Vascular Surgeon at King/Drew to Be Fired

Los Angeles County health officials have decided to fire a vascular surgeon at Martin Luther King Jr./Drew Medical Center for unauthorized moonlighting, insubordination and failure to fulfill his duties at the public hospital.

The action follows an extensive investigation, which concluded that Dr. Edward Sims’ conduct severely compromised patient care at the hospital in South Los Angeles. As an example, according to Health Department sources, their investigators allege that Sims was so deeply involved in his surgical practice at a nearby private hospital, St. Francis Medical Center, that he refused an emergency request to operate on a patient, 31-year-old Torin Comeaux, who died at another public hospital after waiting six hours for surgery in King/Drew’s emergency room.

Sims “was in another OR,” said one county official, “when he should have been in ours.”

County health officials, who declined to comment publicly on the Sims case, have long believed that their sprawling system has a problem with doctors who moonlight excessively in lucrative private practices.

“The reason for the concern over moonlighting is that it means someone is working at two places,” said Health Services Director Mark Finucane, who recently ordered a review of all county doctors’ outside employment. “It is important that it be managed and overseen very carefully, so that patient care is not jeopardized. Someone needs to be available when he or she is called.”

Sims referred all questions on the case to his attorney, Rees Lloyd, who says his client is being made the “scapegoat” in a highly publicized incident that revealed two serious violations of county regulations at King/Drew’s trauma center.

Although Lloyd acknowledges that Sims received a call from the hospital’s emergency room the evening Comeaux was admitted, he denies that the surgeon was asked to operate on the young man and points out that the surgeon “was not on call” that night. In fact, no vascular surgeon was scheduled to be on call at King/Drew at the time, a violation of county regulations that Lloyd blames on Sims’ superiors--particularly the chief of surgery, Dr. Arthur W. Fleming. The attorney also charges that his client’s superiors neglected to notify the county’s trauma network, as required, that the hospital’s emergency room was inadequately staffed.

“They’re trying to concoct something to scapegoat [Sims] and get themselves off the hook,” the lawyer said. Sims, according to Lloyd, cannot be held responsible for any aspect of the Comeaux case because he wasn’t officially on call and, therefore, it does not matter if he was at St. Francis “or Disneyland or Timbuktu.”

The surgeon, his lawyer said, “was never told there was an emergency, and he was never contacted thereafter. He says unequivocally that, if he was told there was a need to deal with that patient, he would have dealt with that patient even if they had to transfer him to St. Francis.”

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As required by law, Health Department sources say, King/Drew notified Sims in a letter dated July 18 that it intends to dismiss him. As a civil servant, the surgeon has 10 days from the receipt of such notice in which to decide whether to contest his firing.

For more than 18 months, Sims not only has been on the county hospital’s payroll as a full-time vascular surgeon, but also has served as medical director of trauma services at St. Francis in Lynwood and performed general surgery there. County employees are allowed to accept 24 hours of outside employment each week, if their supervisors approve.

But Sims, county investigators found, received three written orders from his superiors at King/Drew either to stop working at St. Francis or quit his county job. The first such notice, according to county officials, was sent March 7, 1996. The final notice directed Sims to quit one full-time post or the other by Feb. 10, two months before the Comeaux case.

One of Sims’ duties at St. Francis, according to hospital spokeswoman Linda Woo, is to make sure the trauma unit is “appropriately covered” with enough trained surgeons to do any required operations. In fact, investigators say, on the day King/Drew’s emergency room contacted Sims about Comeaux, the surgeon treated three patients at St. Francis, two while Comeaux was waiting at King/Drew.

Hours later, early on the morning of April 13, Comeaux died. He had been shot the day before by an unknown assailant--apparently by mistake--while driving his young son on a weekend outing. Medical experts say the wound to Comeaux’s knee was not serious enough to endanger his leg or his life--had it been properly treated in a timely fashion.

