Firm’s King/Drew Work Criticized

Los Angeles County supervisors are demanding a reexamination of the work done by a consulting firm paid nearly $1 million to overhaul the nursing department at Martin Luther King Jr./Drew Medical Center.

The Camden Group was hired in December 2003 after a series of questionable patient deaths while under nurses’ care. The El Segundo-based firm agreed to check the competency of frontline nurses, develop plans to improve the quality of care and fill vacant positions.

But under Camden’s watch, the nursing problems continued at the Los Angeles County-owned hospital. A second firm, Navigant Consulting, replaced Camden in November and found that the nursing department remained in disarray.

Some King/Drew nurses didn’t have proper certification, crucial policies could not be found and morale was low among managers, Navigant reported to the county Board of Supervisors.

In addition, the hospital recently lost its national accreditation, in part because of nursing lapses during Camden’s engagement. Federal regulators are threatening to pull their funding from the hospital, located in Willowbrook, south of Watts, because employees have not proven that they can properly calm aggressive patients.

All five members of the Board of Supervisors expressed dissatisfaction with the caliber of Camden’s work. “We paid them all this money. We trusted them. And we came back with nothing,” Supervisor Gloria Molina said at a January board meeting.

Supervisor Zev Yaroslavsky has not ruled out taking action against Camden for the quality of its work.

“I think Camden owes the county an explanation, and if it’s not a good enough explanation, we’ll take it one step at a time,” he said in an interview.

“We don’t want this to be Fleishman-Hillard all over again,” he said, referring to the ongoing criminal investigation into alleged false billings to the Los Angeles Department of Water and Power by the public relations firm Fleishman-Hillard.

Barbara Patton, Camden’s senior vice president of hospital operations, defended her firm’s work, saying the scope of problems at King/Drew was overwhelming.

“We haven’t worked harder at any other engagement in our lives,” Patton said. “You couldn’t underestimate how aberrant some of the situations are in that organization. You walk in and you say, ‘How can this be? This is nuts.’ ”

Patton said some nurses tried to sabotage her firm’s efforts to make improvements in order to maintain the status quo. Employees, for instance, denied that they had received new policies enacted to improve patient care and nurses sometimes continued to act inappropriately even after being retrained.

“Not every nurse at Martin Luther is deplorable,” Patton said. “They’ve got good nurses there. They’re just not in the majority or they leave or they quit.”

Her firm achieved several significant milestones, she said. It moved quickly to add 100 temporary nurses to fill critical nursing vacancies. It instilled accountability among nurses. And it began writing policies and procedures for all manner of nursing responsibilities, she said.

Camden also successfully headed off imminent threats to cut off funding from federal regulators, once for medication errors and once for the use of Taser stun guns on psychiatric patients, Patton said.

Dr. Thomas Garthwaite, director of the county Department of Health Services, defended Camden, saying the firm had inherited a nursing department in complete disarray. Top managers had been ousted for shoddy performance and more than 30% of nursing positions were vacant.

“I don’t think it’s fair to say that they didn’t do a lot of work. They did do a lot of work,” Garthwaite said. “It’s like you peel back one board on your house and suddenly you’ve got termites everywhere. On the outside it looked like a perfectly good house.”

If anything, he said, the health department should have devoted more resources earlier to fix the problems.

Under pressure from the federal government last fall, the supervisors approved a $13.2-million contract with a larger, more experienced healthcare consulting firm.

Navigant, which took over day-to-day operations of King/Drew on Nov. 1, is analyzing all areas of hospital operations, including nursing.

Genevieve Clavreul, a nurse and frequent critic of the health department’s leaders, said her problems with Camden began when the firm was awarded a contract without competitive bidding. County officials maintained the action was necessary because of the severity of problems at King/Drew.

She said the board subsequently ignored concerns she raised about Camden’s performance even as the hospital’s troubles noted by regulators, accrediting groups and the media.

“Camden is a catastrophe,” she said. “All along, the board has been given notice. They’re not doing the job.”

Clavreul has also questioned the work of another consulting firm paid nearly $400,000 last year to help the hospital pass its accreditation review. The hospital fared poorly during the review -- and subsequently lost its accreditation -- despite the work of Linbar & Associates.

County health officials have said they have no documentation or reports regarding Linbar’s performance.

A Linbar representative did not return telephone calls seeking comment.

A lengthy report from Navigant in January found lapses in the quality of Camden’s work:

* Camden said it verified the life-support credentials of all nursing staff. But Navigant found that at least 15% of registered nurses in the emergency room had expired credentials. Camden said some of the certificates may have expired after they were checked.

* Although Camden said it had trained nursing managers how to more effectively discipline problematic nurses, the managers complained to Navigant that it was still difficult “to hold staff accountable.”

* Camden said it trained more than 300 employees, including nurses, last summer on how to properly manage aggressive patients after regulators found that the hospital improperly used Tasers on mental patients. But several months later, Navigant found that nurses lacked the necessary skills.

“Role confusion, lack of training, absent leadership and confusion” were among the problems cited by Navigant in a January report.

But Navigant, too, has encountered difficulties making improvements.

Since Navigant has been at the hospital, federal regulators again found inappropriate use of Tasers. Navigant retrained employees in December, but the staff again failed to perform properly when inspectors drilled them.

Navigant has proposed more than 1,000 recommendations to turn around the hospital, many of which have yet to be implemented.

But Camden’s Patton said change will be slow, judging from what she experienced.

“If you walked in today, or in six months, cold to that organization, you would be blown away by what you found,” Patton said. “Even by all the improvements, it is that far off the mark.”