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SUP. MOLINA, CHAIR: WHAT IS A RADIOLOGY STUDY? KAE ROBERTSON: X-RAY. I'M SORRY, X-RAY. SUP. MOLINA, CHAIR: THAT'S WHAT I THOUGHT. OKAY. SIMPLE WORDS COULD BE USED FOR SOME OF US. KAE ROBERTSON: FOR PATIENTS IN THE EMERGENCY DEPARTMENT WHO NEEDED AN X-RAY... SUP. MOLINA, CHAIR: SO THE EMERGENCY ROOM PATIENT NEEDS AN X-RAY, WHERE DO THEY GO? KAE ROBERTSON: THEY GO TO RADIOLOGY, WHICH IS ACROSS THE HALL AND, TO BE TRANSPORTED THERE, WE WOULD HAVE, IN THE PAST, USED A NURSE, A RESIDENT, MAYBE A NURSING ASSISTANT OR EVEN A TECHNICIAN. SUP. MOLINA, CHAIR: WHAT DID THEY DO BEFORE? KAE ROBERTSON: THE EMERGENCY DEPARTMENT STAFF TRANSPORTED THEM WHICH, AS A RESULT, THEY WERE AWAY FROM PATIENT CARE AND IT WOULD CREATE MORE OF A SLOWDOWN. SUP. MOLINA, CHAIR: BUT DO YOU UNDERSTAND HOW THAT DOESN'T MAKE SENSE TO ME? I'M MEAN, I'M HERE, PERSON READING, "RADIOLOGY BEGAN TRANSPORT FOR EMERGENCY DEPARTMENT PATIENTS NEEDING RADIOLOGY STUDIES." I DON'T KNOW THAT THAT MEANS ANYTHING. DID YOU CHANGE SOMETHING? KAE ROBERTSON: YES. SUP. MOLINA, CHAIR: DID YOU PROCESS SOMETHING? DOES IT MAKE IT BETTER? STRONGER? WHAT'S THE DIFFERENCE? I KNOW NOTHING. KAE ROBERTSON: I'LL WORK ON IMPROVING THAT. THE ANSWER IS, YES, WE DID CHANGE SOMETHING. BEFORE, THE STAFF IN THE EMERGENCY DEPARTMENT DID THE TRANSPORT, WHICH TOOK THEM AWAY FROM THE E.D. SUP. MOLINA, CHAIR: SO WHO DOES IT NOW? KAE ROBERTSON: AND NOW THE STAFF IN THE RADIOLOGY DEPARTMENT WHO ARE OF-- IN A MORE-- THEY'RE THE RIGHT GRADE TO BE DOING THIS TYPE OF TRANSPORT WILL BE DOING IT. SUP. MOLINA, CHAIR: HOW MANY STAFF WILL BE IN THE RADIOLOGY DEPARTMENT? KAE ROBERTSON: I DON'T HAVE THE NUMBER OF STAFF OFF THE TOP OF MY HEAD FOR ANY DEPARTMENT. SUP. MOLINA, CHAIR: SO, BECAUSE THAT RAISES THIS WHOLE ISSUE ABOUT THIS DR. TATE, ABOUT RADIOLOGY. SO... KAE ROBERTSON: THE STAFF WHO WILL DO THE TRANSPORT ARE A TECHNICIAN LEVEL, NOT A PHYSICIAN LEVEL. SUP. MOLINA, CHAIR: I UNDERSTAND. THAT'S WHY I'M ASKING THE QUESTION BECAUSE, IF THEY'RE IN THE EMERGENCY ROOM AND THEY HAVE TO BE NOW-- I'M JUST UNDERSTANDING WHAT IT IS, THEY HAVE TO BE TRANSPORTED, THERE'S A DIFFERENT SET OF PEOPLE WHO ARE NOW TRANSPORTING THEM TO X-RAY. SO, I MEAN, HOW MANY X-RAYS-- BECAUSE I'M CONCERNED AS TO HOW I'M SUPPOSED TO UNDERSTAND WHAT HAPPENED IN RADIOLOGY, BESIDES THE NONSENSE OF NOT VERY SMART PEOPLE NOT REALIZING THAT PEOPLE CANNOT WORK CONSISTENTLY AT 164 HOURS A WEEK AND BILL US FOR 164 HOURS OF WORK. I DON'T UNDERSTAND HOW THIS DEPARTMENT FUNCTIONS. SO, RIGHT NOW, THERE'S ONLY ONE RADIOLOGIST WHO CAN READ AN X-RAY? KAE ROBERTSON: NO. THERE ARE MULTIPLE RADIOLOGISTS WHO... SUP. MOLINA, CHAIR: HOW MANY ARE THERE? KAE ROBERTSON: ...CAN READ AN X-RAY AND-- I THINK, FRED, YOU HAVE THAT IN FRONT OF YOU. I HAVE THAT