Stepping Out Of The Shadow Of 'Killer King' : Code Switch For decades, residents of Compton and Watts in South Los Angeles had to rely on one particularly troubled hospital for their medical care. A new state-of-the-art hospital replaced it, but faced many of the same challenges: too few beds, too many patients who need serious help, not enough money. Then came the coronavirus.
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Stepping Out Of The Shadow Of 'Killer King'

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Stepping Out Of The Shadow Of 'Killer King'

Stepping Out Of The Shadow Of 'Killer King'

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GENE DEMBY, HOST:

I'm Gene Demby.

SHEREEN MARISOL MERAJI, HOST:

I'm Shereen Marisol Meraji. And this is CODE SWITCH.

DEMBY: From NPR.

(SOUNDBITE OF ARCHIVED RECORDING)

ERIC GARCETTI: Today there were 98 deaths in the city of Los Angeles - 218 across our county. Yesterday, we had 259 deaths. That's one more than all the homicides in 2019 in LA city combined - in a single day, equal to a year of homicides.

DEMBY: Los Angeles Mayor Eric Garcetti in an address on January 7, 2021, talking about deaths from COVID.

MERAJI: And he went over those horrific numbers a few minutes into his speech because he spent the first part talking about the mob violence at the Capitol that went down just the day before.

DEMBY: Because over the last month, you know, much of our collective attention has been focused on right-wing mob violence and the impeachment and the beginning of a new presidential administration.

MERAJI: All the while, COVID-19 has been devastating communities across the country. Remember - it took 12 weeks for the number of COVID deaths in the U.S. to go from 200,000 to 300,000 people. But it only took about five weeks for the death toll to jump from 300,000 to 400,000 people. And things here in Los Angeles have been absolutely horrible.

(SOUNDBITE OF ARCHIVED RECORDING)

GARCETTI: We are not - nor will we ever - become accustomed to these numbers as normal, nor will I ever accept them as something we should just live with because every single one of those means everything to somebody out there today.

(SOUNDBITE OF MUSIC)

DEMBY: A few days after Mayor Garcetti shared those grim statistics, NPR's Leila Fadel visited a community hospital in LA, not far from where you are, Shereen.

MERAJI: That's true.

DEMBY: And Leila is back on the show to share what she found with us.

What's good, Leila?

LEILA FADEL, BYLINE: Hey, you two. How are you?

MERAJI: Well...

(LAUGHTER)

MERAJI: I wish we were talking about something a little more uplifting.

FADEL: I know.

MERAJI: But we're not because this is life.

FADEL: Yep.

MERAJI: (Laughter) So you spent a day at Martin Luther King Jr. Community Hospital with doctors and nurses who were dealing with COVID patients in critical condition. First off, why MLK?

FADEL: Well, they opened their doors to journalists to witness what COVID-19 has laid bare, the racial and economic disparities in health care. They're dealing with this crisis right now, and that's overwhelming, but they also wanted to show what they've been dealing with since they opened, serving one of the most economically depressed areas in LA County. MLK Community Hospital is in South Los Angeles, between Compton and Watts.

DEMBY: And I'm assuming - you know what I mean? - because it's called MLK Hospital that it's in a Black community. Most of the patients there are Black?

MERAJI: And you would be right most of the time.

(LAUGHTER)

MERAJI: But actually, it's Latinx, too, because both Compton and Watts are majority non-Black Latino now.

FADEL: That's right.

(CROSSTALK)

FADEL: And my story starts in one of the hospital's hallways, where a woman who only speaks Spanish, who's lying on a bed, confused, without her family, and nurses are doing their best to calm her. Patients like her are waiting in beds up and down the hall for treatment. There are beds in the former gift shop, gurneys in the hospital's meditation room. There are five tents outside where patients are being treated because there's no room anywhere.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

RYAN MCGARRY: So we're living through a surge on a surge on a surge.

FADEL: That's Dr. Ryan McGarry. He's watching entire families come in with severe symptoms of COVID-19.

MCGARRY: And sometimes one leaves and one doesn't, you know? And that's brutal.

FADEL: He compares this moment to battlefield medicine.

MCGARRY: We're surrounded here by multiple tents and tubes and lines and, you know, effectively temporary structures to handle, you know, overflow on overflow.

FADEL: This is a crisis. But this nonprofit safety-net hospital has always served more than it was built to since the day the gleaming facility opened in 2015 to replace its predecessor, shut down in 2007 over deadly conditions.

