Harbor-UCLA Medical Center, which removed its orthopedics chief from his post after widespread complaints of employee harassment and sexual misconduct with unconscious patients, has been placed on probation for “substantial” noncompliance by the accrediting agency for all U.S. physician residency and internship programs.
Neither the hospital nor the county Department of Health Services would say whether the action by the Accreditation Council for Graduate Medical Education grew out of the controversy surrounding Dr. Louis Kwong, the Department of Orthopedic Surgery chairman who was placed on administrative leave more than a year ago.
The accreditation council also declined to explain why Harbor-UCLA has been placed on probation, but the agency was alerted to problems with Kwong by emergency medicine residents who became frustrated that hospital leadership was ignoring their complaints.
Three physicians have filed lawsuits against Kwong and the county, alleging he engaged in sexual misconduct in the operating room, delayed acute surgeries in favor of elective procedures and made repeated misogynistic comments to staff.
Dr. Darrell W. Harrington, who is in charge of training programs at Harbor-UCLA, acknowledged in a July letter to physicians and staff that the probationary status is “considered a serious disciplinary decision by ACGME,” but noted that DHS and hospital leadership “are confident full accreditation will be restored.”
Harrington’s letter, which was obtained by the Southern California News Group, noted that, “Moving forward, Harbor-UCLA will integrate input from important stakeholders, institutional and Department of Health Services leadership as well as our Graduate Medical Education Committee to devise a strategy and pathway forward to address the concerns raised by ACGME.”
Harrington declined to comment and DHS officials did not answer questions about the probationary status. Kwong could not be reached for comment.
Harbor-UCLA, a 570-bed public teaching hospital in the unincorporated West Carson area, is owned by Los Angeles County and operated by DHS. Its doctors are on the faculty at UCLA’s David Geffen School of Medicine and oversee medical residents trained at the facility.
The hospital is among six sponsoring institutions in the U.S. placed on probation by the ACGME for the 2023-24 academic year. Sponsoring institutions are those that oversee, support and administer one or more accredited residency/fellowship programs.
Harbor-UCLA remains fully accredited for existing residency and fellowship programs, but cannot apply for ACGME accreditation of new programs while on probation.
“Harbor-UCLA leadership is already working to resolve the concerns of the (ACGME) council and expects to be able to do so in a very timely manner,” the hospital said in a statement. “In the meantime, current residents, patients, and future applicants should rest assured that this change in status will have no impact on their jobs, their care, or Harbor-UCLA’s ability to recruit new trainees.”
However, all Harbor-UCLA trainee applicants invited to interview with the facility, along with residents and fellows accepted into or enrolled in a program, must be notified in writing of the hospital’s probationary status. Some suggest the status change could dissuade recent medical school graduates from accepting a residency there.
Allegations result in lawsuits
Kwong was targeted in two lawsuits — one by Drs. Haleh Badkoobehi and Jennifer Hsu, both orthopedic surgeons, and another by Dr. Madonna Fernandez-Frackelton, the hospital’s former director of emergency medicine. Both suits, filed last month in Los Angeles Superior Court, also named Los Angeles County as a defendant, alleging officials ignored the women’s repeated complaints about Kwong.
Fernandez-Frackelton, who has worked at Harbor-UCLA for 27 years but was recently demoted, said she filed her lawsuit after Los Angeles County and UCLA officials failed to address her complaints.
“I worked tirelessly within the county system to report these egregious acts of wrongdoing and possible criminal behavior in the Department of Orthopedics,” she said. “Sixty-four of my resident physicians in the Emergency Medicine department complained to hospital leadership and were ignored.
“I finally realized that the hospital leadership and the county were not going to take any meaningful action to stop it. A lawsuit became the only way I could make sure enough people knew that they could no longer hide it from patients, medical staff, and the County Board of Supervisors.”
The Department of Health Services began investigating complaints against Kwong in 2021 and placed him on administrative leave in the spring of 2022. That investigation is ongoing.
