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Extensions of Remarks October 11, 1989 EXTENSIONS OF REMARKS 24133 EXTENSIONS OF REMARKS KING-DREW MEDICAL CENTER The ACS-COT surveyed this program in have "not only struggled valiantly", but AND THE LOS ANGELES TIMES 1983, preceding our designation as a Level I who have sacrificed greatly, worked coura­ trauma center, and again some years later. geously and performed above and beyond I am confident that the reviewers will find the call of duty. Their efforts have been HON. MERVYN M. DYMALL Y that the trauma quality assurance program thwarted by a severe shortage of critical OF CALIFORNIA in this institution, which has been carried beds, staff and funding; over 100 nurse va­ IN THE HOUSE OF REPRESENTATIVES out on a daily basis for the past six years, cancies; equipment that has not been re­ placed since the hospital opened; low sala­ Wednesday, October 11, 1989 demonstrates a commitment that is unpar­ alleled, not only in the State of California, ries and difficulty recruiting; difficulty ob­ Mr. DYMALL Y. Mr. Speaker, recently the but in the United States. Perhaps then, and taining even basic supplies when it depends Los Angeles Times ran a series of articles only then, can this great injustice, which upon action outside the institution; and un­ about the King-Drew Medical Center-Los An­ has been perpetrated on the entire medical relenting stress and burn-out. This occurs geles County Martin Luther King, Jr. General center and the people of Watts/Willow­ all while treating not only an overwhelming Hospital and the Charles A. Drew University of brook, be rectified. number of patients, but a concentration of Although there were four Departments the "sickest of the sick and dying." Medicine and Science-located in the 31st that were responsible for the eight cases dis­ This concern was echoed in the first edito­ Congressional District, California. cussed in the Times' article, these depart­ rial which stated "There is a risk, in the I am hereby submitting a rebuttal, from Dr. ments were responsible for 185,993 patient effort to accelerate reform, that the distin­ Arthur Flemming, F.A.C.S., professor and visits and/or admissions during the time guished commitment of many of the staff chairman, Department of Surgery for Mem­ frame of the review. The absence of newspa­ will be forgotten." The editor<s> acknowl­ bers' review: per reporting of the full and accurate se­ edged that "the hospital's doctors, nurses CHARLES R. DREW UNIVERSITY OF quences and conditions of these cases will be and technicians are forced to work in the MEDICINE AND SciENCE, KING­ amplified. most trying circumstances, many at sub­ DREW MEDICAL CENTER, MARTIN We are enclosing the signatures of more standard wages to maintain this vital link in LuTHER KING, JR. GENERAL Hos­ than 1,300 employees and supporters to em­ the county public health network." PITAL, COUNTY OF LOS ANGELES, phasize the need for "fair and just" treat­ Given these many obvious reasons for pa­ October 4, 1989. ment by the Times, the Board of Supervi­ tient care not being optimal, the Times arti­ Mr. ToM JOHNSON, sors, and the Department of Health Serv­ cles used eight carefully selected cases, pre­ Publisher and Chainnan, Los Angeles ices. sented in a theatrical manner, "during a Times, Times Mirror Square, Los Ange­ We are requesting that you publish the recent two and one-half year period" to at­ les, CA entire enclosure. As of September 28, 1989, tempt to demonstrate that not only was DEAR MR. JOHNSON: On behalf of the fac­ Ms. Spiegel had published nine articles on there inadequate supervision, but also a lack ulty and staff at the King-Drew Medical the King-Drew Medical Center. We would of commitment and competence. There was Center, I am expressing concern over the like to have an alternate view printed. an attempt to extrapolate to the entire in­ series of articles by Ms. Claire Spiegel, Sincerely, stitution the lack of commitment on the Times staff writer, published in the Los An­ ARTHUR W. FLEMING, M.D., F.A.C.S., part of a few staff who reportedly geles Times over a period of 26 days in Sep­ Professor and Chairman, Department ". slept through their shift. ." tember 1989. of Surgery. Of the eight cases discussed by the Times, Many inner city public or county hospitals Enclosure. there were two cases each from the Depart­ are frequently located in high crime, drug, RESPONSE TO THE LOS ANGELES TIMES SERIES ments of Emergency Medicine, Neurosci­ and gang activity areas. Common findings in OF ARTICLES ON THE LOS ANGELES COUNTY ences, OB/GYN and Surgery. During the most of these hospitals are underfunding, MARTIN LUTHER KING, JR. GENERAL HOSPI· two and one-half years of the Times' study, an overwhelming number of patients, and a TAL AND THE CHARLES R. DREW UNIVERSITY there were 185,993 patients treated by these concentration of the "sickest of the sick and OF MEDICINE