INFORMATION. SUP. MOLINA, CHAIR: HOW MANY RADIOLOGISTS TO WE HAVE AT M.L.K.? FRED LEAF: WE HAVE EIGHT PERMANENT RADIOLOGISTS, APPROXIMATELY-- I MEAN, SIX CONTRACT RADIOLOGISTS AND TWO FROM RELIABLE. SUP. MOLINA, CHAIR: YOU HAVE HOW MANY? EIGHT PERMANENT? FRED LEAF: RIGHT. SUP. MOLINA, CHAIR: AND? FRED LEAF: AND WE HAVE SIX INDIVIDUAL PHYSICIAN SPECIALTY CONTRACTS. SUP. MOLINA, CHAIR: INDIVIDUAL. OKAY. AND THEN YOU HAVE... FRED LEAF: TWO ADDITIONAL FROM RELIABLE. SUP. MOLINA, CHAIR: FROM WHERE? FRED LEAF: RELIABLE. THAT'S THE SERVICE THAT DR. TATE WORKS FOR. SUP. MOLINA, CHAIR: SO WHAT WAS-- WHAT WAS THE-- 8 PLUS 6 PLUS 1, WHAT WERE THE 15 OTHER RADIOLOGISTS DOING WHILE TATE WAS DOING 23 HOURS OF WORK EVERY DAY? FRED LEAF: THAT'S, RIGHT NOW, WE'VE ASKED-- WE'VE ASKED FOR, AND... SUP. MOLINA, CHAIR: I KNOW, EVERYBODY'S ASKED FOR IT BUT... FRED LEAF: ...A REVIEW OF THAT BUT I CAN'T ANSWER IT. SUP. MOLINA, CHAIR: ...BUT SOMEBODY'S BEEN AT THIS HOSPITAL AND, NAVIGANT, YOU'VE BEEN THERE. WHAT WAS GOING ON IN THE RADIOLOGY DEPARTMENT THAT THERE WERE 15 PHYSICIANS, PERMANENT, FULL-TIME RADIOLOGISTS, AND YOU HAD ONE PERSON WORKING 23 HOURS A DAY CLAIMING TO DO ALL THE WORK? FRED LEAF: SUPERVISOR, ONE THING, JUST-- I AMEND THAT BY ONE. APPARENTLY, I SEE SAY NOTE HERE THAT ONE OF THOSE PHYSICIANS IS ON EXTENDED LEAVE SO IT'D BE 14. SUP. MOLINA, CHAIR: ALL RIGHT. 14 FULL-TIME RADIOLOGISTS. KAE ROBERTSON: NO. I THINK THAT'S NOT RIGHT. I THINK THERE ARE-- OF THOSE, SIX ARE CONTRACT PHYSICIANS WHO WORK ON AN AS-NEEDED BASIS SO MAY NOT BE ON THE SCHEDULE AT ALL AND TWO OF THE FULL-TIMES ARE DEDICATED TO OTHER MODALITIES IN RADIOLOGY, NOT GENERAL RADIOLOGY. ONE IS RADIATION ONCOLOGY AND THE OTHER IS NUCLEAR MEDICINE. THEN THERE ARE FIVE FULL-TIME, ONE PART-TIME BEYOND THAT. THERE IS A PRODUCTIVITY REPORT FOR THEM ON A REGULAR BASIS, AND IT SHOWS VARIABLE PRODUCTIVITY AMONGST THOSE PHYSICIANS. SUP. MOLINA, CHAIR: WHAT DOES THAT MEAN? VARIABLE PRODUCTIVITY? KAE ROBERTSON: MEANING SOME AREN'T AS PRODUCTIVE BECAUSE THEY'RE NOT READING STUDIES, THEY'RE DOING TEACHING OR OTHER RESPONSIBILITIES. AND IT IS DIFFICULT FOR US BECAUSE WE DON'T HAVE COMPLETE CONTROL OF EVERYTHING THAT THEY'RE DOING... SUP. MOLINA, CHAIR: WELL, WAIT A MINUTE. YOU THINK IT'S DIFFICULT FOR YOU, IT'S VERY DIFFICULT FOR US. BUT I WANT TO UNDERSTAND HOW ANYONE WORKING-- I MEAN, DO YOU HAVE A HEAD OF RADIOLOGY? IS THERE... KAE ROBERTSON: THERE IS A CHAIRMAN OF RADIOLOGY. SUP. MOLINA, CHAIR: DOES HE WORK THERE PHYSICALLY? KAE ROBERTSON: YES. HE'S BEEN THERE, PHYSICALLY. SUP. MOLINA, CHAIR: AND THEN IF HE'S THERE PHYSICALLY-- CAN HE COME TO OUR BOARD MEETING AND TELL US HOW THIS WORKED? KAE ROBERTSON: I THINK THAT THIS STARTED LONG BEFORE HE BECAME THE CHAIR. IT'S MY UNDERSTANDING HE BECAME THE CHAIR IN JANUARY AND THIS HAS BEEN GOING ON