Doctors Do Little?
Cook County’s health care system has been so badly managed, physicians and other employees appear to be shorting taxpayers on hours – with little consequence until now.
By Robert Herguth, Patrick Rehkamp and Andrew Schroedter
Highly paid doctors and other workers in the Cook County Health & Hospitals System are apparently shortchanging taxpayers by failing to show up as scheduled, swipe in as required or sometimes work a full day, according to a Better Government Association investigation.
In late 2012 and early 2013, the BGA tracked the comings and goings of three county doctors – all with private, or outside, practices in addition to their public-sector jobs – and found one of them was at his side job or at home on several occasions when he was scheduled to be working for the county.
A second physician rarely swiped in with an identification card as required – meaning supervisors, and the BGA, had little way of knowing whether this doctor was putting in the hours for which this doctor ultimately was paid.
Another doctor examined by the BGA turned up no irregularities – our investigation included surveillance of at least two weeks per employee, interviews and analysis of county timekeeping records – but we confirmed he’s been scrutinized by the county in the past for allegedly cheating the county on hours while drawing full salary.
This, according to sources familiar with the system but who want to remain anonymous, may be the tip of the iceberg in a system rife with doctors who come and go as they please, often spending hours on a second job when their time sheets indicate they’re at county facilities.
Sources also relayed stories about other medical personnel signing in for one another to avoid detection for their absences.
The BGA decided to look at the government-run medical network because of its size, importance, and reputation for political chicanery and bad supervision.
Before the BGA reached its conclusions, county officials launched their own internal review and began enacting reforms, acknowledging that supervision hasn’t been what it should be.
The health and hospital system is run by a CEO, Dr. Ram Raju, and a board of directors appointed by the Cook County Board president, currently Toni Preckwinkle.
The network includes two hospitals, 16 neighborhood clinics, 1,100 doctors and, in any given year, 300,000 patients – most of whom are poor and without insurance.
About a quarter of the health system’s $964 million operating budget comes from Chicago-area taxpayers, while state and federal funding covers much of the rest.
Bottom-line: the network is responsible for a lot of lives, and a lot of tax money.
Salaries for county doctors top out at about $500,000 a year. Perks include taxpayer-subsidized pensions upon retirement for full- and even some part-time physicians, and malpractice coverage.
Prompted by the BGA inquiry, county hospital officials launched an investigation into the three doctors flagged by the BGA and fired the first doctor, whom they determined was visiting the county’s flagship John H. Stroger Jr. Hospital on Chicago’s West Side only briefly to swipe in some days, before leaving.
In effect, the doctor – who was paid more than $400,000 a year – was believed to be shorting the county on hours. He has appealed his firing, claiming that while he didn’t follow his schedule perfectly, he was putting in his requisite hours – and more – and that patient care was not negatively impacted.
The second doctor was given a written and verbal “reprimand” for not using the swipe card as the rules dictate, county officials said.
If there’s blame to be cast, county administrators deserve their share and seem to have been enabling bad behavior by not enforcing existing rules or instituting tighter oversight to keep tabs on work schedules, the BGA found.
The way things work now, county physicians are paid to work a set number of hours each week. Some doctors are full-time. Some are part-time. Some have private practices. Some have privileges at other hospitals. Some do rounds at a county hospital one day, and county clinics another.
Regardless of their arrangement, on the days they’re slated to work for the county, doctors are required to swipe their ID cards once during the day on a timekeeping keypad, said county spokeswoman Marisa Kollias.
They can swipe in, swipe out or swipe their card at any other time during the day – unlike most of the 6,000 county health workers, who must swipe in when they arrive and swipe out when they leave.
And on days the physicians forget to swipe, or are in the field and are unable to do so, physicians and supervisors are supposed to later fill out “no punch” forms attesting to the hours actually worked, Kollias said.
But the forms often are not completed, the BGA found. So unexcused doctor absences can bring no consequences.
County officials said they don’t know the financial impact of all this, but emphasize most county physicians are honest and hard working.
Even so, Raju acknowledged to the BGA that staff oversight has not been strong enough at the health network, considered a medical “safety net” for the poorest of the poor in the Chicago region.
“Definitely we want to make the process more accountable and supervised better,” said Raju, who was named CEO in 2011. “We are trying to tighten up the whole process.”
To that end, the hospital system’s chief financial officer and director of payroll sent a joint email to all employees on May 24 warning of “disciplinary action” for workers not following time-keeping protocols from here on.
A new electronic timekeeping system also is being planned – although it’s too early to say whether it will involve “bio-metrics,” which can require a thumbprint or an eye-scan rather than a more generic ID card swipe.
Bio-metric technology could prevent another type of abuse that several sources said is rampant: county employees swiping each other in and out so it appears that people are working when they’re not.
One physician who was interviewed for this story said he is familiar not only with instances of doctors gaming the timekeeping system, he recalled confronting a county nurse within the past two years as she swiped in three IDs at the same time – in other words, she was covering for co-workers.
The doctor asked her what she was doing and she said, “Mind your own business.”
Two employees who work as interpreters for the county health system – helping patients who don’t speak English – said until recently two co-workers were covering for each other by swiping each other in and out.
“They were stupid enough to brag to us,” said one of the interpreters, Sebastian Kowalski, who added he believes the county’s inspector general knew about this scheme but did little.
Inspector General Patrick Blanchard said he’s not able to comment on specific cases. However, he said his office has investigated timekeeping abuses over the years and supports tighter timekeeping controls. A bio-metric system “would be a very solid step in the right direction,” Blanchard said.
(As the BGA was readying its own report for release, Blanchard revealed that his office had caught 10 employees at the county’s Oak Forest health campus swiping each other in and out. He is calling for their termination.)
Troubles at the hospital system should worry members of the public, not the least because they’re the ones picking up the tab.
Although local taxpayer subsidies to the health system have decreased in recent years, they are still projected at a whopping $388 million in 2013.
An unwieldy, poorly managed health care system can also translate into bad health care for patients – if there aren’t as many nurses or doctors around as scheduled, patients might not receive treatment as quickly or fully as necessary.
“If people are scheduled and they don’t come in, who is taking care of those patients? Will staff quit because they are so burnt out? Will they get the wrong meds because there are too many patients for the nurses to take care of?” said Ilene Warner-Maron, who teaches health services and health administration at St. Joseph’s University in Philadelphia and was briefed by the BGA on its findings. “It impacts quality.”
Other experts consulted by the BGA concurred.
Even so, the BGA’s research didn’t establish a definitive link between time-keeping lapses and substandard medical treatment at county facilities.
Raju said timekeeping scams have preceded his tenure, but he intends to rein in abuses – even consulting prosecutors if necessary.
“I take these allegations very seriously,” Raju said in an email statement. “Any abuse of the health system’s policies on time and attendance will not be tolerated. We are taking every reasonable step by way of policy and practice to ensure that this type of conduct is detected and acted upon appropriately and swiftly.”
“We are reviewing and updating the relevant policies identifying and correcting any gaps or inconsistencies system-wide. Our managers and timekeepers are monitoring compliance with these policies with renewed vigilance. We appreciate the Better Government Association bringing this matter to our attention.”
Preckwinkle released a written statement saying she has confidence in Raju’s “ability to make systemic changes and improvements at the hospital system.”
“He has assured me he has taken corrective actions. A doctor has been terminated and policies and procedures have been reinforced to ensure hospital employees are working a full day for a full day’s pay.”
This story was written and reported by the Better Government Association’s Robert Herguth, Patrick Rehkamp and Andrew Schroedter. They can be reached at (312) 821-9030 or firstname.lastname@example.org.