ロサンゼルス公立病院の閉鎖/米国医療事情

 6月に、ERで適切な治療を受けられず、ERからの911コールも断られ死亡した事件のあった病院が閉鎖される。
画像ワッツ暴動(1965年8月)の後に設立された。Martin Luther King Jr.-Harbor Hospital という名前のとおり、African Americans の希望と進歩のシンボルであった。Watts/Willowbrook という南ロサンゼルスの最も貧しい地区にある。かつては近くの医学校の教育病院でもあった。連邦政府の定めた23の基準のうち8つを満たせず、最低の医療水準にいたらず、2億ドルの負債。この病院が閉鎖されると、最も近い公的病院まで数マイルあり、殆どが車を持たない貧しい住民のため通院不可能である。
人種差別政策であると言う人もいる。カリフォルニア州の公立病院で Malpractice ランキング1位とされ、病院の質が問われていた、LATimes サイトにはこの病院専用のページがある。

記事だけでは我々には実情は想像しにくい。
米 病院で救急患者を放置死
http://kurie.at.webry.info/200706/article_48.html
パッチワーク・シティ/病院閉鎖が復興を遅らせるニューオリンズ
http://kurie.at.webry.info/200707/article_49.html
ニューオリンズの私立病院のカテリーナ被災後の窮状
http://kurie.at.webry.info/200708/article_8.html

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Los Angeles Hospital to Close After Failing Tests and Losing Financing
http://www.nytimes.com/2007/08/11/us/11hospital.html?_r=1&ref=health&oref=slogin
By JENNIFER STEINHAUER and REGAN MORRIS
Published: August 11, 2007

画像J. Emilio Flores for The New York Times
A patient waiting for a ride on Friday after a visit to Martin Luther King Jr.-Harbor Hospital in South Los Angeles.

LOS ANGELES, Aug. 10 ― Martin Luther King Jr.-Harbor Hospital, built in the aftermath of the Watts riots and one of the few hospitals serving the poorest residents of South Los Angeles, is headed for closing after federal regulators found Friday that it was unable to meet minimum standards for patient care.
That verdict, the culmination of more than four years of federal and local scrutiny over patient deaths attributed to poor care, will result in the loss of $200 million in federal support, half the budget for the hospital, a county facility.
In a letter to the hospital administrator, federal officials from the Centers for Medicare and Medicaid Services said that “repeated certification surveys and complaint investigations have identified serious health and safety violations and documented the hospital’s inability to comply with these federal standards.”
At a news conference Friday, county officials said the hospital would probably close within two weeks, after patients were moved to other hospitals. All 911 calls will direct ambulances to one of the nine other hospitals in South Los Angeles. An urgent care center will operate on the site 16 hours a day.
The hospital, which has gone through years of turmoil, has had a contingency plan in place to accommodate its patients in the event of a loss of financing. County leaders said Friday that they could also try to find a private operator to take over the hospital and try to reopen it within 15 months.
But local officials worried about the uncertainty and the loss of the hospital for residents of the Watts/Willowbrook area of Los Angeles.
“They are going to be left without a safety net for health care,” said Janice Hahn, a Los Angeles city councilwoman whose district includes Watts. “There will be no trauma care, no emergency care and a lack of the basic services this community needs and deserves.”
In recent years, the hospital had come under intense scrutiny after the deaths of many patients that officials attributed to poor care by nurses and other staff members, and it has been out of compliance with Medicare standards since 2004. Los Angeles County public health officials recently found low levels of radioactive material on a diaper discarded from a patient in the intensive care unit.
The center attracted national attention in May after a homeless patient who had come through the emergency room collapsed on the floor, screaming in pain, but got no response from employees. A janitor mopped up around the patient as she vomited blood. She later died.
The center had been anxiously awaiting a verdict about its status from the Centers for Medicare and Medicaid Services, which had recently inspected it. On Friday, the widely anticipated but deeply feared decision came: the hospital had failed 8 of the 23 conditions of compliance with the federal government and thus did not meet the standards to receive financial support.
“This was a make-or-break inspection,” Bruce Chernof, the director and chief medical officer of the Los Angeles County Department of Health Services, said at a news conference Friday. “And what this decision means in plain English is that the hospital’s Medicare contract will terminate next Wednesday. I speak on behalf of the entire Department of Health Services when I say how disappointed we all are that the hospital failed to meet national standards of care despite the best efforts of hundreds and hundreds of dedicated people”
Nearly since its opening 35 years ago in Willowbrook in South Los Angeles, the center has been a symbol of both the political neglect of South Los Angeles and its struggle to emerge from blight.
It pointed to many successes ― it was once a teaching hospital for the nearby Charles R. Drew University of Medicine and Science and featured a respected neurosurgery unit ― and in a neighborhood riddled with gang violence and myriad health problems common to poor urban areas, it was a safety net, though an increasingly imperfect one, for the poor and uninsured. The nearest public center is several miles away, which, in an area with many poor residents without cars, means nearly inaccessible.
Debates over the hospital’s future have always been tangled in racial politics. “It is actually quite tragic that this hospital that came into existence with such high expectations now dies because of the culture of incompetence,” said Joe R. Hicks, vice president of Community Advocates Inc., a Los Angeles research group. “It suffered what has often been called the soft bigotry of low expectations, because the Board of Supervisors were aware that the hospital was being nicknamed killer king by people who lived in the neighborhood and they continued to hide the ball.”
Others echoed the criticism. “The Board of Supervisors failed to put enough money and personnel into the hospital,” said Earl Ofari Hutchinson, a Los Angeles political commentator. “And now,” he said, “we are asking the question we always ask: Where are all these people going to go?”
County supervisors have ranged from defending the center to calling for its closure. “What a tragedy it is that this hospital has been able to function on such a substandard level as it has,” said Tony Bell, a spokesman for Michael D. Antonovich, a Los Angeles County supervisor who has supported the closing.
On Friday, hospital workers anxiously awaited news of their fate.
“Everyone is just worrying here,” said Maria Carro, a clerk in the emergency medicine department. “This hospital is very important to our community, and we don’t know what’s going on with patients, we don’t know what’s going on with employees. We don’t know anything.”