SINCE THE PRIOR CHAIR... SUP. MOLINA, CHAIR: IT DOESN'T MATTER. IN JANUARY, WE PAID $136,000 TO MR. TATE FOR ONE MONTH. KAE ROBERTSON: I WOULD THINK HE COULD COME TO THIS BOARD... SUP. MOLINA, CHAIR: ON JANUARY THE 1ST, ON NEW YEAR'S DAY, HE WORKED 23 HOURS THAT DAY AND, ON THE 2ND, HE WORKED 23 HOURS AS WELL. FROM THE INVOICES. SO CAN HE COME? FRED LEAF: THE ANSWER IS YES, HE CAN COME HERE. WE WILL HAVE HIM. SUP. MOLINA, CHAIR: AND WHAT IS HIS NAME? FRED LEAF: DR. PAYNE, P-A-Y-N-E. SUP. MOLINA, CHAIR: DR. PAYNE. I TAKE IT IT'S P-A-Y-N-E, RIGHT? INSTEAD OF P-A-I-N. ALL RIGHT. SUP. MOLINA, CHAIR: AND WHAT I WOULD LIKE IS AN EXPLANATION AS TO HOW HE AND ALL THE OTHER RADIOLOGISTS ALLOWED SOMEONE TO BE WORKING-- I MEAN, THAT'S NOT EVEN-- YOU CAN'T EVEN BE PHYSICALLY COMPETENT AFTER WORKING 20 HOURS. HOW COULD YOU HAVE BEEN PHYSICALLY COMPETENT TO READ AN X-RAY WHEN YOU'VE WORKED 23 HOURS? FRED LEAF: EITHER HE WAS WORKING THE 23 HOURS, AND IT WAS VERY INAPPROPRIATE OR HE WASN'T AND HE WAS PAID COMPLETELY INAPPROPRIATELY. SO, EITHER WAY, IT'S A VERY BAD... SUP. MOLINA, CHAIR: SO HE POTENTIALLY COULD BE A FRAUD CASE? FRED LEAF: COULD BE, YES, IF WE CAN VERIFY, DURING THIS INVESTIGATION, EXACTLY THE NUMBER OF HOURS HE WAS PRESENT AND IF HIS WORK SCHEDULE WAS CONSISTENT WITH THE INVOICES. SUP. MOLINA, CHAIR: AND IF THERE WAS FRAUD INVOLVED, THERE WAS ALL OF THOSE DOCTORS AND ALL OF OUR COST MANAGERS. I SAW THE INVOICES. THEY WERE SIGNED OFF BY FOUR PEOPLE, SO HOW EFFECTIVE A FRAUD CASE COULD WE HAVE IF WE HAD OVERSIGHT BY FOUR PEOPLE? FRED LEAF: WELL, I THINK IT WOULD BE, OBVIOUSLY, A TOUGH ONE WITH THE DISTRICT ATTORNEY ON THE DOCTOR HIMSELF. HOWEVER, I THINK THAT THE INDIVIDUALS WHO WOULD HAVE APPROVED THESE IF, IN FACT, THEY KNEW HE WASN'T PRESENT, IF THAT'S THE CASE, I DON'T KNOW IF THAT IS, CERTAINLY WE'D HAVE TO LOOK AT THEM AND HAVE THEIR CULPABILITY. SUP. MOLINA, CHAIR: YOU KNOW, IT IS HARD FOR ME TO UNDERSTAND, AND, WHEN I MENTIONED THIS TO OTHER PEOPLE LAST NIGHT IN FRUSTRATION OF RECEIVING THIS INFORMATION, A LOT OF PEOPLE SAID MORE THAN LIKELY THERE WERE KICKBACKS INVOLVED. THAT'S WHAT EVERYBODY ASSUMED. THAT SOMEBODY IS GETTING PAID TO SIGN OFF AUTHORIZATIONS BECAUSE THEY'RE SO STUPID ON THEIR FACE THAT SOMEBODY WOULD BE WORKING 23 HOURS, EVEN ON CALL, IT'S IRRESPONSIBLE. NOBODY IS ON CALL FOR 23 HOURS TO BE PAID AND, IF THEY ARE, YOU SHOULD LET US KNOW WHERE THAT IS, BECAUSE YOU KNOW THAT, WHEN YOU CALL THAT PERSON AFTER BEING ON CALL OR WORKING FOR 22 HOURS, HE CANNOT WORK THAT OTHER HOUR. THERE HAS TO BE-- SO IT'S STUPID ON ITS FACE. SO I'M GOING TO ASK THAT THERE BE AN INVESTIGATION OF PEOPLE AS TO WHETHER, IN FACT, THERE WERE KICKBACKS. THAT IS A VERY SERIOUS ALLEGATION BUT I HAVE TO BELIEVE EITHER THEY'RE REAL, REAL DENSE WHEN THEY WERE SIGNING ALL OF THESE