Hospital Audit Questions Hours

Two dozen physician contractors at Martin Luther King Jr./Drew Medical Center billed for hundreds of hours this year that could not be accounted for, according to a new audit suggesting that fiscal mismanagement and possible fraud persist at the public hospital even as it struggles to reform.

In the emergency department, for instance, the six doctors working under contract billed for a combined 2,200 hours in April and May. Even after taking into account patient care, meetings and lectures, 39% of those hours could not be explained, according to a confidential report that Los Angeles County auditors sent Thursday to the Board of Supervisors.

The doctors collected a total of nearly $75,000 for those questionable billings.

In addition, the audit found that 12 doctors -- some from the ER -- signed deals to become higher-paid independent contractors while they were still on the county payroll or within a year after leaving. That is a violation of county rules, which seek to limit the use of contractors largely to situations in which permanent staffers cannot be found.

One of those doctors, a neurologist, was paid twice for at least 20 hours of work -- as both a contractor and an employee -- in 2002 and 2003, the audit said.

The auditors’ findings focus mostly on the first five months of this year. They come as the hospital is attempting to correct lapses in patient care, which have been linked to numerous patient injuries and deaths, and rampant wrongdoing among staff members.

The county is paying a turnaround firm, Navigant Consulting Inc., $15 million to run the hospital for a year, but many lapses in medical care and management have surfaced under the company’s watch.

The auditors, who are from the county Department of Health Services, found that oversight was virtually nonexistent across many medical departments. Medical department chairmen did not verify the accuracy of work hours reported for contract physicians, and were not familiar with county rules, the audit said.

County supervisors ordered the latest audit in April after The Times reported that King/Drew had paid more than $1.3 million from March 2004 to March 2005 for the services of a radiologist who said he worked 24-hour days for weeks at a time.

“As we have continued to find and fix weaknesses in nearly every system at [King/Drew], it is not surprising that we find weaknesses in physician contracting as well,” wrote Dr. Thomas Garthwaite, director of the health department, in an accompanying memo to the five supervisors.

He said he would recommend ways to strengthen contracting rules this fall.

Garthwaite said that instead of paying permanent physicians an hourly wage, the county should consider paying a competitive fixed rate for their services, with bonuses for quality and productivity. That would reduce the need for contractors.

Supervisor Gloria Molina said Garthwaite was acting too slowly in the face of mounting evidence of wrongdoing among workers.

“Unfortunately I don’t get the assurances I should be receiving from Dr. Garthwaite that he’s going to be taking immediate action about these items,” she said. “It clearly points to mismanagement of the Department of Health Services.”

In an interview, Garthwaite responded that his department would seek to recoup any money it believed it was owed by doctors.

Dr. Eugene Hardin, chairman of the hospital’s emergency department, said the county shouldn’t single out King/Drew for intense scrutiny. “I think it would be only fair if it was done for all the county hospitals,” he said.

Hardin said he believed that the physician contractors in his ER worked all of the hours they claimed, even if they couldn’t prove it on paper. Much of their unaccounted-for time has been spent on research, preparing lectures or reviewing patient charts, he said.

Hardin acknowledged recently that he had terminated one ER physician’s contract within the last year because he was unable to verify the hours the contractor worked, but he said the case was an anomaly.

“I don’t see anyone who I feel has been fudging or cheating on their timecards,” he said. “If I found someone like that, I would ask for money back.”

Until May, ER physicians were required to sign in every day, but the process was discontinued because of physician dissatisfaction, the audit said. Earlier sign-in sheets were set aside for shredding, according to a June 13 e-mail written by Hardin to a colleague and obtained by The Times.

The discontinuance came about the same time that the county’s auditor-controller recommended more stringent oversight of contractors. In a report, the auditor said that the health department “should immediately direct hospital managers to require that contract physicians obtain independent verification they were present when scheduled.”

Two months later, health officials say they are still studying the best way to do this.

Dr. Moustafa Moustafa, one of the ER doctors whose hours could not be entirely verified by auditors, said he and his colleagues worked at the hospital largely out of good will. They could be making much more money in the private sector, he said.

“We’re kind of like an endangered species,” said Moustafa, who earned about $197,000 from June 2004 to this May and averaged more than 45 hours a week.

“Our guys are quitting. It’s too much work for them,” he said. “The money the county is giving is not enough for them. It’s too much headache.”

Among the findings in the audit sent to the supervisors Thursday:

* One ear, nose and throat doctor billed for 818 hours from January to May even though he was only scheduled to work 288. There were no records to explain the discrepancy.

* King/Drew has paid two cardiothoracic surgeons for being on call even though their contracts only allow payments for when they are at the hospital. One of those physicians billed for 471 hours off-site from January to May.

* King/Drew’s payments to the ER doctors for training residents may have been improper because academic services are supposed to be covered under the county’s relationship with King/Drew’s affiliated medical school, which the county also funds.

“It just seems to me at some point there has to be someone up the chain who’s responsible,” Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew, said recently. “We have all these people that we’re paying that are ostensibly looking at these things. I just don’t understand it.”

Burke suggested that the hospital invest in a high-tech system in which physicians scan their handprints when they enter and leave work to verify their presence at the hospital.

“It’s expensive, but it’s effective,” she said.