------------------------------------
King-Harbor fails final check, will close soon
http://www.latimes.com/news/local/la-me-king11aug11,0,3698687.story?coll=la-home-center
The ER is shut down, and the rest will follow within two weeks. Reactions range from grief to relief.
By Charles Ornstein, Tracy Weber and Jack Leonard, Los Angeles Times Staff Writers
August 11, 2007

Martin Luther King Jr.-Harbor Hospital shut down its emergency room Friday night and will close entirely within two weeks, a startlingly swift reaction to a federal decision to revoke $200 million in annual funding because of ongoing lapses in care.

The extraordinary developments mark an end to nearly four years of failed attempts to reform the historic institution, treasured by many African Americans as a symbol of hope and progress after the 1965 Watts riots.

Los Angeles County health services director Dr. Bruce Chernof announced the closure plan Friday afternoon, hours after the hospital learned that it had failed its final test, a top-to-bottom review by the U.S. Centers for Medicare and Medicaid Services. The hospital, formerly known as King/Drew, has shown itself unable to meet minimum standards for patient care since January 2004, according to the regulators.
Effective noon Friday, the hospital declared an "internal disaster" and redirected each ambulance to one any of nine surrounding hospitals. At around About 5 p.m., staff members posted notices saying the emergency room was closed to walk-in patients.
So many temporary nurses had quit or refused to renew their contracts that too few remained to care for emergency room patients, officials said.
"We are down to skeleton staff," said Carol Meyer, director of governmental affairs for the county Department of Health Services.
Because of the uncertainty created by the decision, state California public health director Dr. Mark Horton said the state will have staff at King-Harbor throughout the weekend to monitor the care provided to the remaining patients.
To treat the poor and minority residents served by the Willowbrook hospital, the county plans to contract with nearby private hospitals and add beds at public facilities. Outpatient clinics and an urgent-care center at King-Harbor will remain open after the hospital closes.
Community leaders say their biggest worry is the closure of the emergency room, which saw about 47,000 patients last year.
But, in a community that has long battled for its fair share of basic services, King-Harbor stands for more than just healthcare.
"It's a very personal relationship this hospital and the community have," Lark Galloway-Gilliam, executive director of Community Health Councils, said between sobs.
"People fought to have this place built, and it's been employment for some people. It's been a symbol that our community is somewhat whole, that the resources are there that you need when you want them," she said.
"So much has been taken away, so much has been taken away, it just breaks my heart," she said.
For the families who lost loved ones after medical lapses at the hospital, however, King-Harbor had come to symbolize betrayal, and Friday's news brought bitter satisfaction. Several had shared their stories with The Times in 2003 and 2004. Since then, each new tragedy at the hospital had rekindled the hurt and anger.
"I'm sorry for the people that depended on that hospital, but I'm glad it's gone," said Gail Gordon, whose 43-year-old sister died in November 2002 after surgical and other errors. "My sister died an innocent death.… If they had kept it open, more innocent people would have died."
County officials have said they will seek out a private operator to take over King-Harbor and try to reopen it within 12 to 18 months. But previous attempts to find any takers failed, and success this time is by no means assured. If no private operator can be found, Chernof said, the county may attempt to reopen King-Harbor itself within the same time period.
The county will seek to voluntarily suspend its the hospital's license rather than have it revoked entirely, easing the way for a new operator to take over.
"The only real failure in my mind," Chernof said, "will be if we don't ultimately get to a place where we have a hospital in the community that meets national standards."
The fate of the hospital's 1,600 employees is unclear. Some will remain at the outpatient clinics; others could be reassigned to other county health facilities.
Even some of the hospital's longtime defenders say it is no longer viable in its present form.
Among them are Los Angeles Councilwoman Janice Hahn, whose father, Kenneth, pushed for the hospital's creation as a county supervisor. Pictures of him shaking the hand of the Rev. Martin Luther King Jr. adorn its walls.

