Investigators Looking Into Arrowhead Regional’s Operations

Allegations of malpractice, licensing shortcomings, operational and managerial miscues and substandard accounting practices at the county hospital are the focus of separate inquiries by federal and state agencies, the Sentinel has learned.

The Sentinel was unable to ascertain whether a rumored survey of the hospital’s operations by auditors working at the behest of the board of supervisors is actually underway.

The issues being looked into include current practices as well as those extending back nearly a decade at the Colton-based facility, which is known as the Arrowhead Regional Medical Center.

The sharpest focus is that on the administrative action of Dev GnanaDev, who is both the current medical director of Arrowhead Regional as well as its head of surgery. GnanaDev also happens to be the president of the California Medical Association.
Some of the suspected problems at the hospital originated at a level well below that of GnanaDev and involved several instances of medical malpractice and faulty diagnoses. Others have been attributed to GnanaDev directly.

One known case,  the Sentinel is informed, elicited the interest of federal investigators and involved a thirteen year old girl who had suffered a dislocated neck. Physicians and staff failed to adequately recognize or diagnose the condition, resulting in the child becoming permanently paralyzed. The medical staff further stands accused of having lied to the parents about the situation.

Questions have been raised as well about non-medical issues, specifically fiduciary ones in the hospital’s operations. One area under examination is billing and potential fraud with regard to descriptions of services rendered and billing procedure. Another pertains to a major conflict of interest GnanaDev is said to have participated in under the authority of former county administrative officer Mark Uffer. Uffer signed off on GnanaDev negotiating with his own medical group, Arrowhead Regional Surgical Group, Inc., for the provision of services to the county hospital. Uffer was the director of Arrowhead Regional prior to his 2004 elevation to the post of county administrative officer.

GnanaDev’s apparent conflict of interest has resulted in the manifestation of specific problems at the medical center which have gone unredressed.

In December, the Center For Medicare Services launched an investigation, the Sentinel has learned, on the strength of a call to the state of California about shortcomings in the care of a patent. And while no final report of that accreditation body’s inquiry has been delivered, it is known that the investigators were notified there had not been peer review with regard to some practices and  that a free discussion of treatment modalities and protocols had been discouraged by GnanaDev.

You shouldn’t hide things,” said one hospital employee. “If you bring it out and you take corrective action you’re okay. Some don’t want to be embarrassed, so nothing is done to change or fix things. It is now catching up with them.”

Furthermore, GnanaDev’s comportment has come under question with regard to a situation in which another surgical service provider wrote a complaint about the Arrowhead Regional Surgical Group’s activities. GnanaDev’s reaction, according to one well placed source, was to threaten to cancel the contract of the complaining entity. Specifics with regard to this incident, the Sentinel was told, were kept from the board of supervisors.

At one point, a hospital employee, concerned that GnanaDev’s dual role as head of surgery and medical director represented a circumstance under which the issue could not be dealt with in a forthright manner, approached the hospital’s director, Patrick Petre.

“Patrick, who doesn’t like confrontation and is afraid of Dev, ignored it,” a source employed at the hospital told the Sentinel. “Later on, he [Petre] said he never heard about it.”

Another hospital employee explained the issue thusly: “GnanaDev controls Arrowhead Surgical Services. He runs it and operates it. Theoretically he reports to himself and he negotiated his own contract.”

The Arrowhead Community Surgical Group’s contract, a copy of which has been obtained by the Sentinel, designates the group as the provider of the directors of some of the hospital’s departments, including general surgery, including trauma, otolaryngology, burn surgery, oral surgery, neurological surgery, plastic surgery, opthalmologic surgery and transplant surgery.
According to employees at the medical center, other administrators and higher-ups there have engaged in questionable practices.

A scandal that is looming just below the surface of public consciousness, one employee, said, consists of inadequate supervision and oversight in the emergency room.

It has been said that chief financial officer Frank Arambla has been using non-medical criteria in dictating the hospital’s emergency room admissions policy.

“The CFO has been telling the emergency room doctors which patients to admit and which ones they can’t,” said one employee.
“Residents are running the emergency room,” said another employee. “They are letting physician assistants do whatever they want. The nurses are up in arms.”