AUTHORIZATIONS OVER AND OVER AGAIN OR THEY WERE TAKING MONEY FOR BEING SO STUPID. FRED LEAF: WELL, WE'RE AWARE OF THOSE ALLEGATIONS AND WE'VE INCLUDED THAT IN THE INVESTIGATIVE PROCESS, THE KICKBACK ISSUE. SUP. MOLINA, CHAIR: THEN LET ME ASK ONE OTHER THING. YESTERDAY, WHEN I TALKED TO MR. ORANGESTEIN OF THE L.A. TIMES, WHO I GUESS WAS THE PERSON WHO APPRISED YOU, AS WELL AS MYSELF, OF THIS POTENTIAL FRAUDULENT CASE THAT'S GOING ON, I ASKED HIM, "YOU KNOW, I DON'T UNDERSTAND WHY PEOPLE CALL YOU. IT WOULD SEEM TO ME THAT, IF THEY REALLY WANTED TO HELP US, THEY WOULD HELP US FIND A WAY TO GET THESE CREEPS OUT OF THE SYSTEM WHO ARE TAKING MONEY AND MISAPPROPRIATING IT, MISUSING IT, INSTEAD OF GOING TO THE L.A. TIMES SO THAT IT CAN BE BIG HEADLINES AND BE REALLY DESTRUCTIVE, NOT ONLY TO THE MORALE, TO THE SENSE OF SECURITY TO THE PATIENTS THAT HAVE TO GO INTO THIS HOSPITAL, AND ALSO TO THE PEOPLE WHO ARE WATCHING US EVERY MOMENT OF THE DAY." AND I ASKED HIM, "WHY DO YOU THINK THEY DO THAT?" AND HE SAYS , "BECAUSE THEY ARE FRIGHTENED OF RETALIATION AT THE HOSPITAL." I'M CONCERNED ABOUT THAT. I'M CONCERNED THAT I DON'T KNOW WHAT KIND OF RETALIATION THEY THINK THEY'RE GOING TO GET. I MEAN, I KNOW YOU HAVE BEEN DISMISSING PEOPLE AND FIRING PEOPLE BUT I'M VERY CONCERNED ABOUT THE FACT THAT THERE ARE PEOPLE IN-- WORKING AND, IN THIS INSTANCE, THESE WERE PROFESSIONALS, I MEAN, THIS WERE PEOPLE WHO UNDERSTOOD EXACTLY WHAT WAS GOING ON, FOUND IT UNBELIEVABLY IRREGULAR, FELT STRONGLY THAT THEY NEEDED TO REPORT IT AND MAY HAVE REPORTED IT. IN FACT, THERE IS A QUESTION THAT MR. ROMKEY RAISED WHILE HE WAS THE FINANCIAL OFFICER THERE ABOUT SAYING, "THIS IS LUDICROUS, HOW COULD WE BE PAYING SOMEONE FOR 23 HOURS? AND THERE WAS NO RESPONSE. FRED LEAF: IT LOOKS-- IT APPEARS TO ME THAT THEY TOTALLY IGNORED HIS DIRECTIVE. SUP. MOLINA, CHAIR: I UNDERSTAND IT BUT MY POINT IS-- MY POINT IS, IS THAT IF THEY IGNORE THE CHIEF FINANCIAL OFFICER, THEN HOW IS AN EMPLOYEE WHO, YOU KNOW, MIGHT BE SOMEONE WHO REALLY CARES ABOUT MAINTAINING THE HOSPITAL BUT SEES THESE KINDS OF IRREGULARITIES GOING ON, HOW CAN THEY TRUST A SYSTEM TO GO IN AND AT LEAST LET YOU KNOW OF IRREGULARITIES THAT ARE GOING ON? I THINK THAT YOU'RE GOING TO HAVE TO SET UP A SYSTEM AS TO HOW THERE IS GOING TO BE A PLACE WHERE THEY CAN COME AND TELL US IF THEY KNOW SOMETHING, THAT THEY'RE GOING TO BE PROTECTED FROM ANY RETALIATION AND, I MEAN, THAT'S A TWO-EDGED SWORD, BECAUSE YOU CAN HAVE THE MOST INCOMPETENT PEOPLE SPENDING ALL DAY LONG LOOKING UNDER PETTICOATS AND REPORTING IT AND NOT BEING ABLE TO BE DISMISSED BECAUSE IT MIGHT LOOK LIKE RETALIATION BUT I AM CONCERNED THAT THERE'S AN ENVIRONMENT WITHIN THE HOSPITAL THAT THEY DON'T FEEL THERE'S ANY MECHANISM TO TALK TO NAVIGANT, THE ADMINISTRATORS. THEY'RE EITHER NOT MAKING THEMSELVES AVAILABLE