"When someone from this community goes in with a sick baby or a knife wound or bronchitis, they have to be able to trust that doctors and nurses that treat them are giving them excellent care," the councilwoman said Friday.

Now, she said, the focus must be on creating a facility that "meets basic minimum standards for patient care."

The Medicare agency's letter to the hospital, hand-delivered this Friday morning, conveyed a deep sense of frustration that King-Harbor had squandered repeated opportunities to avoid this end. Fewer than five hospitals a year lose their federal funding.
In its final inspection last month, the hospital fell below minimum standards in eight of the 23 areas assessed by the agency.
"While some progress has been made, significant problems persist at MLK-Harbor Hospital," Herb Kuhn, the Medicare agency's acting deputy administrator, said in a statement. "Conditions at the facility have placed the health and safety of patients at great risk."
In fact, reviewers found a host of serious lapses throughout the hospital, some similar to those that county officials swore had been fixed. They included failure to properly clean bronchoscopes -- devices used to look into the lungs -- which put patients at serious risk of exposure to contagious diseases. In addition, the hospital staff also could not demonstrate its ability to respond to a pediatric emergency, failing to locate critical equipment or even properly calculate how much medication to give a critically ill child.
The federal decision underscores the failure of Los Angeles County government, which despite slashing services, firing hundreds of workers and paying tens of millions of dollars to consultants, could not assure ensure the basic safety of patients at King-Harbor.
Supervisor Gloria Molina acknowledged as much. "We keep getting assurances that the personnel there are trained and prepared and ready to deal with this inspection, and unfortunately we failed pretty miserably," she said.
The hospital has been buffeted by problems almost since it opened in 1972. But the current crisis began in earnest four years ago when a series of patient deaths was linked to serious lapses in care by nurses and other staff members.
In a five-part series published in December 2004, The Times detailed how the hospital had become one of the worst in the nation by a variety of measures, largely because county supervisors failed to take aggressive action for fear of being branded racist.
In August 2006, despite repeated warnings, King-Harbor failed what the federal government billed as a make-or-break inspection. Rather than pull its funding, however, federal officials accepted the county's plan to radically pare services, reducing the number of inpatient beds from about 250 to 48. It The hospital closed its physician-training programs and severed ties with its long-standing academic partner, Charles R. Drew University of Medicine and Science.
It became clear in May that King-Harbor had still not turned around. A 43-year-old woman died after writhing in pain on the floor of the emergency room lobby for 45 minutes. Hospital staffers looked on and did nothing to help; a janitor mopped up around her as she vomited blood. The incident attracted national attention, and, according to some supervisors, seemed to crystallize the hospital's woes.
Federal officials made it clear that if King-Harbor failed an inspection last month, it would be given no more chances.
Almost from the start, there were signs that the hospital would not pass.
On their second day at the hospital, inspectors declared that patients were in immediate jeopardy of harm or death after a psychiatric patient was left unattended and cut herself with a scalpel she found in the emergency room.
Some members of the county Board of Supervisors -- all of whom have been in office more than a decade -- said closure is the only option left.
"For too long, the status quo allowed mediocrity to be the norm," said Supervisor Mike Antonovich. "There is no excuse or reason that we had to waste tax dollars and continue to support a failed system."
Supervisor Zev Yaroslavsky said: "We were given more time than I would have given Los Angeles County if I was the regulator. But we couldn't move far enough, fast enough, and that was the ultimate verdict. I'm not surprised. I'm not sure anybody around here is surprised by the decision they made."
The closure was the right thing to do, said Rona Millage, whose mother died at King/Drew in July 2003 after nurses failed to notice that her heart had stopped -- even though she was connected to a cardiac monitor.
"If they were training their nurses and their staff, lives wouldn't have been taken," Millage said. "So many lives in the last four years.… There's no money in the world that can bring my mom back. I suffer with that every day."
charles.ornstein@latimes.com
tracy.weber@latimes.com
jack.leonard@latimes.com

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