ELAINE BATCHLOR: We've been seeing, you know, a bit of a public health crisis in this community for the past five years.

FADEL: That's Dr. Elaine Batchlor, the CEO, in her office upstairs. The public health crisis? An epidemic of chronic illnesses - heart disease, pulmonary disease, kidney disease, diabetes at much higher rates, as well as higher mortality rates. Here, she's working to get through this crisis, but also using it to highlight the need to bring the same quality of care to this underserved, largely Black and Latino community that, she says, more affluent communities get.

BATCHLOR: This is where the essential workers live. These are the people that are stocking the grocery stores, driving our buses, cleaning up after the rest of us. And they are continuing to be exposed to COVID on the job.

FADEL: Add the dense housing where multigenerations of families live together, the poverty, the secondary health conditions, plus COVID, and it's an explosion of people getting sicker and dying more often.

BATCHLOR: Our small hospital now has more COVID patients than hospitals that are three to four times larger.

FADEL: From this office, she wrote to the governor on Christmas Eve asking for help. The state sent three National Guard medical strike teams, travel nurses, respiratory therapist. She also made a plea for fundamental change.

BATCHLOR: We have a separate and unequal system of funding, and we see the results here.

FADEL: COVID preyed on the inequities. The majority of patients that come into this hospital are on public health insurance. That pays a supplemental amount for inpatient care and makes hospitals sustainable, but that's only if a patient is so sick they have to be admitted. Meanwhile, public health insurance pays a fraction of what private insurance does for outpatient care, and that includes the emergency room that's triaging below her office.

BATCHLOR: They're in our emergency department a lot because they don't have adequate access to care in the community, and we are paying for it.

FADEL: They show up because there's a shortage of 1,200 doctors in South LA. Primary care doctors, specialists, don't set up where they can't make money.

BATCHLOR: You know, we've created a tiered financing system for health care with commercial at the top and Medicaid and uninsured at the bottom. And we need to change that, you know, because that's where many of our Black and brown communities are.

FADEL: The most common procedures at her hospital are completely preventable diabetic amputations and wounds. And the irony is...

BATCHLOR: We're getting paid adequately to amputate someone's leg, but we're not getting paid adequately to prevent that leg from being amputated.

FADEL: So this small hospital leans heavily on philanthropy to bridge the gap and show what's possible. It's why it can pay nurses and doctors competitive salaries and bring in cutting edge technology. But Batchlor says it's not sustainable without changes to the way health care is funded. On the fifth floor, the temporary ICU is inundated.

After New Year's, the staff relocated it and converted half this floor to treat more patients. Every room is doubled up. All but four of the patients on this floor are on ventilators, many on dialysis, and most came in with secondary conditions that make COVID a much more severe disease. Bigger hospitals threw money at travel nurses. This community hospital turned to the state.

MARIA ARECHIGA: We were hit really hard, so tough is, like, an understatement. It's been - it's been horrible.

FADEL: That's the ICU charge nurse Maria Arechiga. She grew up in Compton.

ARECHIGA: I know the community. So potentially, you know, this could be any of my family.

FADEL: On top of supervising nursing staff, tending to patients, she finds herself translating for doctors because so many of the sick are Latino and Spanish speakers.

ARECHIGA: I have to sit there - or one of the nurses that speak English and Spanish - with a straight face and tell them, your family member is going to die.

(SOUNDBITE OF ZIPPER ZIPPING)

FADEL: Plastic tarps with zippers hang in the doorways to convert regular hospital rooms into makeshift negative pressure rooms to keep the airborne virus particles out of the hallways.

ARECHIGA: I feel like this time around, people are coming sicker, and they unfortunately die quicker.

FADEL: As if on cue, Arechiga has to run off. An alarm is sounding - a patient crashing, their organs failing.

ARECHIGA: Give me another crash cart.

UNIDENTIFIED PERSON #2: I'm getting - I'm trying to get bunnied (ph) in here.

FADEL: She hands supplies through the unzipped tarp to doctors and nurses frantically trying to resuscitate a patient in the room. They're in bunny suits, masks and face shields. Then the patient in the neighboring bed goes into cardiac arrest. They call a code blue, a medical emergency.

UNIDENTIFIED PERSON #3: Code blue but not the only...

