often strike young adults and children. Vance Bowers of Orlando, Fla., was 9 when he woke up screaming that his eyes hurt, shortly after 1 a.m. on Jan. 8, 2001. Malformed blood vessels in his brain were bleeding. He was in a coma by the time an ambulance delivered him at 1:57 a.m. to the nearest emergency room, at Florida Hospital East Orlando. Emergency-room doctors soon realized Vance had a hemorrhagic stroke. But neurosurgery isn't performed at that hospital. A sister hospital 14 minutes away by ambulance, Florida Hospital Orlando, did have neurosurgical capability. But in part because of administrative tangles, Vance didn't get to the second hospital until 4:37 a.m., more than two hours after his arrival. Surgery began at 6:18 a.m. "This delay may have cost this young man the possibility of a functional survival," Paul D. Sawin, the neurosurgeon who operated on Vance, said in a letter to the hospitals' joint administration. Florida Hospital, an emergency-medicine group and an ER doctor recently agreed to settle a lawsuit filed against them in Orange County, Fla., Circuit Court by the Bowers family. The defendants agreed to pay a total of $800,000, court records show. Monica Reed, senior medical officer of the hospital, says the care Vance received was "stellar" and that any delays weren't medically significant. Vance's stroke, not the care he received, caused his injuries, she said. Vance, now 13, survived but is mentally handicapped and suffers daily seizures, his mother, Brenda Bowers, says. Once a star baseball player, he goes by wheelchair to a class for disabled children. He speaks very slowly but not in a way that many people can understand. "He remembers playing baseball with all of his friends," his mother says, but they rarely come around any more. "He really misses all that." Write to Thomas M. Burton at tom.burton@wsj.com1 ![[Emergency Treatment]](../images/P1-AC839_STROKEART05082005183236.gif) Return to story1.
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PUBLIC SERVICE |
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Photos by Robert Gauthier
December 5, 2004
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| SYMBOL: Patient Albert Johnson smokes at King/Drew Medical Center, which stands for justice to many black people in south L.A. It was founded to be the nation's "very best hospital," but by various measures is now one of the worst. Some call it "Killer King." |
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| VICTIM: Dunia Tasejo was taken to King/Drew with some scrapes, bruises and two broken baby teeth. There should have been no reason to worry. |
• The hospital's failings do not stem from a lack of money, as its
supporters long have contended. King/Drew spends more per patient than any of
the three other general hospitals run by Los Angeles County. Millions of dollars
go to unusual workers' compensation claims and abnormally high salaries for
ranking doctors.
• The hospital's governing body, the county Board of Supervisors, has been told
repeatedly — often in writing — of needless deaths and injuries at King/Drew.
Recently the supervisors have made some aggressive moves aimed at fixing the
hospital. But for years, the board shied away from decisive action in the face
of community anger and accusations of racism.
King/Drew, founded in the aftermath of the 1965 Watts riots, has stood for more
than three decades as a symbol of justice and political power to many black
people in South Los Angeles and beyond. In reality, if not officially, the
hospital was established by and for African Americans; the majority of its staff
always has been black.
"That hospital means hope to us," said Karimu McNeal, 52, an African American
woman treated successfully for colon cancer at King/Drew in 2002. "When you go
into the hospital and you see people that look like you and take care of you, it
gives you hope for the whole race that we're achieving and doing something."
Mixed with community pride is an undercurrent of concern about King/Drew's
standards. For about three decades it has been known by an unflattering
nickname, "Killer King." Patients have fled ambulances to avoid it, according to
paramedics and one ranking fire official. And police officers say they have an
understanding among themselves that, if shot, they will not be taken there.
The Tasejos, immigrants from Guatemala, didn't know any of this the day
their daughter was hurt. All they knew was that she needed help.
In the seven hours after Dunia's arrival, the hospital would commit a series of
medical errors in treating her, each compounding the one before.
