GRANT PROPOSAL The John Randolph Haynes and Dora Haynes Foundation By: John Isaac Daniel Pettus William (Bill) Palmer Ruthita J. Fike April 28, 2008 TNDY 402E The Legacy of Martin Luther King Professor Wendy Martin Claremont Graduate University Claremont, California William J. Burke, Administrative Director The John Randolph Haynes and Dora Haynes Foundation 888 West Sixth Street, Suite 1150 Los Angeles, CA 90017-2737 Dear Mr. Burke: Enclosed you will find an application and materials related to a request for a grant to study the community impact of the Martin Luther King Hospital in Los Angeles, California, and its eventual dissolution. The building and staffing of this hospital, and then its eventual closing, had major economic, social, and political impacts upon not only its immediate community, but the greater Los Angeles area as well. A four-member team from this University will conduct research about the start of the hospital, its relationship to the community and the county, and causes for its eventual closing. The study will include interviews with health officials, former employees, and city/county supervisors. The many records still in existence will also be examined. It is estimated that funding for this study will amount to $150,000 over a two-year period. On behalf of the University, we hope the Haynes Foundation will be able to offer financial support for this important study, as it should prove insightful for other cities, and allow them to avoid the pitfalls that occurred during and after this ambitious hospital project. Thank you for your consideration. Sincerely, Roger Kenworthy Claremont University Grants Administrator I. Summary of Proposed Activity The story of King-Drew Hospital, later renamed King-Harbor Hospital, is a story that began in the 1960’s. The Civil Rights Movement and the 1965 Watts race riots brought awareness to the discrimination of the black population and the economically disadvantaged. King-Drew Hospital was established as a partial solution to this problem. Named for Martin Luther King Jr. and Drew Medical Center, the new hospital was heralded as a health care solution to the underserved population and had a special mission of empowering the community. King-Drew opened its doors as a county facility in 1972 and was seen as a demonstration of African American achievement and power. From the very beginning, however, the organization faced challenges, and by 2004 those challenges began to appear insurmountable. A series of citations for severe quality issues from the U.S. Centers for Medicare and Medicaid Services demonstrated the lack of adequate systems and well trained personnel. The LA Times reported these issues and many efforts were launched to improve quality outcomes. Nonetheless, the trauma center was forced to close in 2004 and the entire inpatient facility closed in 2007. Since that time the county has been struggling to find acceptable and accessible health care alternatives for the residents surrounding the facility. The outpatient clinics have remained open during this time. This story is an important part of Southern California’s history and poses several questions that deserve focused understanding and research. This proposal includes a process to document the journey of the hospital from its pre opening through the present time. Additionally, it suggests research on the cultural influences that have contributed to the outcomes. This portion of the study will analyze administrative leadership, structure and policies, clinical leadership, and community involvement and impact. A portion of the study will also be devoted to the impact on the healthcare providers-- physicians, residents, nurses and others. Finally, the study will summarize existing public health data to evaluate the long term impact on Southern California. This section of the study will relate the findings to the findings in other studies researching health disparities. The effort of this research could and should be published, certainly in various journals, but potentially as a book. The King-Drew story is one of the largest and most significant health care efforts to serve an underserved population in the United States. The learning from the effort could assist in the development and response to future healthcare needs for Southern Californians and for other American communities with similar issues and demographics. Additionally, the story links importantly to an understanding of the African American and Hispanic communities and to their histories and interrelatedness within Southern California. The proposal seeks funding for two years and includes a four person team who will review public data available on the hospital, its demographics and health status. Additionally, personal interviews will be conducted with County officials, hospital administrators, (past and present), Drew Medical Center administrators and physicians, community leaders and patients. Additionally, a literature review of existing health disparity issues and proposed solutions would be included. II. Objectives 1) To document the Drew-King (renamed Drew-Harbor) Hospital history and experience from the time of the 1965 Watts riots to the current time. 2) To identify major cultural influences and factors that led to the closure of the hospital in 2007. 