Badkoobehi and Hsu allege Kwong committed sexual misconduct on unconscious patients in the Harbor-UCLA operating room in the presence of multiple witnesses. He engaged in “finger-banging” of surgical hip wounds in front of Badkoobehi while making sexual sounds and saying he was finding the “G-spot,” the lawsuit states.
Additionally, Badkoobehi alleges Kwong undraped an anesthetized patient to look at his penis after being told it was large, and that he measured the penis size of some patients.
In another matter dubbed the “baseball incident,” Kwong purportedly ordered that a video monitor in the operating room used to display patients’ vital signs be switched off and used to display a baseball game so that residents could watch during surgery.
Badkoobehi, who was assigned to investigate the baseball incident, alleges Kwong retaliated by stripping her of her position as associate program director.
“The question is not whether Kwong harmed patients, medical students, staff, residents, and attendings,” Badkoobehi said in an email to SCNG. “There are too many documented examples and witnesses for over a decade to have this even be a question.”
Although Harbor-UCLA proclaims to be welcoming, equitable, diverse and inclusive, when evidence comes to light contradicting those goals, it closes ranks and protects itself, she added.
“All we are asking is for the people in power to take an honest look at who in the hierarchy appointed, promoted, and gave special privileges to Kwong, who enabled Kwong’s behavior by looking away or covering up for him and his enablers, and make appropriate change,” Badkoobehi said.
Hsu, who started working at Harbor-UCLA in 2013, alleges in her lawsuit that Kwong told at least three physicians that he wanted to get rid of her while she was out on maternity leave by having her to switch to part-time status so he could release her, and force her to work at a less desirable Los Angeles County hospital.
Hsu said when she joined Harbor-UCLA’s Department of Orthopedic Surgery as its first female faculty member, she didn’t expect gender and pregnancy discrimination or less pay than a male surgeon with identical experience and training.
“However, under Louis Kwong’s chairmanship, I experienced all of this,” Hsu said. “His abuse of this trust has been bafflingly tolerated by county administration, whose lack of action perpetuates to this day a culture of inequality and sexism that pervades across DHS hospitals.”
The lawsuit filed by Badkoobehi and Hsu detail Kwong’s alleged proclivity for bragging to faculty and physician residents about his sexual exploits and discussing erotic topics.
Kwong allegedly discussed “autoerotic asphyxiation” in clinics and sex acts during surgeries. Additionally, the suit alleges, Kwong fostered an environment in which residents were encouraged to attend strip clubs together, and, in at least one instance, they returned inebriated to their official graduation dinner with faculty.
He also allegedly organized department-sanctioned roasts that included crude mockery of residents, including of their race and genitalia, despite the fact that family members and children were in attendance.
“Displays at the roasts included screenshots of patient charts, even including the blood alcohol level of an intoxicated, on-duty police officer who was a patient of Kwong’s,” says the suit, which calls such displays a blatant violation of the Health Insurance Portability and Accountability Act.
Additionally, Kwong allegedly regularly used the word “fag” to describe homosexuals and covered up racism, including an incident in which a junior resident called a chief resident the “n” word in a written document.
Members of the orthopedics faculty and others also complained that Kwong, who is a reserve Los Angeles County sheriff’s deputy, carried a concealed knife and wore a gun at various times at Harbor-UCLA, including in the operating room, clinic, office and conference rooms, and at times when scrubbed in for surgery.
A Harbor-UCLA physician was so worried that he considered getting bulletproof glass installed on his car and wearing a bulletproof vest to work. “His (Kwong’s) anger, weapons, and intolerance of any criticism made staff worry about their safety,” says the lawsuit filed by Badkoobehi and Hsu.
One resident physician took a widely circulated photograph of Kwong with the gun strapped to his leg in the Orthopedic Surgery Clinic.
Staff at all medical centers are prohibited from carrying weapons or having weapons on medical campuses, according to DHS. The only exceptions are for physicians who are reserve deputies and are fully trained to perform law enforcement functions when called on assignment to provide life-saving support.
