King/Drew Consultant Faulted for Lapses

The consulting firm that was found last week to have inflated its expenses at Martin Luther King Jr./Drew Medical Center faces new allegations that it failed to complete the work it promised at the embattled public hospital.

In a report released late Thursday, Los Angeles County auditors accused Navigant Consulting Inc. of deleting unfinished items from its to-do list and refusing to turn over results of a practice inspection showing how unprepared King/Drew was for an upcoming visit by accreditors.

Although the county reviewers noted some accomplishments, they said the Chicago-based firm has made far fewer reforms than it pledged in a one-year contract to overhaul the hospital, which has been beset by patient care and management lapses. The $15-million contract expires at the end of this month and the county must decide whether to extend it.

The audit is the second since June to criticize Navigant and marks yet another embarrassment for the publicly traded consulting company.

“It raises major concerns for us, no question about it,” said Dr. Hector Flores, chairman of the King/Drew hospital advisory board, which advises the county Board of Supervisors about King/Drew.

Navigant, Flores said, “underestimated the extent of the problems” at the hospital, which serves a mostly poor and minority population around South Los Angeles.

Navigant spokesman Andrew Bosman said he would not be drawn into a “tit-for-tat” with auditors, but defended his company’s overall performance.

“There’s different expectations and different viewpoints of what’s happened,” Bosman said. “This is a hospital that’s had two decades of challenges, and it’s a big task to improve it. I know our team is dedicated to working with our client.”

Some of the shortcomings cited by auditors include:

* The firm has not completed competency evaluations for all of King/Drew’s nursing staff, even though the task was considered among its highest priorities. Regulators have repeatedly cited lapses by King/Drew’s nurses in patient deaths and injuries.

Navigant told auditors that King/Drew now reviews nursing licenses and credentials monthly. But auditors reviewed a sampling of 16 nurses’ files and found that three did not contain all the required credentials.

* The firm was supposed to have the hospital ready to reapply for its seal of approval from a national accrediting agency by Dec. 31.

County health department staffers interviewed by auditors, however, said the hospital is not in “full compliance” with any of the 12 standards the accrediting group assesses.

County auditors also said Navigant has refused to show them the results of mock surveys that assess whether King/Drew is prepared to pass an inspection by the Joint Commission on the Accreditation of Healthcare Organizations.

The commission pulled the hospital’s accreditation Feb. 1 after an inspection found incompetent employees, failures to prevent hospital-acquired infections, inconsistent patient care and incomplete medical charts.

King/Drew must pass a new survey by the group to regain accreditation, which is seen as a public vote of confidence and is critical to securing payment by insurers.

* Navigant had not given adequate evidence that its consultants were working the hours they said. In their June review of the firm, auditors said Navigant “did not appear to always provide the required full-time, on-site staff” and requested proof.

Navigant provided a list of its staff members’ hours, auditors said, but without documentation such as attendance logs or timecards.

As a result, auditors said they were unable to verify the list’s accuracy.

* Based on a sample, auditors said Navigant had not completed nearly half of the recommended changes it classified as urgent.

Auditors said the firm appeared to have deleted some promised fixes from its to-do list because it had made little or no progress on completing them. Three recommendations listed as “partially implemented” in the county’s first audit of Navigant’s work have disappeared from the firm’s work plan, auditors said.

Navigant had told the auditors that it had cut 100 recommended improvements because of such things as “changing priorities.”

“That suggests that Navigant did in fact provide us with misleading information,” said Jim Lott, executive vice president of the Hospital Assn. of Southern California and vice chairman of King/Drew’s advisory board.

“That’s not acceptable. Navigant either complies with what they say they’re going to comply with or they’re not meeting the need and purpose to which they were engaged.”

Auditors did note a number of accomplishments by the firm, such as evaluation of doctors’ competency and additional training for physicians. The nursing department has been reorganized to provide more accountability. The length of stay for emergency room patients went down and the use of the operating rooms went up, although not enough to meet Navigant’s goal.

Dr. Thomas Garthwaite, director of the county Department of Health Services, said that overall, he “didn’t find anything in this audit to cause me great concern.”

“I think some people may be confused that when you buy a consultant,” Garthwaite said, “they think you get all A+ executives.” In reality, he said, “You get A’s, Bs and Cs.”

What a consulting firm really provides is an infusion of manpower to a situation where a lot of bodies are needed, he said. “I don’t know how we could have gotten this far without it,” he said.

Garthwaite said he didn’t tell Navigant to withhold the practice inspection results from auditors, but if asked, he would have. “There’s no reason for us to point out our current weakest areas,” he said. “We just want to pass the test, not get a harder one.”

Last month, The Times reported that its review of eight months of expense records found that Navigant had double-billed for plane tickets and charged the county for first-class travel and trips unrelated to King/Drew. At the time, Garthwaite said his agency planned to reject more than $300,000 of the firm’s $1.3 million in submitted expenses.

On Tuesday, county supervisors ordered a third audit, this one focusing on the firm’s expense billings. As a sign of the firm’s concern over the continued negative publicity, Navigant’s Chief Executive William Goodyear flew into town this week to apologize for any inappropriate charges and to offer full cooperation.

County Supervisor Mike Antonovich met with Goodyear on Friday as well.

“No less than full delivery and performance of the terms and conditions of the Navigant contract will be acceptable,” Antonovich said in a statement.