Neither Sims nor the three other vascular surgeons who work at the King/Drew trauma unit were available to operate on Comeaux. Despite that fact, as Sims’ lawyer points out, King/Drew officials failed to notify the county’s emergency medical alert center that their trauma unit was inadequately staffed, as regulations require. Had they done so, Comeaux would have been taken to a hospital where a surgeon was available.

As a result, the young father spent the afternoon and evening at King/Drew awaiting vascular surgery. Shortly before midnight, he was airlifted to County-USC Medical Center, where he underwent more than six hours of surgery. He died that morning.

According to Dr. Donald C. Thomas, the county’s director of health services and clinical affairs, Comeaux’s death “pointed up a number of factors that went wrong, all of which have been corrected.” Health Department sources say that has involved minor discipline of at least four other county employees.

As The Times has reported, the “call schedule” for King/Drew’s trauma unit shows that no vascular surgeon was scheduled for duty from April 11 through April 30. As a Level One trauma center, King/Drew is required to have a vascular surgeon available and within 30 minutes of the operating room at all times.

Surgery chairman Fleming, who is ultimately responsible for scheduling the trauma unit’s vascular surgeons, did not return calls seeking comment.

According to a confidential report by investigators for the Health Services Department, they began probing Sims’ activities when, in the wake of Comeaux’s death, they received an anonymous letter alleging that “on multiple occasions [Sims] has refused to come when placed on call, and openly states in writing that he will not respond when called.”

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The investigators found that on at least two occasions Sims informed his superiors in writing that “if he were called, he would not be able to respond.”

The report concludes that the surgeon was working so many hours at St. Francis that “it does not appear that Dr. Sims can fulfill his duties at MLK.”

Investigators also concluded that there were 24 days on which Sims appeared to be working jobs at both hospitals at the same time--on duty at King/Drew, but on call as the primary or backup general surgeon at St. Francis. Because both hospitals--and county trauma network regulations--require that the on-call surgeon be constantly available for emergencies, such scheduling conflicts “may have or would certainly have impacted his MLK work schedule if he were called upon,” the report concluded.

The report also notes that on the day after the physician’s shifts at St. Francis, “Dr. Sims has either taken off the day [at King/Drew] or worked a minimum day (5 hours or less). This occurred on 17 occasions” from December 1996 through May 1997.

During the five months covered in the report, investigators found, Sims worked his required monthly hours at King/Drew only once. He worked 28.5 hours out of a required 152 in February 1997, 99 hours out of 168 required in December 1996, and 83 hours out of a required 160 in May 1997, the investigators found. Over the same period, Sims worked 35 24-hour shifts at St. Francis.

Hospital administrators, including chief operating officer Randall Foster, medical director Edward Savage and Fleming did not return repeated calls seeking comment.

According to investigators, when Sims was called by Dr. Juan Maldonado, a King/Drew trauma team chief, on the day Comeaux was brought in, the surgeon rejected what county officials characterize as an emergency request.

King/Drew’s staff also tried to reach the hospital’s other vascular surgeons. Fleming, who is also in the vascular surgery rotation, was out of town because of a death in the family. Another surgeon was away attending a hospital-approved conference, and the fourth vascular specialist was recuperating from a heart attack, according to the sources and interviews with county officials.

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Lloyd, Sims’ lawyer, alleges that the surgeon’s dismissal is part of a long-running conflict with Fleming, King/Drew’s surgical chief. Two months ago, in the wake of the Comeaux case, Fleming sent an internal letter to the hospital’s staff in which he appeared to blame some of the trauma unit’s problems on Sims.

Among Fleming’s accusations: “On multiple occasions since January 1996, [Sims] has refused to come in when placed on call, and openly states in writing that he will not respond when called.”

Lloyd, however, said the physician never has refused to operate on a patient, but that he had on occasion written to Fleming to refuse scheduling assignments because they conflicted with his private practice schedule.

“He has never said he won’t come in,” Lloyd said. “He’s said, ‘Give me a different date. I can’t do it on that’ ” date.

County personnel guidelines, however, stipulate that county doctors must give their full-time jobs at public hospitals first priority.