NPR Tavis Smiley Transcript

National Public Radio (NPR)

SHOW: Tavis Smiley (9:00 AM ET) - NPR

HEADLINE: Dr. David Satcher and Representative Maxine Waters discuss problems at Martin Luther King Jr. Medical Center in Los Angeles

ANCHORS: TAVIS SMILEY

BODY:
TAVIS SMILEY, host:

From NPR in Los Angeles, I'm Tavis Smiley.

One of the country's few hospitals focused almost entirely on training minority doctors and treating the poor is in big trouble, and it raises questions about future access to medical care in urban neighborhoods all across this country. According to both internal and external investigations, several deaths have resulted from poor treatment and flat-out negligence by some staff of the Martin Luther King Jr. Medical Center in the Watts area of Los Angeles. Doctor training allegedly has been bad enough to threaten the teaching credentials of King's partner, Drew University, directly across the street.

Dr. David Satcher, former surgeon general of these United States, was brought in not long ago to investigate and offer solutions. He's now the head of another institution geared toward access health care for all, the Morehouse School of Medicine's National Center for Primary Care. And Dr. Satcher joins us now via telephone from Atlanta.

Doctor, as always, nice to talk to you.

Dr. DAVID SATCHER (Morehouse School of Medicine's National Center for Primary Care): Well, thank you, Tavis. Great to be with you.

SMILEY: You were once America's main spokesperson on public health, as I said a moment ago. In a broad sense, are we anywhere near providing equal access to health care for everyone in this country?

Dr. SATCHER: We are nowhere near providing equal access to health care. In fact, I think we've taken some steps backwards. There are almost 44 million people in America who are uninsured and certainly that many who are underinsured. Whenever there is a need, or perceived need, to cut the budget, health care is one of the first things that suffers.

SMILEY: Why do you think that is?

Dr. SATCHER: Well, I just don't think we have a real commitment to assuring access to quality health care for the poor in this country. We need to educate, motivate and mobilize people toward a system of universal access to care, because as long as we don't have that system, then public hospitals suffer disproportionately and their struggle to provide quality care to the people that they serve is a very difficult struggle and it certainly interferes with the training of physicians in those hospitals.

SMILEY: One of our regular commentators, Connie Rice, addressed this very issue of what was happening at King hospital here on this program just weeks ago. You were the one they brought in to try to deal with this dilemma, for lack of a better word. You were charged with investigating King/Drew here in LA. A federal report now says at least five people have died in the last year from inadequate care there and young doctors were leaving with inadequate training. Is there any way out of this nightmare situation, and how do we fix this type of problem at this hospital and prevent it from happening in other inner-city institutions that just don't have the resources?

Dr. SATCHER: Well, Tavis, first let me say why I think it's critical that we fix it. When you really look at what King/Drew has done over the last 30 years or so, it's remarkable. The mission of King/Drew to really educate, train people to serve in underserved communities, is a mission that has been carried out, to a great extent. They have a larger proportion of their graduates going into underserved communities than any other medical school in California and more than most medical schools in this country. They've also educated a larger proportion of underrepresented minority physicians. In addition to that, they've reached out into the community and they've provided Head Start programs and academy programs to gear students toward careers in the health sciences. So we've said first and foremost that it needs to survive. But there also needs to be a culture of accountability at King/Drew, and I'm talking about both the hospital and the school.

SMILEY: Give me a brief overview, Dr. Satcher, of the kinds of obstacles that black medical training facilities face each day in trying to train and ultimately provide care for the least among us, the uninsured and the underinsured.

Dr. SATCHER: Well, areas that are high-poverty areas, and the area around King/Drew is one of the highest areas of poverty in the country--72 percent of the people live in that area make less than 200 percent of the federal poverty level-those areas are inadequately supported, but they also have patients with the most difficult health problems. We know in this country that the poor suffers most from all kinds of health problems and disparities. So if you have a training hospital in that community, you're going to have trouble attracting faculty, you're certainly going to have trouble attracting research faculty who can compete for NIH funding, which you need in order to run quality programs. So it's a struggle of poverty that these institutions are caught up in. So on the one hand, you want people to train there, because when they train there, they're more likely to practice in those areas. On the other hand, it's very difficult to carry out those training programs.

SMILEY: What lessons, at this stage, can other institutions that serve the underserved in this country in inner cities learn from what's happened here at King/Drew at the moment?

Dr. SATCHER: Well, I think a few things. Number one, I think having a strong commitment from the board level on down to accountability and excellence. I think it's critical, and I think in this case, as we said in our report, there was a theory of accountability at the level of the board and at the level of the president's office and I think we made that very clear in our recommendation. If you're caught up in a situation like this, as a minimum you need very strong leadership, leadership that can inspire people at the institution and in the community and leadership that insists upon accountability at all levels.

Secondly, I think we have to be more creative, all of us who are committed to these things, and I talked about in the report the need to develop a center of excellence on multicultural health. King/Drew would be an ideal place for such a center of excellence. It has a population that's changed from predominantly black to predominantly Hispanic. It is predominantly poor. But it needs to be funded to do what it does best, and so I challenge the country, NIH and the Department of Health and Human Services generally, support the King/Drew health center to become a center of excellence for multicultural health in this country, and I appreciate the support that the California Endowment, through Bob Ross and others, have offered.

SMILEY: What do you say to elected officials, specifically to politicians, because I get the sense being here in LA that there's so many politics being played with this issue I'm not sure that the politicians even know how to fix what is health-related, but it just seems to me that this problem has politics all the way through it and that people's lives are being lost, really, over a lot of politics being played.

