Doctor Moonlighting Inquiry Is Urged

Two Los Angeles County supervisors called Tuesday for a sweeping investigation into what one called “the moonlighting scandal” among doctors at public hospitals, saying that the widespread practice represents a breach of public trust that has severely compromised patient care.

Board of Supervisors Chairman Zev Yaroslavsky and Yvonne Brathwaite Burke said they will insist that such a review begin immediately, and that it ultimately result in significant reforms in the way the county regulates the hundreds of doctors it employs.

Supervisor Don Knabe agreed that surprise audits and inspections at the six county hospitals could help clamp down on excessive moonlighting by doctors spending too much time in lucrative private practices. County regulations allow doctors 24 hours of outside employment a week, if their supervisors approve.

The lawmakers’ calls for an investigation were prompted by a Times story Sunday, reporting that a vascular surgeon at Martin Luther King Jr./Drew Medical Center had been fired after county investigators concluded that he was unavailable to perform surgery on a gunshot victim because he was in the operating room at a nearby private hospital as part of an unapproved private practice.

The patient, 31-year-old Torin Comeaux, spent six hours awaiting surgery at King/Drew’s trauma center because no vascular surgeon could be summoned to treat him. He was airlifted to another public hospital’s trauma center, where he later died after surgery on a gunshot wound to the knee that medical experts said should not have been fatal.

Dr. Edward Sims, the surgeon who health officials allege declined an “emergency” request to operate on Comeaux, resigned Monday rather than fight his dismissal through the county Civil Service system, sources said Tuesday.

Through his attorney, Sims has denied any responsibility for Comeaux’s death because he was not on call at King/Drew that day and because no one at the trauma center told him that there was an emergency when they paged him that day. Sims alleged that his superiors were at fault because they failed to put a vascular surgeon on call that day, which is a violation of county regulations.

On Tuesday, Yaroslavsky and Burke said someone should be held accountable for the incident.

“It is one thing when it is just financial mismanagement,” Yaroslavsky said. “But it is another when someone has to die because of it.”

Yaroslavsky, who stressed that he wasn’t passing judgment on Sims’ conduct, directed Health Services Director Mark Finucane to immediately investigate moonlighting among county doctors. “You need to clear the air on this in order to restore public confidence in the system,” Yaroslavsky wrote. “It is imperative that you review this matter immediately and take whatever corrective actions are necessary.”

Burke, who represents the south Los Angeles district that includes King/Drew, said she was angered that past investigations have done little to correct what she described as a long-standing problem among hospital managers, who look the other way when their physicians moonlight excessively.

“Everyone knew about it,” Burke said of Sims’ moonlighting at St. Francis Medical Center in Lynwood, where he serves as medical director of the hospital’s sprawling trauma center.

Sims’ attorney, Rees Lloyd, charged Tuesday that the story concerning his client published Sunday “egregiously violated the rights of Dr. Sims to confidentiality and privacy and . . . [the] persons responsible for the treatment of a patient who died on April 12, 1997, are attempting to get off the hook by scapegoating an innocent man. I have advised Dr. Sims not to continue to work under such conditions, and we will be taking appropriate legal actions against all persons responsible.”

Sims, Lloyd said, will “welcome a full investigation.”

Burke said she was especially troubled by a Health Department investigative report that concluded that Sims was often scheduled at both hospitals at once. In addition, Burke said she could not understand why Sims’ superiors told him at least three times to stop his activities at St. Francis or quit his full-time post at King/Drew, but never acted against him until after Comeaux’s death.

County sources initially said they were so upset at Sims’ alleged activity that they would not let him resign, so that their efforts to fire him could be reported to the Medical Board of California and agencies that monitor surgeons. On Tuesday, however, Sims’ resignation was accepted rather than put everyone involved through a protracted Civil Service case that could result in his dismissal being reduced to a less severe punishment, sources said.

It was unclear whether Sims’ activities would be reported to the Medical Board. Health Department spokesman Fred MacFarlane said he could not comment on the Sims case because it is a personnel matter.

Gregg Rademacher, assistant executive officer of the Los Angeles County Employees Retirement Assn., said any employee eligible for a pension remains eligible even if they are fired.

Burke said the county should seize on the Comeaux case to institute sweeping reforms regarding moonlighting.

“I have asked questions about it again and again,” Burke said. “I have never understood why it is so difficult, or why it is taking so long.”

After The Times reported on widespread moonlighting problems in 1995, county officials pledged an investigation, but it did not lead to any disciplinary action. Recently, Burke said, she has continued to receive complaints about doctors at all county hospitals who moonlight excessively.