King/Drew Consultants Under Fire

The outside consultants being paid $15 million to overhaul Martin Luther King Jr./Drew Medical Center now stand accused by auditors of transgressions similar to those they were hired to prevent: billing for hours their staff did not work.

In a report released Monday, Los Angeles County auditors also said Navigant Consulting Inc. had failed to act on “urgent” recommendations it had promised to complete by Feb. 28. Nearly four months later, almost a third of those reviewed had not been done.

The audit is the latest twist in the months-long saga of mismanagement at the public hospital, which serves a predominantly poor and minority population around South Los Angeles. Navigant has recommended that hundreds of King/Drew employees be disciplined for poor work habits, lapses in medical care and fraud, including lying on timecards.

Now, Navigant’s performance itself has come into question.

“Navigant is not up to the job of turning this facility around,” county Supervisor Mike Antonovich said in response to the audit. “They have failed to meet their own deadlines or to implement the reforms they determined are the most urgent. Their billing practices for staff reflect the malfeasance they were hired to eliminate.”

Navigant officials said they are proud of the work they have done at King/Drew. Although some tasks were not completed on time, Navigant managing director Kae Robertson said, nearly 100% are either done or in progress.

“There’s a very serious need for improvement at the hospital, and we are making progress and our team is working very hard to do that,” she said.

When it was hired last fall under pressure from federal regulators, Navigant said it understood the depths of King/Drew’s woes and could turn the hospital around for $13.2 million.

Less than six months later, Navigant asked for more money, maintaining that the problems were far worse than it anticipated. On May 10, the county Board of Supervisors agreed to give the firm $1.8 million more.

In Monday’s report, however, the county auditor-controller found that “Navigant did not appear to always provide the required full-time, on-site staff.”

The firm billed the county Department of Health Services for its full monthly payments from November 2004 to this April, auditors said, even though some staff were “off site or on vacation at various times.”

In a May 20 letter to Navigant, obtained by The Times, the health department’s chief operating officer, Fred Leaf, said he continued to hear “reports that a number of the Navigant consultants ... do not appear to be on-site for a full five-day workweek but rather are there for two or three days during the week.”

The county is paying Navigant $67,500 per month, plus expenses, for each of three top executives. The fee for nurse managers is $36,000 each per month.

In his letter, Leaf told Navigant that the county would withhold $41,175 from the firm for vacations taken by three senior consultants. Navigant officials say the firm has, contrary to auditors’ claims, provided more staff than it is being paid for. Robertson said some staffers’ time had been substituted for others’ but said that is allowed under the contract.

The firm said it is gathering proof that its staff worked the hours for which it billed.

“We have a lot of people that are there,” Robertson said. “They’re working long, hard hours.... I’m confident that we’re providing all the hours that we’re supposed to.”

In their report, a routine review of the Navigant contract, auditors also criticized the firm’s managers for failing to ensure that King/Drew staffers were following procedures and policies that they established.

Navigant, for instance, had pledged to hold daily “huddles,” in which patient case managers, social workers and nurses would briefly discuss the care of each patient. The huddles were initially held Monday through Friday but stopped inexplicably in mid-March, according to the audit.

Now, such rounds are held weekly, as was the case before Navigant arrived.

Members of the Board of Supervisors are expected to discuss the audit at their regular meeting today.

Supervisor Don Knabe said that he was troubled by what he read but that he wanted to give Navigant a chance to respond.

“Obviously it’s very alarming,” Knabe said. “I don’t know what’s going on, but it’s certainly different from what we’re hearing at the board every week.”

Navigant, he said, needed to explain the allegation that it had billed for hours it didn’t work -- especially given that it was hired to get rid of managers who were doing the same.

“That sounded too familiar, didn’t it?” Knabe said. “I’m sure that people do need vacations, but if we’re paying for it? I don’t know.... When I saw it, I said, ‘Oh, my golly.’ ”

Antonovich, already a critic of Navigant, called on the county to examine whether the firm should be replaced.

“The most important turnaround is made in the first six months,” he said. “That’s when people are most focused, that’s when people are expecting change. Navigant missed this opportunity and now will have to play catch-up.”

But Dr. Thomas Garthwaite, director of the county Department of Health Services, defended Navigant, saying the firm is experiencing the same type of intransigence from King/Drew staff that stymied earlier reform efforts by health department managers and other consultants.

“They may be guilty of over-promising,” Garthwaite said.

“Everyone who has gone into King/Drew during this whole time [since late 2003] has found it much more difficult to get things done than they initially projected,” he added. “Uniformly, people who’ve been there a while find that the usual rules don’t hold. I think it’s just an unusual process. So many systems are broken.”

Patient care lapses have continued on Navigant’s watch. In fact, government health inspectors are reviewing the cases of several patients who died this year after what county officials called medical errors in their care.

Navigant has also been accused, along with county managers, of waiting too long to take disciplinary action against some doctors and other employees accused of wrongdoing.