By the middle of that night, the couple were standing outside the pediatric
intensive care unit, bewildered and increasingly frightened. Alarms were ringing
and doctors were running by. The Tasejos tried to catch the eye of a physician
who had reassured them earlier.
"He looked at me," Elias Tasejo recalled. "He kept walking."
Here is an account of Dunia's care, based on her medical records, a state health
department investigation, a medical expert consulted by The Times and interviews
with her family:
To keep her still during a precautionary CT scan, her 65-pound body was pumped
with enough drugs to sedate a grown man.
Paralyzed by the medications, she had to be hooked up to a ventilator to help
her breathe. Its settings were wrong; a blood test showed she was being starved
of oxygen.
The settings were adjusted to give her more. But inexplicably, an emergency room
doctor ordered a trainee physician to pull out Dunia's breathing tube 20 minutes
later. No one checked to see whether she could breathe on her own.
For the next two hours, Dunia's nurses failed to monitor her vital signs
or breathing, records show. By the time she was transferred to the pediatric
intensive care unit, she was flailing from lack of oxygen and calling, "Mama."
The medical resident who admitted her to the ICU was unable to operate a machine
to check her oxygen levels, and didn't seek help for at least 15 minutes.
By then, Dunia's heart and lungs had stopped working. Doctors resuscitated her,
but later that day she was declared brain dead.
After two days, she was removed from life support.
"This child should not have died," said Dr. Lorry Frankel, chief of pediatric
intensive care at Stanford University's children's hospital, who reviewed
Dunia's records for The Times. "If she had been taken to any pediatric center
that had appropriate policies and procedures in place … she would still be alive
today."
Frankel described Dunia's care as "appalling" and "really pathetic."
After her death, a team of doctors took the Tasejos into a room and promised to
find out what had killed her.
Elias Tasejo said the associate medical director handed him a business card. He
kept it in his wallet for three years, thinking he might hear back. He never
did.
"Our daughter is dead," he said earlier this year, "and we have no idea why."
*
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| A MOTHER'S MEMORIES: Sulma Tusejo wears a pendant containing the image of her children: Daughter Dunia, 9, went to King/Drew with minor injuries from an accident. At the hospital, "they told me to relax," the mother recalls. "Everything was fine." |
Moments passed. When the last voice had been stilled, when every head
turned her way, only then did she speak.
"The hospital," she said gravely, leaning on a cane, "is being closed piece by
piece."
There were murmurs, shouts of dismay.
"We have to stand together to fight this battle," said Mobley, her voice rising.
"We have to rise every morning under God's will … to save Martin Luther King."
That meeting, held to protest planned cutbacks at King/Drew, was one of many
such gatherings she has addressed over the years.
Strong-willed and fiercely protective, Mobley, 74, is at the forefront of a
coterie of African American leaders, most now in their 70s and 80s, who defend
King/Drew with the same intensity that they once devoted to the civil rights
movement.
To them, it is part of the same struggle.
Some vividly recall how things used to be, when they had to find a ride to the
main county hospital some 15 miles away. It was a long trip if you didn't have a
car — and most people didn't. "Twenty-five dollars sick" meant you were in bad
enough shape to pay for a cab across town.
Many remember the case of Leonard Deadwyler, a black man who in 1966 was rushing
his pregnant wife from their home in Watts to County General Hospital (today's
County-USC) in Boyle Heights when police stopped him for speeding. An officer
approached his car and shot him to death. The shooting was determined to have
been an accident, but many saw it as a racist killing.
They also remember how the voters of Los Angeles County, mostly white,
refused to pay for King/Drew's construction, forcing Supervisor Kenneth Hahn to
find money elsewhere. Even now, threats to trim the hospital's budget revive
fears that whites are trying to take it away.
"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."
Mobley's group is small, and its members hold no elective office, yet they are
the curators of King/Drew's dream. They are often called simply "the Community,"
reverently spoken, as with a capital C. It is a status they have guarded ever
more zealously as the neighborhoods around them have become increasingly Latino.
