A Mounting Tab to Fix King/Drew

The tab for fixing decades of mismanagement and neglect at the troubled Martin Luther King Jr./Drew Medical Center is mounting by the millions -- and officials say it will be months before they know if the money is being well spent.

The consulting firm hired to run the Los Angeles County-owned hospital has asked for a $3.4-million increase beyond the $13.2 million it is being given to do the job this year. The new request includes five nurse managers at $36,000 each per month.

Kae Robertson, a director of the firm, Navigant Consulting Inc., said the 25% increase mostly reflects additional costs that had been anticipated when the contract was signed last fall. But it also stems from conditions at the hospital that are worse than the firm had originally thought.

“Even though we had done our homework, and we knew that things were very broken here, what we found was that even simple, basic operational systems were broken,” she said.

From November, when Navigant took over, through February, the firm referred 91 of the hospital’s nearly 2,500 employees to the county human resources office for discipline. So far, 15 of those have resigned or been fired, including five doctors, county officials said.

The latest request by Navigant includes $52,200 per month for a physician manager to provide extensive “mentoring” to King/Drew doctors and to address “significant” performance issues among hospital department heads, according to Navigant’s written request for funds.

Several county supervisors are balking at the cost, saying they are reluctant to pour millions more into a management team that is scheduled to be gone by year’s end.

“We agreed to hire them at a set price,” Supervisor Gloria Molina said. “Now, I can’t say they’re nickel-and-diming us because it’s multimillions of dollars.... That bothers me.”

Under pressure from the federal government, the county hired Navigant last fall after the firm submitted the lowest bid to overhaul the hospital. At the time, supervisors pointedly asked if the firm would seek more money later. Navigant officials assured them at a public meeting that the bid was based on a thorough assessment.

The increase Navigant is now seeking is less than the firm wanted. Last month, Navigant asked the county’s Department of Health Services for about $5 million. At the department’s urging, the firm scaled back its request to $3.4 million.

A breakdown of contract costs shows how much the county is paying Navigant for its expertise: $52,200 per month each for the temporary chief executive officer, chief operating officer and chief nursing officer, and $45,000 per month for each of several advisors to hospital departments. Those figures do not include expenses.

By contrast, a hospital administrator within the county system earns a maximum $195,500 a year, including cash paid in lieu of benefits.

Dr. Thomas Garthwaite, director of the county Department of Health Services, said he supports Navigant’s request for additional funds.

“It’s not a long-term solution,” he said. “What it does is gets you quick leadership, quick assessment, quick knowledge. I feel like they’re doing the hard work, and they’re making progress.”

Since late 2003, King/Drew, which serves mostly poor black and Latino neighborhoods, has been cited repeatedly by regulators and accreditors for serious lapses in patient care. A five-part Times series in December detailed how errors and neglect by King/Drew’s staff have repeatedly injured or killed patients over more than a decade, a pattern that went largely unscrutinized and unchecked.

In February, a national accrediting group took the rare step of pulling its seal of approval from the hospital because of problems identified in 2004.

Since Navigant took over, its consultants have scrambled to right the 33-year-old hospital in Willowbrook, just south of Watts.

In January, the firm compiled a list of more than 1,000 steps needed to fix King/Drew.

But the next month, medical mistakes injured two patients in a week. On Feb. 15, a patient undergoing a tracheotomy suffered neck burns when a cauterizing tool ignited oxygen in the operating room. Two days later, a surgical sponge was left in the abdomen of a shooting victim and wasn’t discovered until several days later on an X-ray. (Last year, the hospital pledged to better track items used in surgery after a metal clamp was left in a patient.)

That same week, the hospital came within days of losing $200 million in federal funds because staff members were relying on county police to subdue aggressive psychiatric patients with Taser stun guns.

King/Drew had failed two inspections. After intensive staff retraining, the hospital won over regulators on a third inspection -- and Navigant threw a party with cake and ice cream to celebrate.

Earlier this month, the hospital’s trauma center closed after intense public debate. The Board of Supervisors approved the closure late last year, saying it was necessary to save the rest of the hospital. Community leaders have maintained that severely injured patients would die if they had to travel to hospitals farther away.

Navigant officials say that, despite upheavals at the hospital, they are proceeding on schedule.

An official with the labor union representing King/Drew’s workers said Navigant has indeed improved morale. But she said she’s concerned the firm isn’t moving fast enough to implement its recommendations because, she said she believes, it is angling for a contract extension that would net it millions more.

“Where is the incentive for them to quickly, expeditiously, efficiently implement their recommendations?” asked Kathy Ochoa, health policy analyst for Service Employees International Union Local 660. “I really think it’s time to start seeing some results from the ideas that have been proposed.”

Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew, said the real test of Navigant’s effectiveness will come later this year, when the hospital reapplies for national accreditation from the Joint Commission on Accreditation of Healthcare Organizations. The commission’s seal of approval has both symbolic and practical significance: Many insurance companies require it in their contracts.

“I think it’s still a little early to measure total performance,” Burke said. “I was skeptical as to whether you could really do that in nine months or a year.”

One of Navigant’s key proposals was to create a hospital advisory board, including some healthcare experts, to provide guidance to the Board of Supervisors about King/Drew. Supervisors approved the makeup of the advisory board this month, but the group has yet to meet.

Several supervisors said they believe Navigant ultimately will succeed or fail based on the quality of managers it recruits to lead the hospital permanently. The consultants have just begun searching for a chief executive and other top-level managers.

As they do, two key members of their King/Drew team are leaving their positions. Interim Chief Executive Elliot Cohen is stepping aside and will focus on improving ambulatory care at the hospital. Chief nursing officer Peg Price is leaving because her commute from North Carolina prevented her from working a full week.

County supervisors say their experience with a previous consulting group has made them wary of consultants’ claims of success. Last year, the Camden Group touted improvements in the nursing department at King/Drew, yet Navigant found widespread problems when it arrived.

“I don’t think we got our money’s worth out of Camden,” Supervisor Don Knabe said. “It’s obvious Camden didn’t do their job.”

Camden officials have strongly disputed criticism of their work, saying they made great strides under extremely difficult circumstances. Camden was paid about $1 million for its work, which was far more limited in scope than Navigant’s.

The county Department of Health Services plans to send its auditors to assess Navigant’s work in coming months.

For now, at least one supervisor said he worries that change is not coming quick enough to King/Drew.

“Racing at a snail’s pace will not achieve the immediate action required to get the hospital on its feet in providing safe, needed medical care,” Supervisor Mike Antonovich said.

“Entering the King/Drew Medical Center,” he said, “needs to be a healing experience and not a trial lawyer’s or mortuary’s meal ticket.”