3) To identify the professional and psychological impact on the healthcare providers providing care at King-Drew hospital 4) To summarize the impact on the health status of the citizens of Southern California. 5) To quantify the financial impact on the Southern California health care system. III. Significance of the Proposed Work The events that led to the closure of King-Drew Medical Center’s inpatient services, while significant, have not been fully documented. Through a clear understanding of exactly what took place in this region of Los Angeles, the medical community and local governments can avoid similar tragedies in the future. The original vision for King-Drew Medical Center was to train physicians and hospital staff who would then work in areas of urban poverty. The hope was that the physicians and hospital staff would reflect the community. This hope was strengthened when the medical center became the training hospital for the Charles R. Drew University of Medicine and Science. One aspect of our research aims to investigate whether or not this vision of a diverse medical center truly came to fruition at King-Drew Medical Center. We also aim to gain access to data relating to the residents who were transferred to nearby teaching hospitals such as UCLA and Loma Linda University Medical Center. If, in fact, this original vision was violated, it will give us a glimpse as to what may have occurred at King-Drew and would hopefully provide a blueprint as to how authorities can avoid tragedies such as this in the future. While the events that occurred at King-Drew received a certain amount of coverage from the local press, this significant part of Los Angeles’ history has not been thoroughly documented by the scholarly community. King-Drew faced many of the same challenges and obstacles that medical centers in numerous urban areas face, yet these issues have never been clearly identified and researched. As recently as March, 2008, Jim Loft, Executive Vice President of Policy Development and Communications at the Hospital Association of Southern California, released a memo on the impact of the closure of King-Harbor, formerly King-Drew. In his memo, the following five factors were seen to influence the region: 1. Changes at service delivery and capacity at King-Harbor Hospital over time; 2. Sizable changes in service delivery/utilization at LAC+USC Medical Center; 3. The closure of five private hospitals in or around the King-Harbor service area during the analysis period; 4. Changes in the County’s patient transfer policy; and 5. An overall increase in demand for hospital inpatient services by the uninsured residents of Los Angeles County. The analysis period spoken of in factor #3 above was between 2000 and 2006. The fact that a number of private hospitals in the region also closed during this period points to the fact that the problems faced by King-Drew were not unique to this one institution. Clearly, this is a challenge that must be met head on if the residents of Los Angeles County are to have any hope of receiving adequate health care. The information gathered and analyzed in this study will be useful to not only Los Angeles County, but to the rest of Southern California, the entire State, and possibly to other states, especially in the increasingly high number of low socioeconomic regions which lack adequate medical facilities. Results will be disseminated through conference presentations, journal publications and potentially a book detailing our findings. Without knowing the events of our past, we are powerless to affect the future. We hope that with this grant, we may contribute to the overall health of the residents of Los Angeles County. IV. Questions and Methodology 1. What is the general history of the King-Drew Medical Center? Research Method: To obtain the general history of the King-Drew Medical Center we will rely on information that has already been provided to the public (e.g. newspaper articles and public documents). We will prepare a coherent and detailed account of these recordings in order to provide the public with an objectified account of the history of the King-Drew Medical Center. We will also complete personal interviews with board members, former administrators, employees and patients. 2. What were the cultural and management priorities that influenced the history of the King-Drew Medical Center from the perspective of city officials, patients, residents, and staff? Research Method: Our main resource to obtain the above information is face-to-face interviews. We will conduct detailed interviews with city officials involved in the different aspects of the history of the King-Drew Medical Center. Interviewing patients of the King-Drew Medical Center will allow us to have a first-hand perspective concerning their experience at the facility. In order that the perspective is balanced we will also conduct interviews with the staff of the facility. Also, to obtain a holistic perspective on the benefit or lack thereof of the King-Drew Medical Center to the surrounding community we will conduct interviews with local business owners and residents. To ensure our ability to obtain such interviews we have established an anonymity policy to all of those participating in the interviews. 