Health Chief Vows to Curb Moonlighters

Seeking to calm a growing controversy over his department’s lax oversight of moonlighting by doctors at public hospitals, Los Angeles County Health Services Director Mark Finucane issued a stinging self-critique Tuesday and pledged to implement an 11-point plan correcting what he said were systemic management problems.

During a lengthy appearance before the county Board of Supervisors, Finucane conceded that lapses in oversight and discipline have allowed many physicians employed by the county to pursue their private practices at the expense of patients in the six public hospitals and dozens of smaller medical centers.

In a detailed memo to the supervisors, the director said he will improve his department’s management and make eradication of excessive moonlighting his “highest priority.”

“Oversight of physician outside employment,” Finucane wrote, “has proven to be a very serious management deficiency and has served to erode the public’s trust in the department.”

A wide array of problems remain, Finucane said, despite probes of problem doctors’ activities by county auditors and investigators for the health department and the district attorney. Many of those problem physicians, he said, have escaped consequences for years because of lax supervision and Civil Service protections that require a carefully documented, step-by-step disciplinary process.

County doctors are allowed to accept 24 hours of outside work per week, if their supervisors approve.

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Citing a Times report Tuesday that disclosed breakdowns throughout the county system charged with regulating such activities, Finucane said, “Outside employment irregularities have continued to occur as a result of inconsistent supervisory practices, misunderstandings among physicians and physician managers relative to work expectations and time reporting, and inappropriate work schedule agreements between medical managers and hard-to-recruit sub-specialty physicians.”

Finucane promised the board repeatedly that the situation would be corrected. He said he would provide a detailed status report in 30 days.

“Talk is cheap,” said Board Chairman Zev Yaroslavsky. “This seems to be pervasive. It seems to go beyond one hospital. I think you need to act. You’ve got to match your actions with your words.”

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Yaroslavsky, who last week called on Finucane to launch a thorough investigation into moonlighting problems, added, “No person should have to die because we’re not holding ourselves accountable for doing our jobs the right way. That’s the ultimate failure, the ultimate breakdown.”

Yaroslavsky was referring to a highly publicized case in which 31-year-old Torin Comeaux, a gunshot victim, died April 13 after spending more than six hours in the emergency room at the county’s Martin Luther King Jr./Drew Medical Center, while doctors tried to find a vascular surgeon to operate on him. One of the trauma center’s four vascular surgeons, who was contacted by King/Drew that day, was later sent a dismissal letter. Health department investigators alleged that the surgeon, Dr. Edward Sims, refused an “emergency” request to help, and ignored three warnings to curtail his private practice work at a nearby hospital.

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Sims was not on call at King/Drew on the day in question, and was operating on patients in his private practice. Through his lawyer, he has denied any wrongdoing and denied that his moonlighting played any role in Comeaux’s death. He resigned last week, and has blamed his hospital superiors for failing to have a vascular surgeon on the call schedule.

Tuesday, several county supervisors told Finucane that they were embarrassed by continued disclosures of moonlighting and managerial problems, saying they have heard of cases in which doctors’ absences have jeopardized patient care.

“Our physicians,” said Supervisor Yvonne Brathwaite Burke, “need to take care of patients right here in our own hospitals.”

Finucane appeared with his second-in-command and chief medical trouble-shooter, Dr. Donald C. Thomas III. Both said they will move to immediately designate a top-level “point person” at each hospital to oversee outside employment issues and root out problems.

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That person probably will report to each hospital’s top administrator or to the medical director, and will be specifically responsible for reviewing each doctor’s current moonlighting activities to prevent conflicts with their county duties.

Department leaders also will review all investigations and audits of problem doctors done over the past 18 months, Finucane said, to see if disciplinary measures are warranted.

Finucane pledged to do away with any under-the-table “deals” that have been struck with surgical specialists to close the gap between their incomes and those usually earned by colleagues in the private sector. From now on, special contracts to pay these doctors extra money or to allow them special leeway in moonlighting will be drawn up only with the Board of Supervisors’ approval, he said.

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The health director vowed that hospital supervisors will be required to watch doctors more closely, evaluate them regularly, to discipline them when needed, and to ensure that their time cards and required outside employment forms are kept up to date and filled out in detail.

“I want all of you to understand: This is the last time we are going to fix this,” Finucane assured the supervisors. “We have made clear we will try to change the system.”

But, Finucane cautioned, such an overhaul will take time. “This has been a problem a long time building,” he said, “and we will still have pockets of it” no matter how aggressive the oversight.

The county employs nearly 3,000 doctors, and just over a dozen investigators charged with uncovering fraud, waste and abuse in all health department programs. For that reason, Finucane said, strict supervision will be critically important as the department tries to clamp down on moonlighting in the coming months.

“I hope this is the end of the apologies and the excuses and the ‘I’m gonna’s’ ” said Supervisor Gloria Molina, who criticized Finucane for not taking decisive action sooner. Molina said an “ingrained culture” of lax oversight and little or no discipline of problem doctors had taken root before Finucane took over the sprawling health department 18 months ago.

“That culture has to change,” she said.