FADEL: Two people arrive with more protective gear, and more nurses and doctors suit up and go in to help get a pulse back.

UNIDENTIFIED PERSON #4: Let's do a pulse check.

UNIDENTIFIED PERSON #5: A has a pulse.

UNIDENTIFIED PERSON #4: A has a pulse?

FADEL: There is practiced calm in the urgency. The staff work in tandem. And then, Dr. Jason Prasso exits, walks away on the phone and comes back.

JASON PRASSO: One patient, unfortunately, did not make it. And I think, realistically speaking, the second patient, while we did get her back, is probably not going to make it either. And so I just want the families to have an opportunity to, you know, spend some time with them.

FADEL: Behind him, Maria Arechiga, with the help of other nurses, rolls the bed with the man's body out of the room and into another for privacy when the family arrives. Despite all they've learned, Prasso says the virus has proven difficult to manage.

PRASSO: There isn't a whole lot that I can offer besides supportive care as an ICU doctor in trying to prevent things from getting worse. And all too often, that isn't enough. It hurts as a doctor to say that. But a lot of times, there's not a lot I can do for patients who have COVID. You know...

UNIDENTIFIED PERSON #3: May I have your attention, please? Code blue, five north, room 501B.

FADEL: Prasso rushes off - another cardiac arrest. By the end of this shift, five people are dead, four Latino, one African American - a bad day, a familiar day.

(SOUNDBITE OF MUSIC)

MERAJI: Shereen.

DEMBY: Gene.

FADEL: Leila.

MERAJI: CODE SWITCH.

So one of my friends who grew up here in Los Angeles, born and raised, was asking me what this week's podcast was about, and I mentioned that we were going to be talking about how hard COVID was hitting MLK Community Hospital. And without skipping a beat, he said, oh, you mean Killer King?

DEMBY: Oh, you mean Killer King - wow. But like, every city of sufficient size has a hood, and every hood has a hospital. So I guess that's Killer King.

MERAJI: And you mentioned this in your story, Leila, but it's worth a reminder that this hospital, MLK Community Hospital, is a state-of-the-art replacement of a hospital that was shut down more than a decade ago, nicknamed, as we said, Killer King because of mismanagement, people being given the wrong medication, all kinds of death. And I can't help but wonder if, in light of this pandemic, in light of all of this death, this new hospital is having a hard time shaking that history and that nickname.

FADEL: Yeah. I mean, that nickname is reference to the county hospital King/Drew. And the shadow of that building that used to house the hospital literally looms over the triage tents outside the Martin Luther King Jr. Community Hospital.

GWENDOLYN DRISCOLL: This is the former King/Drew. They are rehabilitating the whole building, which sat that derelict for years.

FADEL: That's Gwendolyn Driscoll, the communications director. And she was showing me the way the hospital has been overwhelmed in the pandemic. And when this community hospital first opened, there was definitely a conflation. Now, remember; King/Drew was built in the '70s. And it came out of demands during an uprising in Watts for racial justice, and that included access to health care. But the county hospital ended up being a death trap. And today, while that's not the case in this nonprofit private hospital - quite the opposite - it's dealing with the same systemic issues of disinvestment in communities like this one. This is an emergency department that was built to serve maybe 40,000 people a year. In 2019, before the pandemic hit, it served about 110,000 people.

MERAJI: Wow.

FADEL: Yeah, a lot. And Dr. Elaine Batchlor says it has fewer hospital beds per 100,000 people in this community than anywhere else in the county.

DEMBY: Damn.

FADEL: And that lack of access - you two talk about this all the time on the podcast - little access to fresh and healthy food, transportation, it all comes back to the same fundamental disinvestment and historic racial inequities that plague communities like this. But to get back to your question about whether they're still haunted by the Killer King reputation, even in the wake of COVID, with more people being admitted to the hospital in this community than other parts of Los Angeles, with the deaths, everyone I talked to at MLK Community Hospital told me their efforts to rebrand have been successful.

MERAJI: So no more Killer King?

FADEL: No more Killer King.

DEMBY: But, you know, still a lot of the same Killer King foundational stuff, right? Housing segregation and everything.

FADEL: Yeah.

DEMBY: But, Leila, one thing that jumped out to us was something that Dr. Elaine Batchlor, who's the CEO of the hospital - something that she said to you.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

BATCHLOR: We're getting paid adequately to amputate someone's leg, but we're not getting paid adequately to prevent that leg from being amputated.

