The medical director of D.C. General Hospital has concluded that problems with absentee doctors in years past have been eliminated and will be prevented in the future by recent changes in the hospital's procedures.
Dr. Lawrence Johnson made a report to the D.C. Hospital Commission after The Washington Post published an article that quoted persons familiar with the hospital as saying that a number of doctors were not working the full 40 hours for which they are paid.
Johnson said he does not believe this problem exists at the hospital anymore.
"I was able to determine from heads of departments that a few years ago there were physicians they were concerned about not putting in their time. Those doctors were invited to leave and did leave," Johnson said in an interview. "Currently, from everything I have been able to discern, we do not have a problem we can identify."
The chiefs of each service at the hospital, who are responsible for their departments and the doctors in them, said the 40-hour minimum "was met or exceeded in any given work week," by doctors at D.C. General, according to the report.
While some staff physicians have private practices elsewhere, the chiefs of service said "such practice did not interfere with their obligations at the hospital," the report said.
Johnson's report was based largely on interviews with the chiefs of service; the director of nursing; six house officers in the OB/GYN department, and Dr. Thomas Cardella, a D.C. General physician who said in the Post story he is concerned about doctors absenses.
The nursing director said nursing staff are not in a position to report on or monitor doctors hours, but that some "have frequently complained of difficulty reaching physicians on call," according to Johnson's report.
The report blamed that problem on the paging system, improper schedules going to page operators, incorrect phone numbers being listed for physicians and doctors being at the hospital in other emergency situations.
The original Post story was based on interviews with individuals familiar with the hospital, most of whom worked there or had been connected with the institution within the previous year.
Private practices take some doctors away from the hospital when they should be there, the sources said.
The story also quoted a report by the D.C. auditor a year earlier that had found D.C. General was "deficient in assuring that doctors are actually working the number of hours for which they are paid."
Largely in response to that report, the hospital instituted its new timekeeping procedures.
The chief of each service at the hospital must verify that individual doctors work when they are scheduled to and for time they are paid for, under the new procedures. Johnson said he had between two and four weeks of the new timekeeping documents to work with when he did his review.
"The absence of any uniform timekeeping procedures prior to this recent implementation would make a retrospective analysis impossible," the report said.
Members of the medical staff have said that doctors at D.C. General usually work longer than the 40 hours a week for which they are paid and are on call frequently to provide full round-the-clock coverage at the hospital. They say that doctors may be there a number of irregular hours that others working at the hospital would not necessarily know about.
The medical director's report said that four years ago the hospital started assigning patients to an attending physician who is legally responsible for that patient's care.
"Opportunities for abuse have been greatly diminished as physicians now have scheduled responsibilities for direct care and supervision," it said.
Johnson said that, in the absence of allegations against specific individuals, his report is the end of the hospital's response to allegations of doctor absences. The hospital is confident that the new timekeeping procedures will be sufficient to insure proper attendance, he said.