"If you're going to work at King/Drew, you have to work with the Community,"
said Dr. Thomas Yoshikawa, chairman of the internal medicine department. "You
just can't come in and say, 'I'm the new kid on the block. I'm going to play the
game my way.' No, you have to play the game their way."
Defying them can draw charges of racism — even when the transgressor is African
American.
In the fall of 2003, members of Mobley's group paced the lawn in front of the
hospital, as one bellowed through a bullhorn: "Marcelle Willock, you can't hide.
We charge you with genocide."
Willock, who is black and Latina, is dean of the hospital's affiliated
medical school at the Charles R. Drew University of Medicine and Science. The
protesters contended that she had not done enough to protect and support key
programs.
While racial politics sometimes play out on its expansive front lawn, inside the
hospital, King/Drew's legacy is on display.
In the lobby are prominent portraits of King; his wife, Coretta; and local
political dignitaries posing beside former Presidents Clinton and Johnson. A
photograph of King being greeted by the late Supervisor Hahn is hung in two
places there and in at least six others around the hospital.
Down winding hallways is one of the hospital's greatest points of pride — a
trauma unit with state-of-the-art equipment. More gunshot wounds have been
treated here in recent years than at any other hospital in the county. Many in
surrounding neighborhoods credit the unit's surgeons with saving their lives or
those of their sons and daughters.
"There's a lot of violence in the world today, especially in this community,"
said Lee Russell, 40, yanking up his shirt to display rope-like scars from a
November 2003 shooting and stabbing. He praised the King/Drew doctors and
nurses, saying that if the trauma center hadn't been nearby, "I would be dead….
I'm their walking miracle."
Last month, the Board of Supervisors voted to close the trauma unit to focus on
fixing the rest of King/Drew, which like other county hospitals treats patients
regardless of insurance status. In September, the board agreed to hire private
turnaround consultants for $13.2 million. The supervisors' actions were their
strongest to date, brought about only by threats to King/Drew's federal funding
and national accreditation.
The trauma unit's closure, especially, drew residents' ire. "Don't disrespect or
underestimate our community," read a banner hung last month at a rally of more
than 1,000 hospital supporters.
King/Drew has become the "proxy for an entire community's identity," said Los
Angeles civil rights attorney Connie Rice, who is African American.
That creates tension between those who see the hospital in strictly medical
terms and those who see it as an embodiment of their dreams for racial
self-determination.
"You're talking about the fact that the nurses weren't trained to use monitors,"
Rice said, "and they're going back to '60s Watts."
Click here for graphic "Malpractice Costs"
*
Community of grief
Over the years, King/Drew has created another community, one bound by a common
grief.
Jereatha Thomas belongs to it. She rushed her 27-year-old daughter, Demetria, to
King/Drew in June 2003.
In the emergency room, printouts from three electrocardiograms stated plainly
that Demetria Thomas had suffered a massive heart attack. Two labeled it
"acute," the other "extensive."
No one acted on the findings for more than 10 hours, as doctors pursued
other theories. By the time a cardiologist pointed out the obvious, it was too
late, said two experts who reviewed her medical records for The Times.
Two days later, shortly after being transferred to Harbor-UCLA Medical Center
for more specialized care, Demetria died.
Jereatha Thomas has never recovered. She moved out of the house she shared with
Demetria, unable to live with the memories. She works three jobs until she's too
tired to think.
"Since the time my daughter passed away, people have come up to me and said, 'My
aunt, my uncle, my friend died the same way,' " Thomas said. "It was a lesson to
be learned for me. I would never go back to King. Never, ever."
Thomas decided to hold the hospital accountable in the only way she knew how:
She sued. Her case is pending.
Every hospital makes mistakes, some of them fatal. Filing a lawsuit is one of
the few recourses patients and their families have when something goes wrong.
But taken together, the malpractice cases involving King/Drew portray a place
where things often go wrong — sometimes in the same way, over and over.
King/Drew spent $20.1 million on malpractice payouts during fiscal years 1999 to
2003, an extraordinary sum for a public hospital its size in California.
