The move would mark the first time the county had ceded operations at one of its hospitals to outside managers, and it underscored the county's struggles to fix years of problems at the Willowbrook medical center, near Watts.
Navigant Consulting up to $13.25 million to take over from current county managers for at least a year and complete a top-to-bottom review of how the facility operates. The firm could begin work as early as Nov. 1.
County officials said the shift would provide much more oversight of the hospital, with 23 consultants from Navigant doing the jobs that five county managers now perform. The firm intends to perform a new assessment of each doctor's and nurse's competence and productivity as well as a review of each department, such as surgery and the emergency room. It also hopes to quickly computerize records such as nurse staffing reports at King/Drew, the only hospital in the county system to still do them by hand.
Because the county remains liable for any problems at King/Drew and is continuing to pay the hospital's bills, the Navigant team would answer to Dr. Thomas Garthwaite, director of the county's Department of Health Services. The firm can recommend firing or disciplining employees, but because of labor contracts, those moves must be approved by Garthwaite or another county official.
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. Under the deal, the county must file progress reports with federal health officials every 60 days, and faces the loss of federal funds if problems are found.
Some healthcare leaders praised the county's action, calling it a bold move to fix the hospital. But given King/Drew's troubled history, some said that only time would tell whether it succeeded.
"This hospital has 30 years of defective management culture to turn around," said Jim Lott of the Hospital Assn. of Southern California. "To ask them to do that is to walk on water."
King/Drew has reeled in the last year from a series of lapses in patient care, including several that contributed to deaths, according to regulators. The latest revelation came Monday, when the county confirmed that a 28-year-old patient died last Thursday after a nurse turned down the audio alarm on his vital-signs monitor, then failed to notice that his heart was barely beating. On Wednesday, inspectors from the state and a national hospital-accrediting group were at King/Drew investigating the incident.
The accrediting group has recommended pulling its seal of 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.
Bringing in Navigant is one of the most drastic of the county's many efforts to reform the hospital. Over the last year, the county brought in its own management team and hired several consultants at a cost of about $1 million to look at ways to improve specific areas such as nursing and the accreditation process.
Fred Leaf, chief operating officer of the county health department, said the officials recommended Chicago-based Navigant because it had received "good reviews" on such other projects as a turnaround a few years ago of the Watts Health Foundation, a community health clinic and HMO.
The Hunter Group, a division of Navigant since 2002, was hired by UCLA Medical Center last year to improve the hospital's finances. The consultant recommended cutting 475 jobs, provoking the ire of doctors who said Hunter was putting the bottom line ahead of serving patients. The group worked for UCSF Stanford Health Care in the Bay Area in 1999, winning praise from administrators for boosting efficiency but criticism from labor groups for reducing medical services.
Navigant is a well-known consulting company that not only works in healthcare but also advises companies and government agencies on litigation, energy policy, corporate finance and government contracting. It has 1,500 full-time consultants based in 36 cities nationwide.
Leaf said he and others were impressed by the firm's "deep resources" of in-house healthcare experts.
The other finalist, Cambio Health Solutions of Tennessee, quoted the county a maximum price of $24 million, almost double that of Navigant.
Some union representatives have already expressed reservations about Navigant, citing subsidiary Hunter's tough cost-cutting efforts at two Northern California hospitals.
"From an employees' perspective, the Hunter Group has been known historically to slash and burn and cut and reduce," said Kathy Ochoa, a senior health policy analyst for Service Employees International Union Local 660, which represents nurses and other Los Angeles County health employees.
A spokesman for Navigant declined to comment until the King/Drew pact was approved.