Dr. SATCHER: Look, I would say two things. Number one, this institution needs to survive and it needs to thrive. It would be a terrible loss, not only to Los Angeles County, but to California and the nation if we lost this institution, again, because of its unique commitment to the poor and the underserved.

The second thing is we need to find a way to better support these institutions and to reward them for what they do best. If you can give UCLA research money to do what they do best, then we ought to find a way to support institutions like King/Drew to become centers of excellence for what they do best. And so these institutions are often in distress because they're not supported for what they do best, and what they do best is what society needs most.

SMILEY: Dr. David Thatcher is the former US surgeon general and now head of the National Center for Primary Care at the Morehouse School of Medicine in Atlanta.

As always, Dr. Satcher, thank you for your insight, sir.

Dr. SATCHER: OK, Tavis. Great to be with you.

SMILEY: Another outspoken voice on the crisis facing the Martin Luther King Jr. Medical Center here in Los Angeles is US Congresswoman Maxine Waters, who represents the South Central area of the city that includes the hospital. I recently spoke with Congresswoman Waters on this issue and I began our conversation by asking her to describe some of the problems currently facing the King center and the associated Drew University of Medicine.

Representative MAXINE WATERS (Democrat, California): We know that there have been some problems, particularly in the nursing section, of Martin Luther King hospital. There's a shortage of nursing and the training has not been what it should be, and this administration, the Department of Health Services, have an opportunity to correct that. It never should have happened this way to begin with. They should have been on top of that, and we cannot close the hospital or jeopardize the hospital because this was not done. So what we're trying to do is say to the Department of Health Services, 'Stop waiting for a crisis every year. Get on top of what is the mission for Martin Luther King hospital? Don't come in every year and cut some service. Make sure that you're on top of the nursing shortages and the training that needs to be done,' and that's where the problem lies, mostly in the nursing care.

SMILEY: Dr. Satcher, with whom we just spoke, says the administration or the facility needs far more oversight. You've been protesting threats of a shutdown by the county, threats LA County says are unfounded. Have you focused your loudest protests on the right people at the right place?

Rep. WATERS: Well, we think so. As a matter of fact, they are chipping away at this hospital, taking away unit by unit, service by service, and they think that leads to the eventual closing. So it created a lot of attention. They passed a resolution declaring that they're not going to close it, and now we're going to stay on top of them to make sure they don't shut down the neonatal intensive care unit, that this just doesn't become like a gunshot wound trauma hospital. We want all of the services that were intended for that community there in that hospital.

SMILEY: We talk about King/Drew, but as you well know these problems, these difficulties that face King/Drew are facing other urban hospitals around the country. Your thoughts on that?

Rep. WATERS: This country has to make health care a number-one priority. You know, these county hospitals are suffering and I'm worried about Los Angeles because Tenet is talking about closing 19 hospitals or selling them off, so they need federal support, it needs to have high priority support, but you know, that's why we are working so hard trying to beat Bush back on the way that he's spending this money like a mad sailor on everything from Afghanistan to Iraq, and we're neglecting the needs of our society right here in America, particularly with health care and education.

SMILEY: In the two minutes I have left, let me cover two more things right quick. King/Drew was created to serve a primarily African-American community and it was run primarily by black folk. With a majority Latino population now in that area, increasingly, of course, in your congressional district, do you think the facility has suffered because black folk were too slow to acknowledge that shift?

Rep. WATERS: No, I don't think so. I think if there are any problems, and there are, at Martin Luther King, it's because LA County Health Services, who have the responsibility for the oversight, the management, for keeping the supervisors informed, did not do their job. If they needed to strengthen the administration at King hospital, do it. We don't support incompetence, we don't support negligence. What we support is good health-care services, and LA County Health Services, do your job. We know that Latinos represent about 60 percent of the population in this ...(unintelligible) African-Americans about 36 percent now, and we know that that university certainly reflects that diversity in the patient load, and when I look at the interns and the residents, it's certainly reflected there. It's really not an issue. Everybody understands what it is and who it must serve.

SMILEY: We'll let you go with a two-part exit question here. How is this issue, specifically with regard to King/Drew, going to be resolved, and would you feel comfortable being treated there?

Rep. WATERS: Oh, yes. We're going to encourage not only the community that it was intended to serve to come. We have young women who have no prenatal care. They show up on the steps at Martin Luther King when they're about to deliver. We're going to try and get them coming in. I've got some women who are organizing, we're going out into the public housing projects and we're going to supply baby layettes to women who are, you know, delivering then and encourage them to get the prenatal care. We have all that community with no preventive health care going on, no physicals that are going on every year. LA County Health Services never built into the budget outreach for the very people it was supposed to receive, and you're absolutely right. I would feel very comfortable. I know the doctors there and we're going to bring the doctors out into the community, invite the community to come and meet them, see them and the other personnel and strengthen the relationship and get the community more involved with the county health services and talking about how we address these problems in the community.

SMILEY: Maxine Waters is the Democratic congresswoman from South Central Los Angeles, the former chair of the Congressional Black Caucus and now serves as co-chair of the House Democratic Steering Committee.

As always, Congresswoman, an honor to talk to you.

Rep. WATERS: OK. Thank you very much.

SMILEY: Take care now.

Rep. WATERS: And thank you for giving us exposure.

SMILEY: It's our pleasure.

It's 17 minutes before the hour.