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Will Good Men and Women Prevail on August 16,2005 L.A.County Board of Superviors Meeting?

Physician Leadership and Integrity - Posted 04/26/2004 - Robert A. Beltran, MD, MBA

The principles of leadership and integrity addressed in Dr. Solyom's commentary (1) are being challenged at the King-Drew Medical Center (KDMC) in Los Angeles, California.(2) This academic medical center is part of the county hospital system run by the Los Angeles County Department of Health Services. L.A. County has one of the largest uninsured populations, numbering nearly 3 million, in the nation. The ethnic diversity reflects the demographic challenges that will change the face of medicine for the 21st century. Approximately 50% of the uninsured in the county are cared for by the county hospital system.

KDMC has had a 14-year history of operational and periodic quality-of-care issues. Most recently, 5 of 18 residency training programs are experiencing accrediting deficiencies. Of the 5 residencies with deficiencies, 2 have lost accreditation (surgery and radiology). On top of this, state and federal health agencies have identified quality-of-care issues surrounding the deaths of 5 patients and patient safety issues concerning another 11 patients.[3]

Physicians and the care they deliver at KDMC are being examined under a microscope to ensure quality of care, patient safety, and community confidence in the institution. The academic medical center is the only minority academic hospital west of the Mississippi and was established after the racial turmoil that occurred in 1965 in the black community of Los Angeles.

At issue are the "standard" measurement and evaluation tools being utilized to review the institution. The hospital serves primarily uninsured poor Latinos and Blacks as its target population. Physicians have raised the question whether a "one-size-fits-all" measurement standard will appropriately capture the unique circumstances of their patients vs utilizing specific quality and cultural/linguistic competency measures for underserved and vulnerable populations that will produce a clearer picture of the population that utilizes the hospital.

The "moral and ethical fortitude" Dr. Solyom requests in his commentary is being demonstrated by the physicians at KDMC in fighting to resuscitate the institution as well as public confidence and integrity of this minority academic medical center.

The minority community served by the hospital has some of the worst health status measures in the Los Angeles county region and in the nation. The current dismantling of the medical institution that serves this community brings to light the need for "radical transformation and emergency measures" called for in the conclusion of Dr. Solyom's commentary.

Two quotes come to mind when reading Dr. Solyom's commentary:

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

"The greatest form of injustice is the inequality in healthcare." -- Dr. Martin Luther King, Jr.

The sentinel question arises: are there any good men or women left in medicine to champion social justice, fairness, equity, and equality for all Americans?

1. Solyom AE. Leadership responsibilities and integrity of physicians in healthcare. Commentary. Medscape General Medicine. 2004;6(1). Available at: http://www.medscape.com/viewarticle/471135. Accessed April 9, 2004.
2. Calderon J, Beltran RA. The phoenix has risen but has failed to thrive: hope on the horizon for King-Drew Medical Center. J Natl Med Assoc. 2004;96:160-162.
3. Ornstein C, Hymon S. Repeated drug errors cited at King/Drew. Los Angeles Times. March 17, 2004.

Related Links
Clinical Articles
Leadership Responsibilities and Integrity of Physicians in Healthcare
Leadership Responsibilities in Healthcare

Robert A. Beltran, MD, MBA, President, Latino Med Policy Institute, Los Alamitos, California; email medicalquality@email.msn.com

Disclosure: Robert A. Beltran, MD, MBA, has no significant financial interests or relationships to disclose.

Medscape General Medicine. 2004;6(2):e29. ©2004 Medscape

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