3. What impact has the closing of the King-Drew Medical Center had on the healthcare providers (i.e. physicians, residents, nurses and others)? Research Method: One of the initial roles of the King-Drew Medical Center was to be an educational resource to those in the surrounding community who were interested in pursuing degrees in healthcare. By conducting interviews with healthcare providers affiliated with the King-Drew Medical Center we will determine to what extent the closing of the center has affected these persons. Also, of interest is how the closing of the King-Drew Medical Center affected the surrounding healthcare facilities. By accessing documents relating to the transfer of patients and residents to other medical facilities we will determine the positive or negative effects of such transfers. 4. What changes, if any, occurred in the recorded health of the population surrounding the area of the King-Drew Medical Center? Research Method: In order to examine the change in the health of the population surrounding the King-Drew Medical Center we will conduct a detailed analysis of public health records. Our aim is to pay close attention to individual records in order to determine whether change in health varied before, during, and after the close of the King-Drew Medical Center. We will create a table of all the records in order to map, on a large scale, the health of the population in general. Using data collecting technologies we will create graphs and charts to represent the changes in the populations health before, during, and after the closing of the King-Drew Medical Center. 5. What financial impacts has the closing of the King-Drew Medical Center had on the healthcare system of Southern California? Research Method: By accessing public financial records prior to, during, and after the closing of the King-Drew Medical Center we will be able to analyze the financial impact upon of the Southern California healthcare system. One the main goals of this method are to make such data easily accessible to the public. Using computer technologies the data will be represented in multiple formats (spreadsheets, graphs, etc.) in order to document and interpret the financial effect of the King-Drew Medical Center upon the Southern California healthcare system. V. Present State of Knowledge in the Field A growing and abundant literature testifies to the fact that race is a central and determining factor for health disparities. African Americans, among other racial groups, have less access to health care, receive unequal treatment for similar health problems, and suffer from implicit and explicit racism from white physicians. Scholars have often looked at health disparities as being caused by socioeconomic status (SES) but many scholars have found that, holding this factor constant, race continues to determine poor health care. In fact, African Americans and other racial groups have endured a long history of health neglect and abuse, culminating in experiments and exhumed graves, which have led to a long condition of mistrust of mainstream health providers. Moreover, African Americans have long been denied equal access to medical education and careers in high level health industries. The King-Drew hospital had as its reason for being the mission of serving neglected populations around Los Angeles and the training of African American physicians. As the Steering Committee on the Future of the King-Drew Medical Center testified in 2005, these remain the best means of reducing the health disparities among the diverse population. As Venessa Northington Gamble (2002) explained in her essay, “Under the Shadow of Tuskegee: African Americans and Health Care,” African Americans have suffered a long history of neglect, abuse and exploitation at the hands of white medical practitioners. Beginning in slavery, African Americans were subjected to human experimentations which left them even more wounded, if alive. Graves were exhumed. A persistent and justifiable condition of mistrust developed among African Americans in which they feared health care from whites. The practice of experimentation continued long into the 20th century. The Tuskegee syphilis experiments are the most famous, but encapsulate a tradition of exploitation. Many African Americans were used as guinea pigs while in prison, and they were among many subjected to human radiation experiments during the Cold War. Gamble (1995) has also written about the black movement to establish black hospitals in her Making a Place for Ourselves: The Black Hospital Movement, 1920-1945. She chronicles the efforts of African Americans at the end of the 19th and early 20th centuries to respond to the ever oppressive denial of health care and medical education for African Americans. They organized and created, in ways reminiscent of black colleges, a health care system “for themselves.” By 1917, they had created 118 black medical facilities. Yet, following the Second World War, and with the rising hopes of integration, these facilities began a decline as African Americans saw opportunities to push for integrated health systems. Her book is a wonderful historical context for thinking about the establishment and significance of the King-Drew Medical Center. At once showing the failures of integrated health, and the significance of minority doctors training and working for local populations, the tradition of black hospitals remains especially pertinent. Robert Mayberry, Fatima Mili and