Adjusting for the number of patients the hospital saw, that figure is more than
at any of the state's other public hospitals or the University of California
medical centers.
Even County-USC Medical Center, which is three times larger and not
without troubles of its own, spent less. (King/Drew's payouts cannot be compared
to those at public hospitals outside the state, because California has strict
limits on malpractice damages.)
The Tasejos' award was added to the tab this October, more than four years after
Dunia's death. Weary of the legal battle, the family settled for $195,000.
Her father plans to build an altar at her grave in Guatemala, enshrining the
dress and shoes she wore that July day.
"I want to get the [legal] papers so I can put them in the tomb and say, 'Look.
It's over, honey,' " he said.
Malpractice awards are just one sign of trouble at King/Drew.
From 1999 to March 2004, the hospital was cited for violating California health
regulations more often than 97% of hospitals statewide, according to a Times
analysis of state data. It had more violations than any of the county's three
other general hospitals.
The two most prominent national accrediting groups rate King/Drew among the
nation's most troubled institutions.
It is the only hospital in America to have received the lowest possible rating
in its last two reviews from the Accreditation Council for Graduate Medical
Education. The group has ordered the closure of three of King/ Drew's 18
doctor-training programs: surgery, radiology and neonatology. A fourth,
orthopedic surgery, may be phased out under pressure from the council.
King/Drew is also one of only seven U.S. hospitals that the Joint
Commission on Accreditation of Healthcare Organizations has said should lose
overall accreditation this year. The group accredits 4,579 hospitals nationwide.
King/Drew has appealed the decision, but if it fails, it could be forced to
close all its doctor-training programs and lose nearly $15 million in private
insurance contracts.
"This hospital," said Dr. Dennis O'Leary, the joint commission's president, "has
problems of orders of magnitude that are substantially greater than almost all
other hospitals in this country."
Even the top county health official finds King/Drew's failings hard to fathom.
"I'm not sure who would imagine the depths of the problems," said Dr. Thomas
Garthwaite, director of the Department of Health Services. "I'm not sure anybody
has the life experiences to prepare themselves for this."
It is only through brutal experience that some patients and their families learn
of the dangers at King/Drew.
|
| SISTERLY DEVOTION: Gail Gordon looks for sister Sherry Ridley's space at Inglewood Park Cemetery to place roses there with a pole. The events leading to Ridley's death began when a doctor trainee stitched through her colon in error, essentially blocking it, according to her medical records. Later, another trainee's repair job failed, and a senior surgeon opened Ridley up eight more times. |
"My sister went in there healthy," said Gail Gordon, her eldest sister.
"She went from a human being to a monster when she passed."
|
| A FAMILY BEREFT: Nova Adkins, left, and Yvette Turner are two of Sherry Ridley's six close-knit siblings. Her death five days after Christmas in 2002 has left them and their mother, Geraldean, right, with a profound sense of loss. |
Robinson, 46, died within hours. A doctor wrote on her preliminary death
certificate that she had died from natural causes.
After her body had already been embalmed, the King/Drew surgeon called the
coroner's office, suggesting that Robinson's doctor might have made a fatal
mistake.
An autopsy confirmed that the needle had struck her coronary artery, spilling
blood from her heart.
Cases like these sometimes pass unnoticed.
But many of King/Drew's mistakes are well known to the elected leaders
responsible for overseeing the hospital, a board so powerful its members are
called "the five little kings."
*
Vows of action
Spurred by media reports of lapses in patient care at King/Drew, county
Supervisor Yvonne Brathwaite Burke held a news conference to announce "swift and
decisive action."
"Due to a series of highly publicized problems, irregularities, illegalities and
tragic mistakes … the public's confidence in this major county medical facility
has been shaken," she said. "It is unacceptable for anyone who depends on King
hospital … to fear that they won't get the level of care they expect and
deserve."
