County Doctors Face More Oversight

Los Angeles County supervisors ordered their top health officer Tuesday to tighten oversight of county doctors after a critical audit found errors on timecards, including a few cases in which doctors claimed hours for time that they had spent at home, in private practice or at the gym.

The confidential audit, which was obtained by The Times, faulted the county Department of Health Services for failing to better monitor doctors’ work habits, allowing a culture to develop in which physicians showed disdain for filling out timecards and supervisors did not check the cards.

Auditors trailed 30 doctors and found three who reported on timecards that they were working at county hospitals at the same time that investigators saw them elsewhere. One visited a gym, a second took his car to a dealership for service, and a third was at home, investigators said.

Auditors said they would conduct follow-up investigations into the three to determine whether the findings should be referred to county prosecutors.

Another unidentified doctor at Rancho Los Amigos National Rehabilitation Center in Downey was paid for three workdays that he said stretched beyond 24 hours each.

Hospital managers told auditors that the doctor was new and had made an error filling out his timecard, the report said.

“However,” auditors wrote, “the error should have been identified and questioned by the physician’s supervisor when the supervisor reviewed ... and approved the timecard.”

Auditors surveyed timecards for 86 of the 1,200 county-employed physicians and found that 40 had discrepancies in the times and dates listed when compared with hospital schedules. “The culture undermines efforts to create and support physician time accountability overall,” auditors wrote. “This allowed an atmosphere where some physicians abused the system.”

Dr. Thomas Garthwaite, the county director of health services, said he agreed that doctors and their supervisors should work to ensure that timecards were accurate, but he added that many doctors were giving far more hours to the job than they were paid for.

He said the audit unfairly blamed the department for reluctance among physicians to fill out timecards.

In private practice, physicians bill for work they perform, such as surgeries or patient exams, rather than how long they spend on them -- a practice that Garthwaite said discouraged county doctors from logging their hours.

“My estimation is that physicians are not good at following exact schedules because, in general, healthcare doesn’t follow exact schedules,” he said.

Garthwaite said he hoped to introduce payment procedures for doctors that would emphasize the type of work performed rather than the time spent doing it.

“The way we pay physicians in the county needs to be overhauled,” he said.

Supervisor Mike Antonovich said the audit criticized the county health department for its haphazard approach to monitoring doctors’ hours. Only two hospitals required doctors to record the times they arrived at and left work.

“The department is in disarray, and they have no consistent policy in place to monitor their employees,” Antonovich said. “You don’t have to be a rocket scientist to devise a timecard system that is fair.”

None of the county’s medical facilities compared physician work schedules to their timecards, the audit found. And of all the hospitals, only one medical department -- at Olive View-UCLA Medical Center in Sylmar -- compared doctors’ sign-in logs with their timecards.

Acting on the recommendation of auditors, county supervisors ordered the health department to adopt the Olive View department’s practice at all its facilities.

They also ordered the adoption of 10 other audit recommendations, including a standardized sign-in system for doctors and discipline for noncompliance.

County supervisors ordered the audit earlier this year following reports of timecard abuse by county-employed physicians and those under contract at Martin Luther King Jr./Drew Medical Center.

But the latest audit reviewed timecard practices throughout the county’s four general hospitals, at Rancho Los Amigos and at High Desert Hospital, which is in Lancaster.

“We know that this is a systemwide issue, but no one ever talks about any of the others but King,” said Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew. “That’s been going on forever.”