ARMC

By Mark Gutglueck
Friday, August, 23, 2013

In one of the final acts of bureaucratic housekeeping at the county hospital before a new medical director arrives next month, the hospital’s administrator this week prevailed upon the county board of supervisors to ensure that the findings of an internal audit of hospital operations remains beyond the scrutiny of the public and taxpayers. Moreover, the manner in which the item was presented limits the likelihood that the supervisors themselves will review the audit.

Patrick Petre, the director of San Bernardino County’s Arrowhead Regional Medical Center, cited a section of the state evidence code to keep under wraps a recently completed audit of the hospital’s operations that was reviewed by a handful of county employees who serve as a liaison between the hospital’s medical staff and the board of supervisors.

The board voted unanimously to comply with Petre’s request. That action came less than three weeks before Dr. Richard Pitts will assume the position of the hospital’s medical director on September 9.

A cloud has hung over the county hospital since February 2010, when California state and federal investigators began looking into alleged irregularities at the institution, including faulty diagnoses that led to the deaths or permanent injuries of patients; billing fraud with regard to descriptions of services rendered; a fiduciary conflict of interest in which the hospital’s former medical director, Dr. Dev GnanaDev, owned the medical corporation, Arrowhead Regional Surgical Group, Inc., which had an exclusive contract for the provision of certain surgical procedures at the hospital; the hospital’s alleged free provision of off-the-books medical care to individuals, including members of the board of supervisors and high ranking county officials; inadequate supervision and oversight of the emergency room, violations of law with regard to the use of physical restraints on patients in the hospital’s behavioral health ward, together with inadequate peer review of the hospital’s policies and practices.

The county initiated the first of a series of internal audits shortly after the state and federal probes were revealed as being under way.

In May 2010, the Centers for Medicare and Medicaid Services threatened to suspend Medicare and Medi-Cal payments to ARMC if the county hospital did not show improvement in operations and patient care.

On November 4, 2010 a team of more than 20 investigators, including FBI agents, members of the U.S. Attorney’s office and district attorney’s office employees, served search warrants at Arrowhead Regional Medical Center, hauling away thousands of documents and computer files. No criminal charges were ever filed, but the county’s internal examinations of its operations intensified.

Last January, GnanaDev, who had come under continuous criticism because of the perceptions of the conflict involving his dual role as the hospital’s medical director and as owner and head of the surgery group with a hospital contract, departed as medical director and was replaced by Dr. Emily Ebert, who has served the last eight months as the acting medical director of the county hospital.

Doctors and other medical professionals who work at the hospital reported that Petre was unwilling or unable to assert his overarching management authority at the hospital to hold GnanaDev in check, and had shrunk from providing recommendations to the board of supervisors that would have curtailed GnanaDev’s domination of hospital operations and the promotion of his surgical group’s financial interests, even in the face of indications this created a circumstance that was contrary to the interests of some of the hospital’s patients. Petre’s reluctance could be at least partially explicated by the consideration that some of the members of the board of supervisors had been the recipients of the off-the-books care rendered at the hospital.

In May, a number of the problematic issues that have plagued the hospital over the last four years were discussed in depth during a so-called joint conference committee meeting that involved Petre, members of the hospital staff and county employees designated to report to members of the board of supervisors. The results of recent audits of Arrowhead

Regional Medical Center’s operations were reviewed, including and together with further specific information regarding misfeasance and malfeasance by hospital staff.

This week, at the board of supervisors’ Tuesday meeting, Petre recommended to the board that it “accept the joint conference committee meeting minutes of the meeting held on May 15, 2013, and direct the clerk of the board to maintain as confidential closed session documents pursuant to Evidence Code Sections 1157 et seq.”

In making his presentation, Petre disclosed that the members of the board of supervisors had not themselves seen the audits or been directly provided with information pertaining to the hospital’s operations. Rather, Petre said, the information had been provided to “liaisons,” who were tasked to report to the supervisors the main points of what was discussed and could provide or withhold details as they deemed fit.

“On March 22, 1994, the board of supervisors established a joint conference committee to serve as a communication mechanism between the board of supervisors as the governing body of Arrowhead Regional Medical Center (ARMC) and the medical staff of ARMC,” Petre said. “A meeting of the joint conference committee was held on May 15, 2013. Discussion items at this meeting included updates on the ARMC facility, inpatient behavioral health unit, medical staff issues, legislation, and state and federal budgets as recorded on the meeting minutes. Pursuant to Evidence Code sections 1157 et seq., reports of hospital audit or quality assurance committees may be ordered to be held in closed session. Documents pertaining to the closed session portion of the joint conference committee meeting are available for review by the governing body, but shall otherwise be maintained as confidential by the clerk of the board.”

Many of the actions and activities at the hospital at issue in the Centers for Medicare and Medicaid Services and FBI probes and the subsequent audits were extant before a majority of the current board of supervisors were in office. Supervisor Janice Rutherford was not elected until November 2010 and did not assume office until January 2011. Current supervisors James Ramos and Robert Lovingood were elected in November 2012 and were sworn into office in January. In 2010, allegations surfaced that former supervisor Paul Biane, who was defeated by Rutherford later that year, was a beneficiary of the off-the-record medical care at the county hospital, as was supervisor Josie Gonzales, who remains on the board. In this way, an indirect byproduct of Petre’s recommendation was to protect Gonzales and prevent her from being embarrassed in front of her board colleagues. The timing of this week’s action also serves to keep the information from being available to Pitts.

Those knowledgeable about the contents of the hospital audit material and the items discussed at the May 15 joint conference committee meeting include deputy county counsel Frank Salazar; Monique Allen, who is on the county administrative office staff; and deputy executive officer for finance and administration Valerie Clay.