AND SCIENCE (KING-DREW four services. Thus, these 8 cases represent dying." The Health Care Financing Admin­ MEDICAL CENTER) < 0.004% of the total. istration <HCFA> report is replete with such While we acknowledge difficulties in re­ examples. <Submitted by Arthur W. Fleming, M.D., cruitment and shortages of staff, the trans­ In many institutions, the above factors F.A.C.S., Professor and Chairman, Depart­ lation by the Times that "there is a lack of are accepted as logical explanations for the ment of Surgery) highly skilled medical staff" adds insult to existence of the problems. Despite the fact OVERVIEW injury. If two recent graduates are excluded, that we are in a combat hospital during "The obscure we eventually see. The com­ 90% <55 of 61) of the surgical department peace time, somehow the level of compe­ pletely obvious it seems, takes longer."­ faculty, are board certified. The Depart­ tence, commitment, and management Edward R. Murrow. ment of Surgery includes cardiothoracic become the central issues. Between September 3 and 28, 1989 the surgery, general surgery, ophthalmology, We will validate the commitment of many Times published nine articles by Claire oral and maxillofacial surgery, orthopedic of the faculty. However, it is not my aim to Spiegel, Times staff writer, pointing out surgery, plastic and reconstructive surgery, suggest that patient care is optimal, but to multiple deficiences within the health care and urology. present the problems and solutions with system at the Martin Luther King, Jr.-Drew The editorial in the Times went well compassion and sensitivity for the commu­ Medical School <King-Drew Medical Center beyond our expectations in stating that, nity we serve. These aspects were not ad­ or KDMC>. There were also two editorials "The revelations have a meaning beyond dressed in the articles by the Times. and one article in the Metro section of the the confines of King" <KDMC). Most impor­ The editoral statement that ". this Times wedged in between the articles by Ms. tantly, it stated that "They <the revela­ problem is compounded by egregious admin­ Spiegel. tions> measure the conscious, deliberate, istrative failures" is expressed without bene­ The articles have had a profound effect structural underfunding of public medicine fit of knowing the magnitude of the re­ on most of the employees at the KDMC as in the United States. The nation remains source deficits, how these deficits impact on well as on members from the surrounding alone among industrialized democracies the entire medical center complex, or that community and, most regrettably, on the with a system of health care that excludes some of the charges, especially on patient patients themselves. The articles were deni­ from the basic protection substantial num­ care issues, are not factual. grating, humiliating and demoralizing. The bers of people, an estimated 37 million We wholeheartedly endorse the concept greatest impact, however, is on the individ­ Americans, including more than 5 million of a very extensive and thorough in-state, uals who must entrust their lives to us. Californians." out-of-state and national review. We will re­ There are many physicians, nurses, physi­ We agree that "The state and country are quest the American College of Surgeons cian assistants, medical students, techni­ not providing enough money for the hospi­ Committee on Trauma <ACS-COT> review cians, paraprofessionals, and other support tal. ..." However, whether "this problem the King-Drew Medical Center trauma care. staff at the King-Drew Medical Center who has been compounded by egregious adminis- e This "bullet" symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor. 24134 EXTENSIONS OF REMARKS October 11, 1989 trative failures" should be determined after in the HCFA survey to medicare deaths at treated at King over a recent 2112-year thorough evaluation of the impact of the the KDMC. However, there were only four period." lact of adequate resources on all aspects of trauma patients-thus, there was a 50% Fact: Of the eight cases discussed by the patient care and administration are com­ mortality rate. The fact that both patients Times, two were from the Department of pleted. who died had lethal injuries does not enter Surgery, with both having gunshot wounds The editor<s> have very appropriately out­ into the equation. Although the death rate <GSW>; two were from the Department of lined what is essential for permanent resolu­ is calculated on the percentage of the total Neurosciences and consisted of one trauma tions: replacement for some of the outdated hospital admissions, a low percentage of <GSW> and one non-trauma case; two were equipment, construction of a new trauma medicare patients and a small number sur­ from the Department of OB/Gyn and also center, closer supervision from the county veyed could bias the statistics.
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