King/Drew Supervisory Panel Urged

The Los Angeles County Board of Supervisors should immediately transfer oversight of Martin Luther King Jr./Drew Medical Center from the county health department to a “more independent and knowledgeable board,” consultants recommended Monday.

In an extensive report, Navigant Consulting Inc. also said that in its opinion, the hospital’s trauma unit, which is in the process of closing, will not be able to reopen until July 2006 at the earliest.

And the report documented many problems at the hospital’s outpatient clinics.

“It’s as broken there as it was on the inpatient side,” said Kae Robertson, a Navigant director.

Under Navigant’s central recommendation, the proposed independent board would take over responsibility for King/Drew’s medical care and its educational programs. The board -- to be made up of experts in finance, business and hospital management -- would report directly to the supervisors, bypassing the county Department of Health Services.

Supervisors have been discussing whether to create an independent authority to govern all the county hospitals, but resolving that larger issue should not hold up creating a board for King/Drew, the consultants said.

Robertson acknowledged that the recommendation would create a different form of oversight for King/Drew than the county’s four other public hospitals. But, she said, “this one has more problems than everybody else. This one has special needs right now.”

The supervisors are expected to take up the proposal and others at a meeting next Tuesday.

All told, Navigant has made 1,052 recommendations to improve King/Drew, about one-quarter of which it deemed urgent.

The county is paying Navigant $13.2 million to assess King/Drew’s problems and manage its day-to-day operations.

Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew, said she supports the proposed independent board because the health department has been unable to fix myriad problems at the hospital for more than a year.

“I’m not saying I’ve lost confidence” in the health department, Burke said, “but they did have a year to look at all this.

“We need someone who knows what they’re doing and who has run a hospital to have the ability to say how this can be carried out and to evaluate Navigant as they go along.”

Dr. Thomas Garthwaite, director of the county health department, said he supports the proposal even if it means ceding power.

“It makes a lot of sense,” Garthwaite said. “We’re in the middle of a lot of the decision-making, and having perhaps a group of knowledgeable individuals somewhat removed from that would help provide an additional set of guidance.”

But Supervisor Mike Antonovich said an independent board for King/Drew would have “no authority to implement changes.”

“Having another volunteer advisory board doesn’t eliminate the unethical work behaviors that have been reported in the past nor does it make assurances that King/Drew staff are doing their job,” Antonovich said.

The consultants’ findings about the trauma unit at the hospital also may generate controversy. The decision this fall by the supervisors to close the trauma unit generated heated opposition. Political leaders said they would try to reopen the unit quickly.

But Navigant’s consultants said that many challenges must be resolved before the trauma unit can return, including reestablishing a training program for aspiring surgeons.

“We very much understand there’s a community need for trauma, and it should come back,” Robertson said. “But the most important thing is that there’s a safe environment for trauma patients to be cared for in.”

In describing the hospital’s clinics, the report told of patients waiting six months to get appointments with doctors and then several hours to be seen once there. Frequently, there weren’t enough interpreters for Spanish-speaking patients. And the waiting rooms were so crowded that patients had nowhere to sit.

“Patients routinely fight in the clinical area because they are so overcrowded,” the report said.

Navigant traced the root of the problem to an antiquated system known as “block scheduling,” in which dozens of patients are assigned appointments at, say, 9 a.m. or noon, instead of being spread throughout the day. As a result, they wait hours to be seen and often must reschedule when a doctor runs out of time.

“Patients have to jump through hundreds of hoops to get anything accomplished,” the report said. “Patient flow is driven by what is convenient to nurses and physicians, not what is convenient to patients.”

Robertson said her team found that the hospital had a staff that was adequate in size, but was deployed in the wrong ways. “The biggest issue is that there’s been lack of leadership at the organization,” she said. “We need good leadership.”

She said the hospital had found that many employees were eager to embrace changes and improve the hospital, but that others were openly resisting. Some workers still maintain that King/Drew has no more problems than other hospitals, a contention Robertson said was incorrect.

“We’re going to hold people accountable,” she said. “We’re going to expect people to do a good job. People who want to work in that kind of environment will be happy to work with us there.... At some point, naysayers will have to move on.”

Times staff writer Mitchell Landsberg contributed to this report.

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Proposed oversight Navigant Consulting Inc. recommends that an advisory board of up to 11 members be set up to oversee care at Martin Luther King Jr./Drew Medical Center. Here are some key elements of the plan:

Board of Supervisors in charge of county hospitals and their funding King/Drew Medical Center Advisory Board recommended by consultant

** Permanent members King/Drew chief executive officer (No vote) Drew medical school dean Professional staff representative County health services director Members 3 to 7 experts in hospital and clinic administration, health policies and caring for underserved populations.

(3-year initial terms) ** Among advisory board responsibilities would be: * Appointment of medical center executives * Quality of care * Medical staff credentialing * Agreement covering patient care and teaching missions. * Medical residency programs * Strategic plan, including Board of SupervisorsÕ funding request * Business practices * Human resources, outside of civil service rules ** Source: Navigant Consulting Inc. report