Elizabeth Ofili, (2002), in “Racial and Ethnic Differences in Access to Medical Care,” found that not much has improved in health disparities since the Department of Health and Human Services conducted a major research project in 1985. Minorities receive less access to health care and when they do have access, they receive far less than equal treatment. While factors like insurance, language and socioeconomic status are important, race continues to stand out as a determining factor. Minorities were “less likely to have any physician contact in the past year, even accounting for income and health status.” Moreover, African Americans, when they did have physician contact, did so less often than whites, and reported “less satisfaction with the physicians’ treatment.” Minorities go to the hospital less often than whites, “even after taking into account differences in health status, source of payment, and the site of hospitalization.” And they received fewer procedures yet were subjected to more amputations. While several studies have noted the lack of pain medicines at pharmacies in de facto segregated residential areas, Hispanics were two to seven times (depending on the nature of the study) more likely not to receive any pain medication in the hospital. David Williams and Chiquita Collins, (2002), in “Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health,” have pointed to the total impact of segregation on health. They note that blacks have higher death rates and higher (and increasing) infant mortality rates. Health care facilities are more likely to close in poor and minority communities than in others. Moreover, they argue that while many scholars have blamed socioeconomic status on health disparities, residential segregation is the cornerstone and underlying cause of this. The focus on residential segregation throws in sharp relief the double compound of how segregated housing imperils education and work, which in turn contribute to poor health conditions, as well as limiting health care possibilities. This argument carries a special salience in thinking about the health threats and opportunities for minority residents served by the King-Drew Medical facility. Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, (2003), edited the research report for the Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, published as Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. They determined, as have many scholars, that race supersedes socioeconomic status in thinking about health care disparities. They argue that “evidence of racial and ethnic disparities in health care is, with few exceptions, remarkably consistent across a range of illnesses and health care services.” For example, African Americans suffer poorer treatment for heart disease, suffer higher rates of mortality, and in diagnosis, treatment and analgesics for cancer, the disparity is large. This remains true for renal disease, pediatric care, maternal and child health, mental health, rehabilitation and nursing care, and surgery. Still, while neglected in all of these areas, they endure more amputations. Two recent studies have looked closely at health care in Los Angeles County. Marianne P. Bitler and Weiyi Shi, (2006), in “Health Insurance, Health Care Use, and Health Status in Los Angeles County,” focus much of their attention on health insurance and immigration. Still, they determine that, in seeming contradiction to all of the scholarly testimony noted above, minorities have used their health facilities on a regular basis and there are no significant disparities. Thomas C. Buchmueller, Mirielle Jacobson, and Cheryl Wold, (2004), in “How Far to the Hospital? The Effect of Hospital Closures on Access to Care,” conclude that the poor and elderly suffer most as they have restricted access to care--because of the distances and costs and inconveniences of transportation, they receive fewer tests and immunizations, and they have an increase mortality and infant mortality rates. Much of the increase in mortality is due to the long distances traveled for trauma and other emergency cases. They note that closures shift the regular patient health care from hospitals to outpatient clinics and doctor’s offices. And some hospitals are more efficient because of the closures. Still, they caution that the marked increase in death should outweigh these financial concerns. They note that between 1997 and 2003, Los Angeles County lost 10 percent of its hospitals. The Association of American Medical Colleges has published a number of articles related to unequal access for minorities to medial school and the medical profession. In “Minorities in Medical Education,” Castillo-Page discusses how they lament that the numbers of minorities in medical schools are “alarmingly low.” They blame, however, the “pipeline” which refers to K-12 education. Many minorities do not receive the proper education as youth, and many do not graduate from high school, fewer from college. They regret the number is so low; and it seems to circle back to the article mentioned earlier about segregate housing and its impact on education. It seems all the more pertinent to the mission of the King-Drew Center which sought to educate minority doctors. In “Diversity in the Physician Workforce,” Castillo-Page (2006) discusses how they argue that 6.4% of the graduating