OR SOMETHING THAT THEY WOULD HAVE TO GO TO THE L.A. TIMES AS THE ONLY MECHANISM BY WHICH THEY COULD TRUST THAT THIS INFORMATION WOULD GET OUT TO THE PUBLIC AND GET INTO OUR ATTENTION, BECAUSE IT'S NOT GETTING-- I DON'T GET ANYTHING FROM YOU ALL. I REALLY DON'T. I GET REPORTS THAT I DON'T UNDERSTAND. KAE ROBERTSON: IN TERMS OF SETTING UP AN EMPLOYEE LINE, I BELIEVE, SUPERVISOR BURKE, THAT YOU'VE HAD ONE... SUP. BURKE: I HAVE A 1-800 NUMBER, YES. KAE ROBERTSON: AND THAT THAT IS... SUP. MOLINA, CHAIR: HOW MANY CALLS HAVE YOU GOTTEN, MS. BURKE? SUP. BURKE: NONE. SUP. MOLINA, CHAIR: ALL RIGHT. WELL, THAT SPEAKS FOR ITSELF. KAE ROBERTSON: ...FREE OF RETALIATION. SO FREE OF RETALIATION AS WELL. I THINK THAT THERE, YOU KNOW, THAT WE HAVE A ISSUE RELATIVE TO YEARS OF A CULTURE THAT ARE VERY HARD TO CHANGE, AND WE HAVE MADE OURSELVES, AS NAVIGANT, AVAILABLE TO THE EMPLOYEES. WE HOLD REGULAR FORMS, WE'VE MADE ROUNDS, AND I'M NOT SURE HOW TO CHANGE. SUP. MOLINA, CHAIR: YOU KNOW THAT'S A CRITICAL COMPONENT OF THE CHANGE? IT'S ESSENTIAL. KAE ROBERTSON: IT IS. IT'S VERY ESSENTIAL. SUP. MOLINA, CHAIR: AND SO SOMEBODY IS GOING TO HAVE TO GET TO A POINT OF ROOTING SOME OF THAT OUT BECAUSE I'M VERY CONCERNED ABOUT IT. I KNOW THAT WE PROBABLY-- THEY DON'T FEEL BUT-- AIRING IT OUT IN PUBLIC, ALTHOUGH I DON'T LIKE-- I THINK THIS IS SOMETHING-- I'M GLAD IT CAME TO OUR ATTENTION AND I APPLAUD THE PERSON WHO DID CALL MR. ORENSTEIN. I ONLY WISH THAT I COULD HAVE THE-- CONVINCE THEM THAT IT WOULD BE WORTHWHILE TO CALL MYSELF, DR. GARTHWAITE, YOURSELF, ANYONE AND THAT YOU WOULD TAKE THE SAME ACTION AS WE'RE GOING TO TAKE NOW BECAUSE WE DIDN'T TERMINATE IT UNTIL WE WERE CALLED BY THE L.A. TIMES, WHICH IS REALLY UNFORTUNATE. NOBODY WONDERED ABOUT THE 164 HOURS A WEEK THAT THIS DOCTOR WAS BILLING US WHILE WE HAD, I DON'T KNOW, FIVE OR SIX PERMANENT RADIOLOGISTS THERE WHO COULD HAVE DONE SOME OF THIS WORK. I UNDERSTAND THAT HE WAS GIVEN A RESIDENCE THERE AS WELL? FRED LEAF: YES. HE WAS PROVIDED WITH A ROOM IN THE INTERNS' AND RESIDENTS' RESIDENCE DORM. SUP. YAROSLAVSKY: LET'S CHARGE HIM RENT. SUP. MOLINA, CHAIR: AND HE WAS-- ALSO HAD AN OPPORTUNITY TO BE VISITED BY HIS WIFE THERE WHILE HE WORKED 23 HOURS A WEEK? FRED LEAF: APPARENTLY. THAT WAS HIS STATEMENT. SUP. MOLINA, CHAIR: AND ALL OF THIS WAS KNOWN? FRED LEAF: YEAH, IT WAS APPROVED BY MEDICAL ADMINISTRATION. SO, I MEAN, IT WAS KNOWN AND IT WAS INTERPRETED BY THE STAFF WHO APPROVED THESE-- THIS ARRANGEMENT TO BE APPROPRIATE, WHICH IS UNBELIEVABLE, BUT IT WAS. SUP. YAROSLAVSKY: MADAM CHAIR? ON THAT POINT, MAY I? SUP. MOLINA, CHAIR: SURE. SUP. YAROSLAVSKY: DID THE COMPANY FOR WHOM THIS-- WHAT WAS IT? FRED LEAF: RELIABLE. SUP. YAROSLAVSKY: I'M THINKING RELATED BUT THAT'S ANOTHER COMPANY. RELIABLE, SHOULD THEY HAVE THOUGHT THIS WAS OUTRAGEOUS? FRED LEAF: