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King Drew Medical Center: The Crisis, Challenge and Response

The following letters give insigth to the leadership and accountability issues at a hospital which serves a majority Latino Population.

Esteemed PSA Colleagues, Exiting President, Dr Shacks, Entering President Elect, Dr Dang, and members of the Medical Administration:

I was asked to define my plans in regards to the imminent July 1st date, beginning of the new fiscal year, and consequent change of PSA Officers. I wish to do so in this letter, which will hopefully be delivered to each of you by June 30th.

Our Medical Center has been through many tensions and crises, but nothing compares with the last few years of turmoil. The upcoming critical inspections will offer a final verdict on the current state of the institution, and we’ll finally discover whether we live or die.

The prognosis is fair, although not yet final. We have long waited for an opportunity to reclaim our honor, and to be acknowledged for the critical function we cover in this community. The next few weeks may indeed see this positive outcome, or the opposite. Tensions and conflicts seem to increase, in this atmosphere, and tempers flare.

The difficult interactions that we continue to experience have their root in issues of control, respect or lack thereof, and ignorance. Misguided assumptions are made, presumptions of guilt are the norm, professional behavior is forgotten … I am sad, and concerned. The spirit of our PSA has withered, and our departmental conflicts have prevented us from building a coherent response to the storm upon us, but we also seem to not have learned much from our history.

Many things have changed, over the past couple of years. The ongoing renovation and remodeling have certainly enriched and improved the environment, offering a substantially more pleasant experience for both our patients and the hospital personnel. Safety and quality of care have received long needed attention. We still believe firmly in the value of training new generations of physicians who will be exposed to the neediest of patients, and will hopefully embrace our legacy of dedication, enthusiasm, and awareness. We eventually trust them to contribute to the highly needed changes in health care delivery that our society will soon require. We are welcoming these young colleagues, this week, and we are glad to be offering them a more stable, satisfying experience than the recent difficult years have allowed, in the energy renewal brought by the restored training program accreditation.

All these changes are precious, and we are proud to be living them. What has not changed is the tense relationship between the administrative arm of the Los Angeles County/DHS and the medical staff of King Hospital. The need to remove a few bad apples has degenerated into a witch hunt, where you are guilty indefinitely, without due process, and yours is the onus of proof. Drastically foreign outsiders were placed in positions of leadership, a plan that has effectively destroyed the healthy tissue together with the ailing one in this organism. Outspoken faculty members, full professors in the UC system, whose record of dedication and creativity is legendary, and whose efforts are integral to our institution, are seen as enemies of progress. Their vision generated the most productive service areas of King, but they were exiled and their reputation is smeared. It is our loss, and a severe loss for the community. The worst part, however, is how the PSA has failed to express its indignation, and feared to speak up, each member fearing to expose oneself.
I was deeply honored when you chose me as President Elect of our Professional Staff Association. Your trust and your expectations were that I would represent you and speak for you, hear your demands, highlight your contributions to the King renaissance, organize our communal efforts and energize our association to take ownership of the institution. I have experienced, however, how the voice of PSA members and officers can be very easily silenced. My efforts in defense of my esteemed Division Chief, Dr Xylina Bean, were belittled at DHS level as “expected emotional responses”, and my letter was blocked from circulation. No other voices have spoken up. The matter is conveniently mired in bureaucratic procedural quicksands, and unlikely to be solved any time soon. In all of this, PSA is impotent. We are taken out of the loop, the authority of the PSA is moot, altogether inconsequential, and void of weight.

As you may know, I am on personal leave, and trying to sort through the stress and distress of the past months and years. I have considered the date of July 1 as a watershed, and weighed in my mind the commitment and the obligation, with the disillusion and the disappointments. The CMS inspection is not here, yet, albeit very close, but this fact adds to the uncertainty, its outcome may and may not return life to a normal flow. None of us truly knows, and I do hope to be proven wrong.

What bothers me the most is that there seems to be no hope in the PSA, since there is no voice, no strength, and our role has become meaningless. This change has not happened in one day, or one year, but the effects have worsened, the impression of complete powerlessness grows. The inability to protect our members, the irrelevance of our role is what ultimately brings about my conclusion. I regret to have to renounce this honor, but I cannot be your PSA president for July 1, 2006. And I need to state very firmly that the essence of my decision stems from the events concerning Dr Bean’s ousting. My resignation is in protest for her removal, and for the silence that has been imposed on it.
I understand that my decision leaves a void that will have to be filled. There are other strong representatives that may better fit the current times and the urgent needs. I pray that the King Drew Professional Staff Association may find its way toward a more solid standing, and ask you to continue to work for King Drew and its community.
Respectfully submitted,

Roberta Bruni, MD
Los Angeles, June 29, 2006

Roberta and Interested KDMC physicians,

First and foremost, thank you for sharing your perspectives, disappointments and encouragements for a brighter more effective future for the KDMC PSA. As many of you may know, I am not a member of the medical staff at KDMC, but for 22 years was a clinical community general surgeon in the greater South Los Angeles area.

I had the good fortune to write several editorial commentaries on the crisis at KDMC which were published in widely read professional publications. Strangely , the first commentary was co- written with a Drew medical school faculty member called:

"The Phoenix Has Risen But Has Failed To Thrive: Hope On The Horizon For King-Drew Medical Center"

This article appears in the February issue of Journal Of The National Medical Association February 25, 2004 quote-" "If you want something you've never had, you must be willing to do something you've never done." It's time to transform the King-Drew Medical Center so that it will thrive to train future generations of physicians who are dedicated to improving the health and well-being of culturally diverse and underserved communities globally.

Roberta has challenged those of you who have remained at KDMC to create the necessary leadership to transform and sustain KDMC.

The collective leadership of the KDMC PSA apparently has chosen to be silent publicly with the consequence of being impotent and weak.

Apparently things will only get worse following this course of action. It's never too late to take an ownership position and become agents of change by implementing effective leadership.

This is the "golden opportunity or sudden death threat" which faces the KDMC PSA. This was the title to the second commentary published in November 2005 in the JNMA. I spoke about the nature and timing of this opportunity being dependent on coordinating and integrating action in an effective and efficient manner.

Edmund Burke stated," All that is necessary for the triumph of evil is for good men and women to choose to do nothing."

The eyes of our nation's diverse ethnic communities will be upon KDMC as it goes through the CMS and JCAHO surveys. Failure is not an option. Your success will raise the tides of support and confidence for future minority academic institutions and ethnic physicians.

Use this opportunity to create a solid sustainable foundation that will result in relevance and power to the KDMC PSA and the community it serves.

Best wishes and warmest regards,

Robert A. Beltran, M.D., M.B.A., FACMQ, CHCQM
Physician Executive
Health Care Management/Latino Health Affairs

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