students at medical schools are minorities. They claim that minority physicians are crucial for closing the health gap. They state that minority physicians increase access to health care for minorities, increase patient satisfaction and expand options for patient care. The Final Report of the Steering Committee on the Future of the King-Drew Medical Center, (March 2005), “Fulfilling the Promise: A Roadmap for Meeting the Healthcare Needs of South Los Angeles,” confirms the argument of the studies addressed above. They note the significance of the “unique training environment” which trains minority students especially for helping underserved populations, and describes it as a “model” for teaching “culturally competent” physicians. Moreover, they claim that there is “little doubt” that the center has effectively reduced the disparities and health care. While management problems have plagued the institution, the purpose and plan of the facility has shown to be a “model” for providing health care to minorities and training doctors to help them. VI. Timeline and Budget A. Two Year Timeline We intend to complete this study in two years. In order to gather and analyze the large amounts of both quantitative and qualitative data, we plan to employ three full-time researchers and have also included funds for a health care consultant when needed. We also intend to publish our work and to present at 2-3 conferences. It is our goal to collect data during the first six months of the study. An additional six months will be spent analyzing the data. The first six months of the second grant year will be dedicated to disseminating results through conference presentations and journal articles. Finally, the last six months will be dedicated to completing a manuscript for publication and hopefully and produce a book titled: A Snapshot in Time: The Closure of King-Drew Medical Center B. Budget 3 full time researchers = $40,000.00 x 3 = $120,000.00 Consultant = 5,000.00 2 conferences, travel and = 10,000.00 presentations Data collection/analysis = 10,000.00 Projected Total Cost = $150,000.00 C. Timeline Year 1 Data Collection = July ’08 – December ‘08 Analyzing data = January ’09 – June ‘09 Conferences and Disseminating results = July ’09 – December ‘09 Production of book = July ’09 – June ‘10 References Bitler, M.P., & Shi, W., 2006, “Health Insurance, Health Care Use, and Health Status in Los Angeles County”: San Francisco: Public Policy Institute of California. Buchmueller, T. C., Jacobson, M., & Wold, C., August, 2004, “How Far to the Hospital? The Effect of Hospital Closures on Access to Care,” (Cambridge: National Bureau of Economic Research). Castillo-Page, L., 2006, “Diversity in the Physician Workforce,” Association of American Medical Colleges. Castillo-Page, L., “Minorities in Medical Education,” Association of American Medical Colleges. Collins, C., & Williams, D., 2002, “Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health,” in LaVeist, ed, Race, Ethnicity and Health: A Public Health Reader: San Francisco: John Wiley. Gamble, Venessa N., 2002 , “Under the Shadow of Tuskegee: African Americans and Health Care,” in Thomas A. LaVeist, ed, Race, Ethnicity and Health: A Public Health Reader: San Francisco: John Wiley. Gamble, Venessa N., 1995, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945: Oxford: Oxford University Press. Mayberry, R., Mili, F., & Ofili, E., 2002, “Racial and Ethnic Differences in Access to Medical Care,” in LaVeist, ed, Race, Ethnicity and Health: A Public Health Reader: San Francisco: John Wiley. Nelson, A. R., Smedley, B. D., & Stith, A. Y., 2003, edited Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care: Washington, DC: National Academies Press. Steering Committee on the Future of the King-Drew Medical Center, Final Report, March, 2005, “Fulfilling the Promise: A Roadmap for Meeting the Healthcare Needs of South Los Angeles.” APPENDIX I CURRICULUM VITATE OF LEAD RESESARCHERS PRINCIPAL INVESTIGATOR AND PRIMARY CONSULTANT APPENDIX II The John Randolph Haynes and Dora Haynes Foundation Research Grant Criteria

Hello Everyone! I thought that I would use the ‘comment wall’ to begin my search for two committed teammates. Allow me to generally introduce myself. My name is Dale and I am a Ph.D. student in Religion who is interested in religion within America. The Transdisciplinary project—as I understand it—gives students an opportunity to think deeply and broadly about the pressing issues of our society and to work for social change. Recently, I read an excellent article by Justo L. González that challenged me to pursue research into the immigration issues and problems within California. I am seeking two dedicated colleagues that are also passionate about this issue. My hope is that we will all make this article the focal point or even spring board for our research project. I am generally open to how we would narrow our project but want to broadly focus on Martin Luther King Jr.’s vision and immigration in multicultural California. If you are interested drop me a note and I will be glad to get you a copy of this article. González, Justo L. “The Dream: A Future for the Present.” In I Have a Dream: Martin Luther King Jr. And the Future of Multicultural America, ed. James Echols, 69-82. Minneapolis: Fortress, 2004.

Welcome everyone. Just wanted to test this out.