WELL, THE STATEMENT FROM RELIABLE, AND WE'RE HOPING, BY THE WAY, THAT BOTH DR. TATE AND RELIABLE COOPERATE WITH US IN OUR INVESTIGATION, BUT THEY INDICATED THAT, ONCE WE, YOU KNOW, BOOK THE DOCTORS OR ANY EMPLOYEES THAT THEY PROVIDE, THAT IT'S BETWEEN THE CONTRACTOR AND THE CONTRACTEE, MEANING THEIR DOCTOR, TO DETERMINE WHAT HOURS THEY WORK. SUP. YAROSLAVSKY: WHAT IS THE RELATIONSHIP BETWEEN RELIABLE AND THE DOCTOR? FRED LEAF: THEY ARE LIKE AN EMPLOYMENT AGENCY SO THEN THEY HAVE VARIOUS TYPES OF SPECIALTIES... SUP. MOLINA, CHAIR: THEY'RE A REFERRAL AGENCY THAT REFERS... FRED LEAF: ...WHO-- YEAH, THEY'RE LIKE APPLEONE, IN ESSENCE. SUP. YAROSLAVSKY: WHO DO YOU PAY? FRED LEAF: WE PAY RELIABLE FOR THE SERVICES OF THE PHYSICIAN. SUP. YAROSLAVSKY: SO... FRED LEAF: SO IF WE AGREED, "WE," THE COUNTY, AGREED ON A PAYMENT ARRANGEMENT OR A UTILIZATION ARRANGEMENT, THEN RELIABLE'S POSITION IS THAT WE PROVIDE THE STAFF AND THEN THE MANAGEMENT OF THE HOSPITAL WOULD MAKE A DETERMINATION AS TO HOW THOSE STAFF WOULD BE UTILIZED. SUP. YAROSLAVSKY: WHEN YOU'RE DONE, I'D LIKE TO JUST-- PUT ME DOWN. SUP. BURKE: I JUST-- WHILE YOU HAD MENTIONED THAT-- MAY I JUST CLARIFY ONE ISSUE ON THAT? WHEN MR. ROMKEY PULLED THIS UP AND SAID THERE WAS A PROBLEM WITH IT, WAS HE FINANCE DIRECTOR OR WAS HE THEN THE C.E.O. OF THE HOSPITAL? FRED LEAF: HE WAS THE C.E.O., THE ACTING C.E.O. SUP. BURKE: IF THE C.E.O. OF THE HOSPITAL FINDS THAT SOMETHING IS INAPPROPRIATE AND ASKS ABOUT IT, WHERE DOES IT GO NEXT? FRED LEAF: DIRECTLY WENT TO THE FINANCE FINANCE, THE CHIEF FINANCIAL OFFICER SAYING, ONLY PAY FOR HOURS WORKED AS WELL, AS THE MEDICAL DIRECTOR AND THE CHAIR, ALL OF THESE PEOPLE HAD THIS INFORMATION. HE DIRECTED THAT BE DONE AND ONE WOULD EXPECT THAT TO HAPPEN. SUP. BURKE: WHO DID HE DIRECT TO DO THAT? FRED LEAF: PARDON ME? SUP. BURKE: WHEN MR. ROMKEY DIRECTED THAT THEY ONLY BE PAID FOR HOURS THAT WERE ACTUALLY WORKED, WHAT HAPPENED NEXT? WHO DID HE DIRECT THAT TO? FRED LEAF: THAT WAS DR. PEEKS, DR. PAYNE, AND THE C.F.O. AT THE HOSPITAL. KAE ROBERTSON: I THINK IT'S IMPORTANT, PROBABLY, TO CONTINUE THE INVESTIGATION BECAUSE I DO THINK THERE IS SOME VARIATION IN TERMS OF WHAT WAS DIRECTED TO BE PAID AND TO WHAT WAS DIRECTED TO BE WITHHELD, SO IT IS IMPORTANT, I THINK, TO CONDUCT A THOROUGH INVESTIGATION. FRED LEAF: HOWEVER, THE EVIDENCE WE HAVE TO DATE SHOWS THAT THE INFORMATION, BY THE WAY, KAE, THAT WAS BROUGHT THIS MORNING IS NOT ACCURATE SO THAT'S WHY WE'RE LOOKING VERY CLOSELY AT IT. SUP. BURKE: THE INFORMATION SO FAR IS NOT ACCURATE... SUP. YAROSLAVSKY: WHAT'S NOT ACCURATE? SUP. MOLINA, CHAIR: WAIT, WAIT, WAIT, WAIT. FRED LEAF: WE WERE TOLD THIS MORNING THAT THERE WAS A, YOU KNOW, THEY WERE ONLY SUPPOSED TO WITHHOLD 10% AND WE CAN FIND NO EVIDENCE OF THAT EXCEPT IN LOWER LEVEL STAFF ACTIVITIES. SO THAT'S