It was time for "drastic action." The hospital, she said, needed a "crisis
management task force" and a major administrative shakeup. Her colleagues on the
board approved Burke's plan.
"This," said Supervisor Zev Yaroslavsky, "is a major step; it's a
beginning at MLK."
Those remarks might have been made this year. In fact, they were delivered
nearly nine years ago.
Many such pledges have been made in the years before and since. But they have
not produced meaningful change.
In 1989, the supervisors were jolted by a Times investigation into King/Drew
that described a series of botched cases. In one, an 18-year-old shooting victim
survived even though her throat was mistakenly slit by trauma surgeons.
The supervisors ordered an investigation and pushed for a top-level task force.
They also removed the hospital's administrator, provoking a wave of community
protest.
King/Drew drifted out of the spotlight — for a while. But notorious cases arose
periodically in subsequent years, grabbing public attention and prompting more
promises of reform.
In 1992, Nelson Yamamoto, a 26-year-old sheriff's deputy, was taken to King/Drew
with four gunshot wounds. Joking with nurses as he arrived, he was dead two days
later. The coroner said the deputy died of the gunshot wounds. But the district
attorney later faulted the care provided by doctors, in particular a surgeon who
administered a lethal combination of heart drugs.
"We have no doubt that there are many competent, dedicated healthcare
professionals at Martin Luther King hospital," the district attorney's report
said. "But we cannot turn a blind eye to the facts as we have found them."
The doctors involved in Yamamoto's care were never charged. The incident,
however, cemented some police officers' impressions that King/Drew was not a
safe place to go.
In 1994, Aleta Clemons, a 42-year-old woman who went to King/Drew for a
hysterectomy, was infused with blood that had tested positive for the AIDS
virus. But no one had bothered to check the test results.
In 1998, Blanca Maldonado, 52, drank a glass of tissue preservative, a poisonous
chemical mixture accidentally left on her hospital bed stand by a doctor in
training. She staggered to the closest nursing station, pleaded for help and
died a short time later.
Each of these cases led to promises by the Board of Supervisors that King/Drew
would be fixed.
A pattern emerged: A crisis would bring superficial reform, followed by a short
period of relative calm, soon to be followed by another crisis.
"Members of the Board of Supervisors tiptoe around Martin Luther King hospital,"
said political consultant Kerman Maddox, who is black. "They have to pay
attention when they're forced to pay attention, but when they're not … they'd
rather ignore it and hope it'll go away. They'd rather not get in battles with
people in the community, because they would appear to be racially insensitive."
Few people have been in a better position to know what is going on at King/Drew
than the supervisors. They receive county, state and federal reports spelling
out the hospital's most severe patient care failings, along with other
documentation.
The supervisors also must sign off on malpractice payments of more than $100,000
— two dozen from King/Drew in the last six years alone. Confidential paperwork
describes precisely what went wrong and how the hospital plans to fix it.
Yet, again and again, the board has professed shock at the hospital's tragedies.
Last year, when a series of crises erupted at King/Drew, the supervisors —
four of whom have been on the board more than a decade — reacted much as they
had before. They called for another task force, which had virtually the same
mission as the 1996 group and was even staffed with some of the same people.
Top health department officials took control of King/Drew's operations. And
under their watch, the hospital was twice threatened with the immediate loss of
federal funding for, among other things, repeatedly bungling medication orders.
When the supervisors announced plans early this year to scale back the
hospital's prized neonatal unit, community activists, led by Rep. Maxine Waters
(D-Los Angeles), geared for a fight.
Waters threatened at a protest meeting to climb "on top of [the] desk" of health
department officials. A short time later, the county backed off, saying its
proposal needed further study.
While the board vacillates, patients suffer.
*
A cry of despair
|
| "THAT HOSPITAL TOOK MY LIFE AWAY FROM ME." In recent months, Clemons' health has deteriorated markedly. Her gait is no longer steady. She takes 16 pills daily. She did get a $450,000 legal settlement and the promise of free lifetime care -- at King/Drew. |
Jordan, a specialist in infectious diseases, said hospital officials had
tried to dissuade him from telling Clemons about the mistake. He felt it was his
duty.