However, even then, reserve deputy physicians at Harbor-UCLA must follow strict safety protocols, including proper storage of their handguns in a locked safe box while at the hospital. They are not allowed to carry a firearm during surgery.
Fernandez-Frackelton, who served as Harbor-UCLA’s emergency medicine program director for a dozen years, believes Kwong carried the gun to intimidate hospital personnel and alleges she was demoted after filing grievances concerning the safety of residents, faculty and staff.
Kwong ‘protected and defended’
Fernandez-Frackelton submitted a complaint to the ACGME on March 16, 2022, contending Harrington prevented her from removing trainees — interns, residents and fellows — from the hostile work environment created by Kwong.
The 10-page complaint, obtained by the Southern California News Group, alleged Harrington “has protected and defended” Kwong for many years, despite “complaints about sexism, racism, hostile work environment, bullying, illegal narcotic prescriptions, unethical surgical consents of patients, and retaliation.”
Harrington was aware of the grievances but undermined Fernandez-Frackelton’s authority to pull emergency medicine residents from orthopedics rotations by assuming the responsibility himself of creating work schedules for all Harbor-UCLA interns, the complaint states.
“I would attempt to stay after our Graduate Medical Education meetings to discuss program-related issues with Dr. Harrington, but he was always sitting with Dr. Kwong,” Fernandez-Frackelton said in the complaint. “I now realize that this was intentional — that it was done to prevent me from raising concerns, again undermining my ability to function as a program director.”
Fernandez-Frackelton sent Harrington a text in June 2021, asserting her authority as a program director to remove emergency medicine interns from rotations. “I’m just trying to advocate for my interns and for a balance of the more painful services among all interns,” she wrote in the message obtained by the Southern California News Group.
“You don’t want to go there,” Harrington replied in what Fernandez-Frackelton interpreted as a threat.
Meanwhile, program directors for Harbor-UCLA’s Family Medicine and Neurology departments, who also complained to Harrington about the malignant, “toxic masculinity” work environment within orthopedics, succeeded in having their trainees removed from rotations, according to Fernandez-Frackelton.
Residents revolt
Additionally, four emergency medicine chief residents filed a complaint with the ACGME on March 14, 2022, further detailing the difficulties interns have experienced in orthopedics rotations.
“The leadership in our department has attempted to work closely with both Orthopedic Surgery Department leadership and hospital leadership to improve the culture and the educational value of this rotation,” the seven-page complaint states. “However, despite the numerous meetings that have occurred across numerous calendar years, no meaningful improvement has occurred.”
The complaint alleges that from 2020 to 2022 emergency medicine interns and residents were subjected to a litany of troubling incidents during orthopedics rotations, including:
- An orthopedic surgery resident called an intern a “f—— moron” for not doing something during an overnight shift when that expectation was never communicated to them.
- An emergency medicine resident was asked to sign orders, document exams, and provide recommendations on a consult for a patient that they had not assessed.
- Patient care was provided using non-HIPAA-compliant software such as WhatsApp Messenger and Excel documents.
- Explicit, unprofessional education lectures were held on the topic of sexual positions following joint replacement.
- Orthopedics personnel made racist, homophobic/transphobic or disparaging remarks about people with mental health issues or limited English proficiency.
- A resident was asked to obtain informed consent for a patient on behalf of a surgeon and forge a surgeon’s signature. Additionally, a resident was asked to write notes and prescriptions for a controlled substance for patients they never examined.
- Orthopedic residents were found vaping in patient care areas.
In January 2022, emergency medicine residents, frustrated by the lack of progress in having their concerns addressed, unanimously signed a statement indicating extreme dissatisfaction with Harbor-UCLA’s six-week orthopedic surgery rotation. They requested that it be removed entirely or significantly reduced.
“However, despite all our efforts, to our knowledge, no satisfactory resolution has come about from these discussions, many of which we have not been privy to,” the chief residents said in the complaint.