WHY, AS KAE SAID, WE NEED TO... KAE ROBERTSON: THERE ARE SO MANY, I THINK, THINGS THAT ARE COMING TO LIGHT THAT IT REALLY REQUIRES A FULL INVESTIGATION. SUP. MOLINA, CHAIR: ALL RIGHT. LET ME UNDERSTAND THIS. KAE, IN YOUR ADMINISTRATIVE ASPECT OF REVIEW, HERE'S-- YOU HAVE A GENTLEMAN WHO SIGNS HIS-- I GUESS IT'S HIS-- WHAT IS IT? A TIME SHEET, IT SAYS ON THE TOP. AND IT'S-- I TAKE IT THE SIGNATURE, THE AUTHORIZED SIGNATURE MUST BE THE CHIEF OF WHOEVER THE DEPARTMENT WAS. BUT YOU CAN TELL IT'S WRITTEN, LIKE, ON THE SAME DAY WITH THE SAME PEN AND THE SAME HANDWRITING AND HE REPORTS THAT, ON THE 7TH OF NOVEMBER, HE WORKED 24 HOURS. ON THE 8TH, HE WORKED 16. ON THE 9TH, HE WORKED 16. ON THE 10TH, HE WORKED 16. ON THE 11TH, 16, ON THE 12TH, 20 AND THEN, ON THE 13TH, HE WORKED ANOTHER 24 HOURS. THIS WAS ONE WEEK. AND IT'S SIGNED BY HIMSELF AND THEN APPROVED, AGAIN, WITH ANOTHER DIFFERENT SIGNATURE. THEN I TAKE, I DON'T KNOW WHAT YOU'VE... KAE ROBERTSON: I'M SORRY, SUPERVISOR, BUT WE DON'T GET THE TIME-- PART OF WHAT NAVIGANT DOESN'T DO IS THE... SUP. MOLINA, CHAIR: ALL I KNOW IS... KAE ROBERTSON: ...TIME REPORTS SO I HAVEN'T SEEN WHAT YOU'RE... SUP. MOLINA, CHAIR: NO, I UNDERSTAND BUT I'M JUST TRYING TO TELL YOU THE LEVEL-- SO ALL OF THAT GETS APPROVED. THEN IT GOES ON TO RELIABLE, AND THEY'RE VERY CLEVER HOW THEY TURN AROUND AND BILL US, BECAUSE THEY TAKE THAT AND BUILD IT INTO INCREMENTS DIFFERENTLY. THEY TOOK HIS OWN TIME SHEET AND THEY BILLED US FOR EIGHT HOURS, FOUR HOURS, EIGHT HOURS, AGAIN, ALL ON THE SAME DAY, BUT IN DIFFERENT SEGMENTS AND SO THAT WAS A 30,000-DOLLAR BILLING FOR THAT WEEK. AND THEN YOU HAVE THIS APPROVAL PROCESS THAT IS CLEARLY THE DEPARTMENT OF HEALTH SERVICES, THAT BEGINS WITH APPROVAL BY PATRICIA M. GRAY? IS THAT A NAME THAT YOU-ALL KNOW? FRED LEAF: IS THAT THE FIRST APPROVAL? SUP. MOLINA, CHAIR: YES. FRED LEAF: THEN IT DOESN'T MAKE SENSE TO ME, NO. THAT SOUNDS MORE LIKE A BILLING OFFICE PERSON. SUP. MOLINA, CHAIR: BEATRICE? I DON'T KNOW, I DON'T KNOW THE NAME. THEN I HAVE NO IDEA WHAT THIS NAME IS, APPROVAL LEVEL I, ANOTHER APPROVAL, APPROVAL LEVEL II, HANNAH-- SO THIS MUST HAVE, LIKE, SEVEN APPROVAL SIGNATURES. THIS PAPER HAS TRAVELED ALL OVER THE PLACE AND YET HE WAS PAID $30,000 FOR WORKING-- IN ONE WEEK, HE WORKED 24 HOURS TWO DAYS. FRED LEAF: YEAH, THERE WOULD BE CLINICAL APPROVAL AND THOSE OTHER NAMES YOU READ OFF, I BELIEVE, WORK IN FINANCE, SO THEY WOULD BE THEN THE FINANCE WRITE-OFF THAT YOU HAD CLINICAL APPROVAL BEFORE IT WAS PAID, THE WAY I WOULD INTERPRET THAT. SUP. MOLINA, CHAIR: YOU KNOW, WE HAVE A CONTRACT HERE ABOUT SOME PHYSICIAN SERVICES AS WELL, WE HAVE ONGOING CONTRACTS. WHAT ARE WE SUPPOSED TO TRUST ON THIS? IF, IF-- I MEAN, YOU HAVE A WHOLE LEVEL OF SCRUTINY AND ACCOUNTABILITY, AND NOBODY EVER, ALONG THE WAY-- I MEAN, THEY EVEN DID A