The Interim Louisiana State University Public Hospital "lacks a broad vision and remains in a post-Katrina reactionary mode," according to a report that also found numerous management inefficiencies that add up to $66 million a year. The report found that per-patient costs are far above national standards, the nursing staff is top-heavy with administrators, operating rooms are under-used, and purchasing services are poorly managed. The conclusions are contained in a 161-page assessment by Alvarez & Marsal, the consulting firm that was brought on board in to oversee the hospital's day-to-day operations and search for efficiencies.