One of the most senior doctor-professors at the countys Martin Luther King Jr. Medical CenterCharles Drew University Medical School has been accused, in a union grievance, of ordering faculty physicians to work, sometimes without pay, in his own private clinic.
A top county Department of Health Services official acknowledged the grievance this week, and assured the Weekly that at this moment, the questionable activity has been stopped. DHS Assistant Director Donald Thomas added, Were still in the process of investigation. Both county and Drew University officials are handling the investigation, he said.
The complainants are being referred to by some county-health insiders as the Imperial Heights Eight. The grievance was filed with the Los Angeles County Employee Relations Commission by Joe Bader, who heads the Union of American Physicians and Dentists (UAPD), which early this year won the right to represent the countys public-health physicians.
The UAPD grievance emerged this autumn, after the involved physicians and several colleagues -- in all, eight fully qualified teaching doctors employed by Los Angeles County for upward of $100,000 per year at the Imperial Heights Health Center -- said they were admonished by Dr. Ludlow B. Creary and an administrative assistant for protesting to county Department of Health Services Director Mark Finucane about some of Crearys work assignments.
These assignments allegedly were sometimes scheduled either for regular county work hours or for the doctors days off to be carried out at a private clinic run by Creary, according to documents filed with the grievance.
According to an unsigned memorandum from the doctors to Finucane, dated August 10, the doctors initially believed that the Drew Family Practice Medical Group at Daniel Freeman Medical Center in Inglewood was a public King-Drew facility, with the sole purpose of providing [medical] residents and students with an educational experience in a managed care environment.
The memo said that several of the doctors gradually grew disillusioned with the arrangement, because they were not paid in a timely manner, or were not paid at all. Nevertheless, the memo asserts, other doctors continued to work at Crearys clinic on their days off, without pay, because they believed that this type of sacrifice was necessary to insure that our resident [physicians] obtained proper supervision.
But this enthusiasm flagged, according to the memo, mainly due to the paradox of what appeared to be a lucrative private practice that apparently had no resources available for physician compensation.
Creary, who for nearly 25 years has chaired the Department of Family Practice at the controversy-plagued King-Drew hospital, termed the doctors allegations against him false and slanderous in his own responding October memo. He further used language that the complaining doctors said they found threatening to their careers.
According to an unfair-labor-practice charge also filed by the union, On Sept. 1, the [eight] physicians were threatened with loss of their MLK-Drew jobs . . . as the result of their disclosure of the illegal activity.
This document further alleges that Patricia Mathews-Juarez, the executive coordinator of Crearys department -- who is also an administrator of Crearys private clinic at the Freeman Medical Center -- threatened [them] with the loss of their jobs as the result of their disclosure.
The incident is but the latest example of the discord that has occasionally marred operations at King-Drew. Founded in the aftermath of the Watts Riots under the guidance of late 2nd District County Supervisor Kenneth Hahn, the King-Drew medical center was created to serve the then largely African-American population of South Los Angeles County, as well as to provide opportunities for medical education for minority students. Its founding responded to complaints by 1960s black-community leaders that their community lacked its own medical services.
In the nearly 30 years since King-Drews completion, the surrounding population has become mostly Latino, while several competing private hospitals have also moved into the area.
Perhaps the most publicized problem at King-Drew over the past decade has been an alleged pattern of discrimination occurring between some senior African-American staff and their subordinates, many of whom are Hispanic.
Alan Clayton, of the Los Angeles County Chicano Employees Association, said that at least twice, the countys civil service board has found in favor of such employees.
Other problems have included a high rate of county malpractice lawsuits and claim payouts for patient deaths and other patient-care mishaps -- $1.32 million in 1994 alone, the year an official county bed audit also found the hospital seriously behind in collecting its patient accounts due. But King-Drew has also had a persistent issue involving the ongoing private practices of senior staff members, many of whom are employed by the county on a full-time basis at the hospital, its associated medical school, or both.
Hospital insiders suggest that this situation leads both to treatment delays at King-Drew and, in some cases, to fatal mistakes in the treatment of patients. It has been suggested in court documents that some of these mishaps might have been avoided if young physician interns and residents were working under the proper supervision of their seniors.
It has also been suggested that the private-practice-vs.-public-service problem is not unique to King-Drew within the countys health-care system.
