Navigant Is Expected to Take On King/Drew

The private company expected to be chosen today to operate Martin Luther King Jr./Drew Medical Center has a great deal of experience cutting costs and improving hospitals’ bottom lines.

But Navigant Consulting’s mission at King/Drew would be much different -- and significantly more complex.

The Los Angeles County-run hospital in Willowbrook, just south of Watts, is reeling from patient-care lapses that have been linked to several deaths. Navigant is being asked not to slash budgets but to help improve patient care and make sure doctors and nurses are doing their jobs properly, officials said.

So instead of financial wizards and efficiency experts, Navigant would need to tap physicians and other medical professionals who can break down operating room procedures, scan nursing charts in search of possible errors and master the complicated world of accreditation.

Navigant officials would not say whether they have handled a hospital where their sole purpose was to fix patient-care lapses, citing client confidentiality.

In a letter to the county dated Monday, they did offer three unnamed examples of contracts in which the firm dealt with clinical problems. One involved a hospital in the southwestern United States that the company said was in danger of losing funding from federal regulators and accreditation from the same national group that has been threatening King/Drew.

But the letter did not say why accreditation was in jeopardy or what steps the company took to avoid losing accreditation.

County officials said they remain confident that the Chicago-based company is the right choice, citing the slate of doctors and other consultants the firm plans to bring on board to help with the turnaround effort. The Board of Supervisors is to vote today on a $13.2-million contract for the firm.

Officials also pointed to Navigant’s work two years ago helping Watts Health Foundation, an HMO and clinic, close a multimillion-dollar deficit, as a sign that it can work effectively with the South Los Angeles community. As part of their work with the organization, Navigant worked with a community board led by local elected officials, including Rep. Maxine Waters (D-Los Angeles), one of the biggest critics of the county’s handling of King/Drew.

“There was some insensitivity coming into the game,” said Assemblyman Jerome Horton (D-Inglewood), who also served on the committee. “But we eventually worked it out and were able to work together well.”

When Navigant first reviewed Watts Health Foundation, it concluded that the organization’s financial problems were so severe that it could not be saved, Horton said.

“It was community involvement that kept the Watts Health Foundation open and encouraged them, with a little nudging, to go the extra mile,” he said. “That’s why it’s important for the community to stay involved. These guys are just a management firm.”

Navigant carried out a massive reorganization, separating the health maintenance organization from the clinic and reducing financial liability.

Navigant worked with the foundation for two years, though Horton believes the firm should have left earlier, a move that would have saved thousands of dollars in consulting fees.

“Near the end, they did not have an exit plan and therefore they overstayed their welcome,” he said.

King/Drew’s problems far eclipse the difficulties at the foundation.

King/Drew has faced a series of lapses in patient care, including several that contributed to deaths, according to regulators. The latest revelation came about a week ago, when the county confirmed that a 28-year-old patient died after a nurse turned down the audio alarm on his vital-signs monitor, then failed to notice that his heart was barely beating.

The county agreed to bring in outside managers as part of a pact last month with federal health regulators, who have threatened to cut off $200 million in federal funding. That money accounts for more than half of the hospital’s budget.

The Joint Commission on Accreditation of Healthcare Organizations has also begun the process of pulling its approval, which could lead to the closure of doctor-training programs at King/Drew and the loss of nearly $15 million in private insurance reimbursements.

The county Department of Health Services wants Navigant to manage day-to-day operations at King/Drew and complete an assessment in 60 days. The company would bring 23 consultants -- 11 of whom would stay for at least a year. The county needs to sign a contract with an outside consulting firm today or risk being out of federal compliance.

Supervisors Gloria Molina, Yvonne Brathwaite Burke and Zev Yaroslavsky said Monday they have little choice but to vote for the contract.

Molina said she would have a lot of questions for Health Department officials today. “This is a lot of money,” she said. “And while the reality is we’re going to have to pay it one way or another, I want deliverables and I want to know that at the end of the day, they are really going to be able to take control of these issues.”

Burke agreed, but said she was going to introduce a motion that could limit the Health Department’s activities while Navigant is doing the assessment. She wants the county to hold off on closing the trauma unit at King/Drew until after Navigant has had time to investigate. The board, with Burke opposed, has scheduled a hearing for next month to consider closing the trauma center.

County officials selected Navigant over Cambio Health Solutions of Tennessee, which quoted the county a maximum price of $24 million, almost double that of Navigant.

Cambio is currently running Alameda County Medical Center, in the Bay Area, which is being threatened with sanctions because of problems with patient care. Cambio officials said they were brought in to help with finances but discovered they needed to address medical lapses, including a case in which a mental patient allegedly killed a doctor at John George Psychiatric Pavilion.

Cambio found that correcting medical issues required a different set of resources and brought in KB Behavioral Health Care Consultants, solely to deal with the issues at John George. The consultants say they have made progress, but the U.S. Centers for Medicare and Medicaid Services still has to review some of their corrections.

Medical lapses “are extremely difficult to address,” said Jim Braley, Cambio’s project manager at Alameda. “They’re typically the result of long-standing cultural, policy issues. It takes a substantial number of people ... upwards of 23 to 30 people there at any one time, rewriting policy and procedures.”

Braley expressed skepticism that Navigant could fix King/Drew, given the size of its contract.

“I think it would be very difficult to do what needs to be done for [Navigant’s] price,” he said.

But Fred Leaf, the Health Department’s chief operating officer, said Navigant wrote the best of the five proposals that the county received from consultants. A review of 23 resumes submitted by the company shows eight registered nurses, three physicians, a pharmacist and others with nurse management or radiology backgrounds. Each resume boasts at least 15 years of healthcare experience, serving as consultants, administrators or practitioners.

Leaf said he expected “a whole different presentation” from Navigant because they are affiliated with the Hunter Group, which has a reputation for harsh financial restructuring. “But very surprisingly, they definitely put all the right people together,” he said.

Some unions are skeptical of the Hunter Group, which some believe puts the bottom line ahead of patient care. SEIU Local 660, the union that represents county hospital workers, said Monday it has hired its own consultant to monitor Navigant’s actions.

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Times staff writer Charles Ornstein contributed to this report.