Doctor’s Marathon Shifts in Question

Martin Luther King Jr./Drew Medical Center paid more than $1.3 million over the last year for the services of a radiologist who said he worked an average of 20 hours a day, seven days a week, during one recent six-month stretch, records show.

Los Angeles County health officials said Monday that they have launched an investigation into the marathon work hours of Dr. Harold A. Tate, who was employed under a contract at the hospital. The county has paid Reliable Health Care Services Inc., a temporary agency that supplies healthcare workers to hospitals, up to $225 per hour for Tate’s services.

Health officials said they were unaware of the enormous payments made on Tate’s behalf, or his round-the-clock schedule, until the information was requested by The Times under the state’s Public Records Act.

Dr. Thomas Garthwaite, director of the county Department of Health Services, wrote in a memo Monday to the Board of Supervisors that he has “directed the hospital to withhold payment of any outstanding invoices pending the results of the department’s review.” He also said that Tate no longer works at the hospital.

In an interview, Tate stressed that he worked every hour listed on his timecards. “I took showers at the hospital. I ate my meals at the hospital. I never left,” said Tate, 45, whose permanent residence is in Las Vegas.

He said the hospital’s radiology department was so short-staffed that there was often no one else around to read X-rays and perform critical diagnostic tests. “For me to leave would be to leave the place without coverage,” he said.

Invoices and time sheets show that four King/Drew employees, including the radiology department’s interim chairman, signed off on all of Tate’s hours, even when they reached 22 to 24 a day for weeks on end.

Dr. Vaughn C. Payne Jr., the department’s current interim chairman, did not return calls for comment. Dr. Theodore Q. Miller, who was interim chair until August 2004, said he had “no recollection of the timecards that you’re talking about.”

Miller said Tate worked for the radiology department during a time when it desperately needed staff for nights and weekends and to cover the trauma center, which has since closed. The shortage became particularly acute last summer after a national accrediting group closed King/Drew’s doctor-training program in radiology.

Miller said he recalled Tate working through a weekend but never “working weeks at a time, 24 hours at a time.”

Hospital medical director Dr. Roger Peeks said he, too, knew Tate was working a lot, but believed the bulk was restricted to weekends. In hindsight, he said, someone should have been paying attention.

“Nobody should work that many hours,” Peeks said. “And it was wrong on everybody’s part. It’s wrong on our part for not catching it sooner, and Reliable had to know that he was working those hours. They’re paying him.”

E-mails obtained by The Times suggest that the hospital’s acting administrator did at one point last summer question Tate’s 24-hour days and ordered the staff to pay only for time Tate was awake and working.

“We can only pay for hours worked!!” David Runke wrote in one e-mail on June 28. Make “sure you don’t authorize payment for hours not worked!!”

Health department spokesman John Wallace said he could not explain why Runke’s orders were ignored and the invoices paid.

Shane Nagore, a vice president with the Culver City-based Reliable, said his agency isn’t in a position to verify a doctor’s hours, which are worked out directly with the contracting hospital.

“We have nothing whatsoever to do with the scheduling of any doctor who goes to King/Drew,” Nagore said. “They ask us for doctors. We provide them with those doctors. At that point, it is completely at the discretion of the hospital to schedule those doctors as they feel they’re needed.”

Reliable pays for liability, medical malpractice and workers’ compensation insurance for its contractors, but Nagore said Tate received more than three-quarters of the money paid to the agency for his services.

That means that Tate received about $1 million of the $1.319 million King/Drew paid Reliable for Tate’s services between March 2004 and February 2005. The payments to Tate follow repeated problems with physician work habits and special contracts at the public hospital in Willowbrook, just south of Watts -- and promises by county health officials to scrutinize them.

Supervisors, for instance, criticized the salary and productivity of King/Drew neurosurgeon George E. Locke, who earned more than $1 million in the last two fiscal years while performing only a handful of surgeries.

In December, The Times detailed that Locke’s timecards sometimes showed him working more hours than he actually spent at the hospital. For instance, last July 26, Locke’s timecard showed him working 12 hours and being on call an additional 14, for an impossible total of 26 hours. He was at the hospital for 6 1/2 hours.

Locke retired in February. His attorney has said Locke did nothing wrong.

King/Drew also paid nearly $1 million over five years to a surgical instrument company owned by one of its orthopedic surgeons, in violation of Los Angeles County’s conflict-of-interest laws.

King/Drew has come under intense scrutiny from regulators and accreditors over the last 21 months because errors and neglect have repeatedly harmed or killed patients.

A Times investigation published in December found that the hospital’s failings did not stem from a lack of money, as its supporters had long contended. In fact, in many instances, money at the hospital had been squandered. Millions of dollars went to such things as unusual workers’ compensation claims and high doctor salaries.

Garthwaite, the health department director, said the payments to Tate showed additional gaps in oversight at the hospital. “Obviously, someone has not paid close attention to what they’re signing,” he said. “I don’t know the reason why.”

Tate said officials at the hospital were well aware that he was often working round-the-clock, and he finds it baffling that they now deny it. In fact, he said, for months on end his wife had to come to the hospital to see him because he couldn’t leave.

“They’re the ones who asked me to do it,” he said, referring to hospital officials. “They signed the invoices, didn’t they? And they approved it, right?

“They never complained about the quality of work. They never complained about me being unavailable. They never complained about the quality of the interpretation or the procedures.”

Dr. Robert Wachter, chief of the medical service at UC San Francisco Medical Center and coauthor of a book on medical errors, said he couldn’t see any valid reason why a radiologist would need to work such long hours.

“I would be concerned,” he said. “Can you be as careful after 20 hours as you were in your third hour? It defies logic to believe that the answer is yes.”

In his memo to the county supervisors, Garthwaite said that hospital staff members said Tate “spent quite a bit of time working at the hospital, but also indicated that he was provided a room to sleep on campus.”

“Thus, we believe that the facility paid Dr. Tate for time that he was on call rather than performing interpretations.... The intent of the contract was not to compensate a physician while he slept, nor

Supervisor Gloria Molina said Monday she had “never seen anything as outrageous as this particular contract.”

Molina said she was embarrassed not only that King/Drew paid Reliable so much, but that the county had to learn about it from The Times.

“It just seems as though the [health] department can’t be trusted when it comes to these types of contracts.

“I don’t know if this is the final humiliation,” she said. “I’m just trying to understand at this very moment.”

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Highly paid

Martin Luther King Jr./Drew Medical Center paid more than $1.3 million to a health staffing company over a 12-month period for the services of one radiologist, Dr. Harold Tate.

Monthly billings*

2004

*--* March $65,063 April 66,875 May 73,063 June 24,813 July 138,150 August 144,900 September 111,375 October 157,950 November 132,075 December 144,000 *--*

2005

*--* January 122,175 February 138,825 *--*

*--* Total $1,319,264 *--*

*At $125 per hour through June 2004 and $225 per hour thereafter

Source: Los Angeles County Department of Health Services