Health Official Feels Pressure To Speed King/Drew Cleanup

By LAURENCE DARMIENTO

Staff Reporter

It’s not a position any public official wants to be in.

Embarrassed by repeated disclosures of bad care at Martin Luther King Jr./Drew Medical Center, Los Angeles County supervisors berated health services director Thomas Garthwaite at a public meeting, complaining that he did not appear to grasp the gravity of the situation and they were losing confidence in his ability to fix it.

The critical words, coming from three of the five supervisors at their Aug. 10 meeting, don’t bode well for Garthwaite’s job status.

“It always starts this way,” said Norman Roberts, a headhunter who brought in Garthwaite’s two immediate predecessors. “Once they get into public browbeating, that is the beginning of the death knell.”

The challenges for Garthwaite at the 223-bed Willowbrook hospital and its affiliated medical school are immense. Training programs have been shut down, and investigations have found poor surgical procedures that left a clamp in one patient and the liberal use of stun guns on psychiatric patients.

The problems have left Garthwaite skating on “thin ice” with supervisors whose patience is “exhausted,” according to one county official.

Two supervisors interviewed last week Yvonne Brathwaite Burke and Don Knabe insisted his job is not in immediate jeopardy. But Knabe acknowledged he would not have unending patience in waiting for Garthwaite to clean up the mess. “At the end of the day Garthwaite will be held responsible,” he said. “It certainly can’t continue forever.”

Latest problem

The Aug. 10 outbursts came as supervisors discussed a new affiliation agreement the county is negotiating with the Charles R. Drew University of Medicine and Science, which provides physicians and medical students for the hospital.

The supervisors complained that the agreement failed to provide enough measures to ensure that patients were getting good care and that the county was spending its money wisely. (Regulators and accreditation agencies have sanctioned the medical school and the hospital.) Supervisors also complained about the length of time it was taking to hire a new hospital administrator.

“I don’t think you are listening to us. I really do not, and the community has a right to be concerned,” Supervisor Gloria Molina told Garthwaite. Burke added: “Somebody has to get on the ball here.”

Supervisor Zev Yaroslavsky complained that after months the department has not “gotten its arms around this hospital situation.”

In an interview last week, Garthwaite acknowledged the frustration of county supervisors but defended his performance in dealing with the 32-year-old King medical center.

“There is a very long and entrenched history and culture at that organization that has developed over 20 years,” he said. “It cannot be changed in six months, one year or even two. It is a four, five, six-year commitment to change.”

Garthwaite said he and his staff have taken aggressive action to turn the hospital around and encourage change at the medical school, noting that personnel actions have been taken against 240 employees from terminations to demotions to reprimands.

Among those who have left are a dozen employees in top leadership roles, including the chief executive, chief nursing officer, chief medical officer and chief of surgery. A private consulting group also has been brought in to improve nursing care.

Burke acknowledged the ongoing problems have been a “source of embarrassment” for the board, but said she believes Garthwaite is trying his hardest, though there could be improvements.

“I wish this were a simple thing where you could fire someone at the top and these things could go away,” she said. “It’s going to take a long time.”‘

But Knabe said he doesn’t believe that Garthwaite has been forceful enough in dealing with bureaucracy at the hospital.

“I am extremely frustrated by what seems to be going on over there. I think you need a screamer and a shouter to be over there every day. You have to ride herd, whether it’s Garthwaite or somebody underneath him,” he said.

Supervisor Michael Antonovich, a Garthwaite critic, was in China last week and unavailable for comment. Supervisors Zev Yaroslavsky and Gloria Molina did not return calls.

Wrong fit?

When Garthwaite was hired two years ago, fixing up the mess at the hospital was not considered to be at the top of his agenda, even though it was the subject of critical reports long before he was appointed.

Instead, the county was faced with having to negotiate another agreement with federal officials to bring in hundreds of millions of dollars to keep the entire health system afloat.

Since the county health system has been receiving special federal aid since 1995, supervisors also knew that as part of the negotiation process, they would have to present a restructuring plan aimed at making the $3 billion operation more efficient and patient-friendly.

Garthwaite, a low-key doctor and former top Veterans Administration administrator was seen as the right person for the job, given his record of dealing with large bureaucracies and his Washington experience and contacts.

Among his top priorities has been “rationalizing” county health care, improving medical records and other big-picture goals. He was praised by supervisors for his efforts to gain $250 million in state and federal aid in a new agreement last year, while also developing a plan that cut clinics and trimmed other services with the least impact on patients.

But he now faces a smaller, but in many ways more difficult task: turning around a county hospital with deeply embedded problems that have gone untouched for years.

“He may not have been the right personality fit to begin with,” said one former top health department official. “In that job you have to scare somebody every once in the while. He does not radiate that.”

Garthwaite took exception with the idea that he has to yell or otherwise intimidate people, saying that is not his style and is not necessary, noting the top hospital officials who either left, were fired, resigned or retired under his pressure.

“Fear is not what I want. I want the right people in the right jobs, and I want them performing well,” he said. “(But) ask the people who no longer work for us if I can make the hard decisions.”

Even so, supervisors have a history of repeatedly changing health directors Mark Finucane, Garthwiate’s predecessor, lasted five years.

“Is he damaged goods? I don’t think so yet, but the next six months will be critical,” said one local public affairs consultant. “If there is not some major improvement, certainly the supervisors will be looking for some heads to roll. It’s the most thankless job anywhere.”