DIFFERENT INVOICING ON THE DIFFERENT ACCOUNT BUT, AT THE END OF THE DAY, IT HAS ZEROS ON EVERYTHING AND THEN IT JUST HAS DIFFERENT LINE HOURS AND LINE AMOUNT BUT-- I MEAN, I DON'T UNDERSTAND WHAT WE'RE SUPPOSED TO-- WHAT ARE YOU GOING TO INVESTIGATE? FRED LEAF: WHO EXACTLY WAS INVOLVED, WHO ACTUALLY STRUCK THE DEAL ON THE NUMBER OF HOURS THEY WERE WORKING... SUP. MOLINA, CHAIR: IT DOESN'T TAKE-- YOU CAN READ THEIR HANDWRITING RIGHT HERE. FRED LEAF: WELL, BUT THERE WAS AN INITIAL CONVERSATION, OBVIOUSLY, BETWEEN THE CHAIR OR THE MEDICAL DIRECTOR TO DETERMINE THAT THIS PERSON WOULD WORK THAT MANY HOURS. SUP. MOLINA, CHAIR: IT WENT ON FOR A YEAR AND A HALF, FRED. FRED LEAF: RIGHT. IT DID. AND WE'RE GOING TO ALSO LOOK AT EVERY PHYSICIAN AGREEMENT BECAUSE, BASED ON THIS ONE, I WOULD SAY YOU'RE CORRECT, YOU CAN'T TRUST ANYONE. SUP. MOLINA, CHAIR: HE WASN'T THE ONLY PHYSICIAN. NO. HE WASN'T THE ONLY PHYSICIAN BECAUSE YOU ALSO HAVE A JOSE SOLOMON TANDOCK ALSO WAS PRETTY GOOD AT WORKING HIS 24 HOURS. DID HE HAVE A ROOM THERE AS WELL? FRED LEAF: THAT ONE, AT THIS POINT, WE'RE NOT AWARE OF. SUP. MOLINA, CHAIR: AND SO THEY WOULD SUBMIT A LOT OF PEOPLE BUT IT'S INTERESTING THAT, EVEN UNDER THIS, WITH THIS SIGNATURE, IT HAS BILLINGS FOR DR. TANDOCK BUT IT DOES-- ONLY HAS THE TIME SHEET FOR DR. TATE. FRED LEAF: HM. SUP. MOLINA, CHAIR: SO I DON'T KNOW WHAT YOU GUYS ARE GOING TO BE DOING AS FAR AS INVESTIGATIONS BUT THIS REALLY SPEAKS MIGHTILY BEYOND KING DREW. AND I AM CONCERNED. I DON'T KNOW WHAT THEY'RE SUPPOSED TO MONITOR AT KING DREW AND THEN IT GOES THROUGH A PROCESS, AND IT GOES THROUGH ALL THIS-- IT'S JUST HARD TO UNDERSTAND HOW YOU ALL ARE GOING TO BE ABLE TO EVEN GET TO THE-- WHY CAN'T YOU PUT THESE FOUR PEOPLE IN THE ROOM TOGETHER ALL AT ONE TIME AND TELL THEM TO EXPLAIN WHY THEY SIGNED OFF ON THIS? FRED LEAF: WE'LL BE PUTTING THEM INTO A ROOM TOGETHER AND SEPARATELY, YES. SUP. MOLINA, CHAIR: WHEN WILL YOU DO THIS? FRED LEAF: WE WILL. SUP. MOLINA, CHAIR: WHEN? FRED LEAF: THE INVEST-- THE INITIATED THE REVIEW... SUP. MOLINA, CHAIR: WHEN? FRED LEAF: ...YESTERDAY. THEY SHOULD BE COMPLETED WITHIN THE NEXT PROBABLY WEEK. SUP. MOLINA, CHAIR: SO THEY ALL MET WITH ALL THESE PEOPLE? FRED LEAF: NOT-- NO, NOT AS OF YET. THEY JUST STARTED LAST EVENING SO... SUP. MOLINA, CHAIR: WELL, COULD I MEET WITH ALL OF THEM? FRED LEAF: ALL OF WHICH PEOPLE? SUP. MOLINA, CHAIR: I WANT TO FIND ALL THESE PEOPLE... FRED LEAF: SURE. SUP. MOLINA, CHAIR: ...THAT SIGHED OFF ON THIS THING. FRED LEAF: SURE, YOU CERTAINLY CAN MEET WITH ANY OF THEM. ANYBODY YOU WOULD LIKE TO MEET WITH, WE'LL SCHEDULE IT. SUP. MOLINA, CHAIR: GOOD. CAN THEY MEET WITH ME TOMORROW? FRED LEAF: YES. SUP. BURKE: MAY I ASK A QUESTION? SUP. MOLINA, CHAIR: SUPERVISOR ANTONOVICH WANTED TO... 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