Two weeks later she learned that she was, in fact, infected with HIV.
Clemons, now 53, hadn't planned on going to King/Drew at all. She was supposed
to have her hysterectomy at Harbor-UCLA. She'd even stored her own blood there
in advance, on a doctor's advice. But when she began hemorrhaging unexpectedly,
her sister took her to King/Drew because it was closer.
"I begged her not to take me there," Clemons said. "But she said that I would
have bled to death."
In late 1995, Clemons took her questions and concerns about what happened to
Supervisor Burke. Jordan went with her.
Burke was full of promises, Clemons recalled, wanting to make sure she had a
job, a formal apology and a house of her own. Clemons said she never got those
things.
Burke said she did not recall meeting with Clemons. "At no time did I say I
would get her a house or a job," the supervisor said. "Whenever she calls, we
try to do whatever we can to assist."
Clemons did get a $450,000 legal settlement, paid out over more than a decade,
and the promise of free lifetime care — at King/Drew.
"This," Jordan observed, "is like having to live with the person that raped
you."
Even 10 years later, Clemons thinks about going to the Board of
Supervisors to remind it of Burke's other pledges.
"I tried to get up the courage, because I really want to talk to them face to
face," Clemons said. "Every time, I just get depressed. I can't go."
In recent months, her health has deteriorated markedly. Her gait is no longer
steady. She takes 16 pills daily.
She lives in King/Drew's shadow. She can see it from the rear window of her
apartment.
"Every time I look at that hospital I think about what happened to me," Clemons
said. "That hospital took my life away from me."
Click for graphic: "L.A. County Hospitals
Times staff writer Steve Hymon, researcher Scott Wilson and data analyst
Sandra Poindexter contributed to this report.
(Copyright (c) 2004, Los Angeles Times)
This is from school student writing on this issue in Los Angeles. Most students are taught that only the government, or the police, can do anything to solve crime and poverty -- schools no longer teach personal responsibility -- thus the people in these areas are all the more likely to fail in their duty to bring honesty and morality into their own community.
But, it can be done!
Karl Loren
....
....
There are also a number
of hazards in the human environment. The most obvious of these is the high crime
rate. Police statistics are the most useful source of
information and a very reliable, media programmes often provide information
about crime rate but they are much more likely to show bias.
They often link crime with drug trafficking and poverty, both of which are also human hazards.
These hazards are not spread equally amongst the community. An area of Los Angeles known as Watts has high proportion of people living below the poverty line at 28% (Geography an integrated approach 1995) and a high portion of people classed as Afro-American or Hispanic at 89%. The high poverty leads to poor standards of living and relatively few people have a chance to go on to further education.
The local authorities say they are attempting to help the community but they feel the people must do more to help themselves.
They even threaten withdrawing welfare payments after two years without work.
Residents often believe that they are being targeted for this bad treatment because they are from racial minorities and this creates friction between them and the police especially after allegations of heavy-handed policing.
With few opportunities for jobs many young people tend to drift into crime (Bradford and Keni~ 1988) leading to high crime rates in these poorer areas and in Los Angeles as a whole. The response of the local authorities to this has been strict penalties such as prison sentences and boot camps, even for relatively minor offences such a shop lifting.
This however has made many residents resent the police to an even greater extent therefore increasing the likelihood of riots, and has not addressed the heart of the problem. The danger posed by these riots and the possible damage to property as in the Rodney King riots are also major hazards.
[Karl Note: Notice how this student avoids placing ANY responsibility on criminals for being criminals, or out-of-work people for being out-of-work. When a person's problems are caused by others, the solution is seen to be elsewhere -- and it never gets fixed! This student was deliberately taught this way in a school system full of teachers that do harm, not good!]
This is the Karl Loren Happiness On Line Web Site Karl Promises To Answer Any Personal Message, Personally.
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