Crearys case is further complicated because he already collects not just one, but two, distinct county salaries, totaling $201,000 a year: According to official county figures, in 1997 he earned $114,500 as chief physician in Family Practice; he also earned an additional $86,500 for his professorship at the associated Drew Medical School.
But Creary further maintains the Inglewood private practice at Freeman called the Drew Family Practice Medical Group. It was to this clinic that he ordered several county doctors. For this service, some of the King-Drew physicians, already on the county payroll, were granted no additional remuneration, and some were allegedly asked to work during what would have been their official, taxpayer-paid hours of service. The physicians, who were normally employed at the countys Imperial Heights Health Center, a King-Drew satellite outpatient facility, gradually began to avoid service at Crearys Inglewood clinic in favor of off-hours work at non-county clinics where they were promptly paid for their labors.
Later, the doctors August memorandum alleges, Creary attempted to get the King-Drew residency training director, who schedules faculty teaching and training during their official hours of county employment, to schedule the doctors to work at his clinic, on the grounds that it was a county site. There had been some early university involvement in setting up the clinic, but according to the state Department of Corporations, this clinic was incorporated in 1981 as a private, stock-issuing company, with Creary registered as the president and Mathews-Juarez as agent. The state records further indicate that the clinics corporate status had been suspended as of September 1995: This corporate suspension followed three previous state Franchise Tax Board suspensions: in 1983, 1990 and 1995.
By September of this year, most of the Imperial Heights faculty had themselves discovered that Crearys clinic was definitely not a county operation and that, as the faculty grievance states, it was illegal for county doctors to work there and put their hours on their county time cards.
After the alleged threat of firing, the union charge asserts, on or about Sept. 22 and Oct. 13, 1999, Dr. Creary interrogated several Family Practice resident physicians at Imperial Heights Health Center and solicited from them any problems they are having with the [protesting] physicians.
A few days later, he wrote several of the dissident doctors (whose names were not disclosed in the union filing) a memo on King-Drew letterhead, advising that their protests would be dealt with in an appropriate manner.
This phrase, the union protested in return, constitute[d] acts of retaliation.
The Imperial Heights case was by no means the first time that Crearys official behavior at King was singled out. Indeed, Creary has tended to guard his clinical turf at the county hospital as though it, too, were his personal partnership. Particularly when it comes to fiscal oversight.
In April of last year, according to King-Drew documents, Creary -- with the assistance of another department associate, Paul Juarez -- stonewalled a team of auditors by refusing them routine access to his patient records. Juarez, in a letter to hospital officials, alleged that, in attempting to perform a routine fiscal audit, the hospital authorities were planning another illicit seizure. He further contended that for the clinics clerical employees to allow the auditors to see the records would mean they were acting in conspiracy with [the university and the auditors].
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James Kyle, then the medical schools compliance officer, canceled his inspection (which, although Kyle had given four days of advance warning in writing, Creary and Juarez had termed a raid) for that day, noting that this was not the first time Creary had refused to open his files to routine audits. According to King-Drew records, he also denied auditors access the previous year to patient records at his clinic in Inglewood.
Once again, our efforts have been impeded by you or members of your staff, Kyle said, apparently a reference to his foiled February attempts to view the same records. Kyle added, We will pursue all legal remedies to gain access to the university medical records in question.
Kyle is now acting dean at the Drew Medical School, and some insiders speculated that he might, in this new capacity, not just demand access to Crearys in-house clinical records, but try to oust the recalcitrant Family Practice chief altogether. Dr. Thomas, the county administrator, said that the universitys end of the investigation kicked off by the grievance was in Kyles hands. But a King-Drew source said that Kyle announced, at a December 17 faculty meeting, his intention to resign by early next year, leaving the probes future in doubt. Neither Kyle nor Creary could be reached for comment.
Whatever his future in local public-health practice, and despite the defunct corporate status of his Freeman clinic in Inglewood, Creary may yet have a future in the private sector. According to the state corporate records, the senior physician now presides over four for-profit California corporations of unspecified size, plus a nonprofit called the Drew University Medical Faculty Plan. State records also show that a dozen other Creary-led companies have been suspended over the past eight years -- mostly because of state tax payment problems.