State audit hits Department of Public Health on investigation delays, control over public money

Hartford Courant (CT)

The state Department of Public Health struggles to complete investigations of doctors and facilities on time and lacks adequate control over millions of dollars’ worth of contracts, employee overtime, leave payments and license fees, a state audit released Thursday said.

“When investigations are not completed in a timely manner, there is an increased risk that facilities that pose a danger to the public will continue to operate unabated,” said the 68-page report by the State Auditors of Public Accounts, an independent, bipartisan office that reviews all state departments and operations at least every two years.

“It appears that a lack of adequate managerial oversight and staffing resources contributed to the condition,” the auditors reported in the latest DPH survey, focusing on the 2016-2017 fiscal year.

The survey identified at least three other investigations of health care facilities that weren’t begun in a timely manner. The delays were as long as 175 business days, the report said.

In one recent case that was not part of the audit, DPH in November had to return to Silver Hill Hospital in New Canaan to re-investigate the 2018 suicide of Leo Civitelli, a Wall Street investment banker, after The Courant revealed he’d overdosed on malaria pills brought to him by an unauthorized visitor, and that rigor mortis had set in before his body was discovered. DPH did its initial investigation a year after the suicide, and officials acknowledged they should have assigned a much higher priority to the case and visited the hospital in a mater of a few days.

The department said it has assigned an inspector to work exclusively on priority complaints and will produce monthly reports on DPH response times. In 2017, the agency received 1,445 complaints about healthcare facilities, including hospitals and nursing homes.

The auditors also looked at a sample of 10 investigations into alleged violations by doctors and found that in three of them, the investigation exceeded the department’s 90-day deadline by 76 to 210 days.

In two instances, the department delayed the investigation process by more than 180 days to search for a medical consultant to review treatment records.

Consultants are usually doctors who are certified in the same specialty as the doctor under investigation. The consultant can’t have any conflicts – for example, he can’t know the doctor -- and sometimes it takes DPH a long time to find the right consultant for the case, agency officials said in written responses to the audit.

A follow-up audit of the 2018-2019 fiscal year is about 50 percent complete, said John Geragosian, a Democrat, who runs the office with Rob Kane, a Republican.

Every finding and every department response to those findings are re-checked, Geragosian said.

In the audit report released Thursday, DPH said that it had addressed most issues by the fall of 2018, either by hiring staff, re-training managers, updating software, or developing new policies and procedures. DPH attributed some of the deficiencies to a lack of funding from the legislature.

Current DPH Commissioner Renee Coleman-Mitchell began work in April 2019.

“The Department has been working on implementing the corrective action plans proposed as part of the Department’s responses contained in the report,” said Av Harris, who is the department’s spokesperson.

Among the audit’s other findings:

DPH didn’t follow its own protocols on multiple payments to employees for overtime, leaves from work, telecommuting and working from home, including failure by supervisors to obtain the required pre-approvals. The auditors looked at 40 overtime and compensation cases and 13 didn’t have the required pre-approvals. “Accountability over personnel costs is negatively affected when employees are credited with compensatory time and overtime hours without obtaining prior authorization or properly providing the rationale for earning such time,” the auditors said.

Lack of consistency and documentation in the collection of millions of dollars in license fees and other funds due the department.

Lack of timely execution of contracts and work-order approvals for some community-based health services.

Incomplete data collection on the quality of emergency medical services throughout the state.

“Without comprehensive, reliable data, the department is unable to research, develop, track, and report on appropriate … measures for the state’s emergency medical services system and to properly report these matters to the General Assembly,” the audit report said.

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