Allegations of mis- and malfeasance in the department of behavioral health have also surfaced. Specifically, patients, who by law are not to be kept in restraints for more than six hours, were in some cases physically immobilized by straps or other bindings for as long as four months, the Sentinel has been told. These restraints were maintained even while the patients were eating and showering. In some cases, after family members lodged a complaint the restraints were removed. In other cases, where no family members were present to take note of the practice and even in some cases where family members did, the restraints were not removed.

“Some patients were tied to a bed for months on end,” one employee at the medical center told the Sentinel. “It’s like an image out of a horror movie.”

Guillermo Valenzuela, the medical center’s associate medical director and the president of the county medical society and chairman of the women’s health division, and Rodney Borger, the chairman of the county medical society, were derided by some medical center employees as having been too subservient to GnanaDev. It is known that both Valenzuela and Borger recently approached supervisor Brad Mitzelfelt and sought to reassure him about the sufficiency of operations at the hospital, arguing that there is no need for substantial changes in the way the facility is being run.

Valenzuela is a registered lobbyist and there have been reports of irregularities in the methods GnanaDev and those in his orbit have utilized in seeking to keep the county board of supervisors from bringing its authority to bear to change policies at the hospital.

Two county hospital employees told the Sentinel that GnanaDev has made a practice of directing those with whom he is professionally associated to put up money, which he then forwards to the electioneering funds of various supervisors in an effort to curry favor with them.

A recurrent report from those working at the hospital is that at least three of the members of the board of supervisors as well as members of their staffs and families have been provided with medical care at the medical center to which they were not entitled.
“I can tell you there were some county VIPs who were given treatment at the hospital they were not supposed to get,” said one employee. “Because of who they were – members of the board or their people – they were moved to the front of the line. They were never billed or the bills disappeared. This was improper because this was outside the scope of the medical plan and the mission of the hospital to provide quality care for all citizens regardless of their ability to pay. I know at one time hospital staff was talking about a clinic that was to be devoted to county employees.”

The provision of the free medical service to members of the board of supervisors, the Sentinel was told, appeared to be one means by which GnanaDev had prevented the board from holding GnanaDev and other administrators at the hospital accountable for their actions.

“That free medical care to the supervisors was not reported on their [California Form] 700s,” a hospital employee said.
California Form 700s are statements of economic interest that must be filled out by California public officials, including those in elective office. The hospital employee suggested that the failure of the county supervisors who had received medical care at the county hospital to disclose that free care on their Form 700s provided GnanaDev with blackmail material by which the medical center’s officials were able to limit a critical evaluation of the medical center’s function.

On the non-medical end, there is overwhelming evidence that billing for services at the hospital was done improperly.  In one of the divisions at the hospital, billings were delayed for over two years. This was hugely problematic, since most insurance companies do not accept bills that are more than two months delinquent and Medicare will not accept billings that are more than one year old.

“This came about because someone wasn’t doing the work that was supposed to get done,” a county hospital employee said. “At one point there was two years’ worth of work that had just piled up. At that point it was too late to bill the insurance companies and too late to bill Medicare or Medical. In some cases they did bill the patients.”

When one county employee assigned to tracking certain phases of the hospital’s billing set to work on that assignment, in fewer than seven hours she found over $1 million worth of services to patients to whom no bills for service had been posted. In scores of cases, billings for operating room services went out in a way that only one of every four units was posted. An unofficial internal tally of operations showed that in one year there was a $10 million shortfall in operating room billing.

The same informal audit of the hospital’s operations turned up fraud or lack of follow-through in the 1011 program, through which the county seeks reimbursement for services rendered to illegal aliens.

There were reports in late February that the board of supervisors was considering bringing in a consultant to examine the medical center’s operations. The Sentinel, however was unable to confirm that such an effort was ongoing.

The examination of the hospital’s operations by the Health Care Facilities Accreditation Program run by the American Osteopathic Association, the Center for Medicare Services or federal investigators could result in the medical center losing its accreditation, meaning the hospital would no longer be eligible to care for Medicare patients.

At press time, the Sentinel’s efforts to reach Petre and GnanaDev at the medical center were not successful.