King/Drew Might Fail Inspection

Martin Luther King Jr./Drew Medical Center remains unprepared for an upcoming government inspection that is expected to determine whether the public hospital will lose $200 million in federal funding, Los Angeles County’s health director said Tuesday.

The grim assessment by Dr. Thomas Garthwaite comes after the county Department of Health Services has spent two years and tens of millions of dollars trying to instill accountability in employees and address sometimes-lethal lapses in patient care.

In a 20-page memo sent to the county Board of Supervisors before its regular meeting Tuesday, Garthwaite said federal regulators and county health officials believe there is a “significant possibility” that the hospital will fail to meet minimum standards needed to retain its federal support, which amounts to more than half of its annual budget. The inspection could occur any time in the next two to three months.

If the funding is lost, Garthwaite told the board Tuesday, he would recommend closing King/Drew or handing control of it to a private hospital chain. The hospital south of Watts serves a mostly poor and minority community in South Los Angeles.

Despite his prognosis, Garthwaite also told the board Tuesday that he would seek a six-month extension -- worth up to $5 million -- for the consulting firm that was hired to turn the hospital around and prepare it to pass its regulatory inspections. The money for Navigant Consulting Inc. would come on top of the $15 million it has been promised under a one-year contract that expires at the end of this month.

The proposed contract extension has provoked heated debate among supervisors, health department officials and county lawyers.

In three separate reports, county auditors have criticized the firm for overstating the work it has done and submitting inflated expense reports.

And in an Oct. 12 e-mail, reviewed by The Times, Senior Assistant County Counsel Leela Kapur wrote to a health department manager: “What is the answer to the board’s question, if asked, ‘Why is the department paying Navigant millions of dollars to complete tasks they were already suppose[d] to have completed under the original contract amount?’ ”

In an interview, Garthwaite said reforming King/Drew has proved harder than expected -- especially recruiting nurses and managers. Dropping Navigant at this late date would remove many of the managers the hospital needs to operate, he said.

Garthwaite said he does not blame Navigant for failing to meet all of its promises.

“I think you could certainly argue that in September, October 2004, it would be very difficult to imagine all the unanticipated challenges that have occurred,” he said.

A consulting firm that competed against Navigant for the original contract sent an unsolicited bid Tuesday to the Board of Supervisors, saying it was better equipped to help the hospital and ready to step in.

FTI Cambio Health Solutions is “prepared to offer you an alternative that will finally allow you to achieve the results you desire and do so in a manner that is affordable and offers a lower risk,” managing director Thomas Layton wrote in a letter to supervisors.

By a 3-2 vote, the board passed a motion by Supervisor Mike Antonovich calling for county officials to study the Cambio proposal and report back next week. Before the motion was approved, however, county Chief Administrative Officer David Janssen said he had already concluded that Cambio’s bid was an “enormous distraction.”

Antonovich and Supervisor Gloria Molina have openly complained about Navigant’s stewardship. On Tuesday, Molina said the firm “hasn’t been all that helpful” in the effort to reach the hospital’s goals.

King/Drew nursing attendant Tamasha Earl told the supervisors that Navigant has tried to scapegoat the hospital staff.

“It is their credibility that is in question,” said Earl, a union shop steward. “They have no track record with the clinical challenges we’re facing at King/Drew.”

Navigant managing director Kae Robertson, who was at Tuesday’s Board of Supervisors meeting, declined to comment.

The most pressing concern for King/Drew right now is the upcoming federal review. The U.S. Centers for Medicare and Medicaid Services has said it will conduct a top-to-bottom inspection within 60 to 90 days, Garthwaite said.

“If it stretches out toward the 90 days, we have a much better chance than if they come tomorrow,” he told the board. “If they come tomorrow, it’s likely we won’t pass.”

In his memo, Garthwaite detailed how King/Drew would fare today in 23 areas needed to keep federal funding, using a rating system of one to five (with five signifying substantial compliance). Although the hospital is doing better than it was in October 2004, according to the memo, consultants assigned scores of four or five in only eight areas.

In one category, pharmaceutical services, Navigant rated King/Drew in minimal compliance with federal rules, citing problems with documentation, administration and follow-up. That same area was identified as in crisis in March 2004 after a meningitis patient was mistakenly given a potent anti-cancer drug for four days.

Jeff Flick, regional administrator for the Medicare agency, said regulators do not comment on inspections before they are done.

“Our surveys are objective, with no determinations made in advance,” he said.

Garthwaite said King/Drew was even less prepared for an inspection by the Joint Commission on Accreditation of Healthcare Organizations, which withdrew its seal of approval in February because of lapses found during an inspection last year. The hospital is seeking to restore this accreditation, which is critical for certain funding and public relations.

Preparations are running so far behind schedule that King/Drew has sought to postpone its inspection to March from December.

Garthwaite told the supervisors that he was concerned about releasing the information about King/Drew’s lack of preparedness.

“I put it out in the public domain with some trepidation,” he said, “but I think it’s important for everyone to understand where we are.”