DEMBY: Can you just walk us through why it is more cost-effective to cut off somebody's leg than it would be to provide the care that would keep them from being in the position where they would have to have their leg cut off to begin with, you know?

MERAJI: Yes, please. Tell us.

FADEL: Yeah. I mean, it's not like they want to be cutting off people's legs at the community hospital. But one pays, and the other doesn't. So what happens is, if you're going to do regular preventative health care, public health insurance pays nothing compared to what private insurance pays. And the vast majority of patients that come into this hospital are on public health insurance.

DEMBY: Right.

FADEL: So Medicaid, Medi-Cal. And that's any doctor's appointment where you're not so sick that you have to be admitted to the hospital. This is Batchlor explaining it.

BATCHLOR: So Medicaid pays about 50 cents on the dollar of what Medicare pays for. And Medicare pays, you know, like, a fraction of what commercial insurance pays. So you've got Medicaid, like, down here at the bottom. And it's so low in California that physicians don't - can't sustain a practice in a community like this. So that's why they aren't here. That's why we're missing 1,200 physicians.

FADEL: Yeah, 1,200 physicians. So outside the hospital and its wraparound services, it's basically a health care desert because doctors don't set up practices where they can't make money. And other hospitals don't want these patients because they don't make money and keep their hospital sustainable off them. A spokesperson for the hospital describes it as medical apartheid. And that's one of the reasons, Batchlor says, the prevalence of diabetes is three times higher in this community than in the rest of the state, and the mortality from diabetes is 72% higher.

So you end up with a sick community that shows up in the emergency department downstairs from Batchlor's office because they don't have anywhere else to go, and they get there when it's really advanced, these diseases are advanced. And by the way, the emergency department is considered outpatient care.

MERAJI: What?

FADEL: Yeah, the hospital loses about $10 million a year running it.

MERAJI: I always thought that that's where these hospitals made money.

FADEL: No, quite the opposite. And that's basically where people go for their regular medical care - the emergency department. So basically, what Batchlor and her staff are doing are leaning on millions of dollars in philanthropy and charity to make up for those losses and provide the medical care that's missing in this community.

MERAJI: In my mind, that doesn't feel like a sustainable model.

FADEL: Right.

MERAJI: Relying on philanthropy and charity to subsidize health care.

DEMBY: Right, right.

MERAJI: Preventative health care. So the question is, how do we fix this? How does this get fixed? Like, what is the solution here?

FADEL: Yeah. And you're totally right. Batchlor says that, like, what she's doing, what she considers her life's work, to bring health care to this community, is not sustainable without fundamental policy change. And in her mind, it's pretty simple - fund medical care the same across the board. And that hasn't been the case, really, ever. She's using the hospital to do pilot programs to show what's possible, gathering data to show the way this type of care keeps a community healthy and then going to policymakers to say, see, this works; now change the insurance-funding model and fix this. And it's also why she let journalists in in the midst of this catastrophe because, as I said, COVID has laid bare these inequities and made them really impossible to ignore.

(SOUNDBITE OF MUSIC)

MERAJI: That was NPR race and identity correspondent Leila Fadel. And that's our show. And like we said last week, we're going to be taking some time to think about what we want to dig into in 2021, and we want to hear from you. What issues do we need to pay more attention to? Who are the artists and activists and cultural leaders we need to be talking to? And obviously, we have to do really important things and serious stories, but do you want more pop culture and fun? (Laughter) Or do you want more hard-hitting journalism?

DEMBY: Let us know by emailing us at codeswitch@npr (ph) - with the subject line Race in 2021. Or hit us up on Twitter, on Instagram or OnlyFans. We're at @nprcodeswitch.

MERAJI: This episode was produced by Alyssa Jeong Perry and edited by Leah Donnella and me. Leila's original piece first aired on All Things Considered and was edited by Marcia Davis. It was fact-checked by Natalie Escobar and our intern Summer Thomad.

DEMBY: And we would be remiss if we did not shout out the rest of the CODE SWITCH fam. So that is Karen Grigsby Bates. That is Jess Kung. That is Kumari Devarajan. That is LA Johnson. And that is Steve Drummond. I'm Gene Demby.

MERAJI: And I'm Shereen Marisol Meraji.

DEMBY: Be easy, y'all.

MERAJI: Peace.

(SOUNDBITE OF MUSIC)

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