Los Angeles County-USC Medical Center cannot account for the workday whereabouts of nearly 12% of physicians hired under a $70-million contract, according to a county audit released Thursday.
Although the contract requires USC to provide licensed physicians for patient care and to train medical residents, the hospital "does not systematically monitor whether physicians are complying with the work schedules," according to the report by county Auditor-Controller J. Tyler McCauley.
McCauley said that the inability to locate doctors at the 745-bed hospital had been an issue "for a number of years." He said the county's main goal was to change the perception among some physicians that accounting for their whereabouts "was something that doctors shouldn't be concerned about."
Conducted during two- and three-month spans over three years at County-USC and the Claude Hudson Comprehensive Health Center, the review found that auditors had been "unable to locate" 7% to 15% of physicians at the hospital at any given time.
The audit is required under a contract with USC, which requires the university to provide the equivalent of about 435 physicians and 75 nonphysician staff members to the hospital. The school is supposed to provide work schedules indicating when the doctors will be providing resident supervision or patient care.
Carol Mauch, USC's associate general counsel, said that the physicians provided by the school had been "running around trying to save lives, not standing in place, glued to the floor," and that the county's auditors would "walk into a room, look around and say the physician was not there, and then leave."
In fact, the audit noted that physicians might have been providing services in other locations, but that auditors had attempted to track down doctors and, in some cases, had still been unable to locate them.
"There may be reasons that some ... weren't there and there may not be reasons for others," McCauley said. "The biggest concern is that there's not a system of accountability."
McCauley' report found that the university provided some work schedules that consisted of weekly lists of physicians scheduled to work, but that the schedules did not indicate specific days and times that individual doctors were expected to be present.
The audit also found that there was no consistent format used for the work schedules, and that they sometimes were produced late, after the month they applied to had already begun.
Peter Gruen, County-USC's service chief of neurosurgery and president-elect of the hospital's medical staff association, said that doctors are required to fill out a form with only four options to indicate their locations on a given day.
"I'm in 24 locations" a day, Gruen said. "I gave up my gym membership because, between the lab, the clinic and the operating room, I walk 5 miles a day."
But Gruen agreed that the hospital does need to improve its ability to track doctors who "aren't there when they're supposed to be."