Tulare Hospital Board Member Facing Recall Effort

Dr. Parmod Kumar’s days on the Tulare hospital board may be numbered.

During the November 8 election, Tulare Local Health Care District (TLHCD) board incumbents—Chairwoman Sherrie Bell and Linda Gadke, who have been central to several controversies there—were rejected harshly at the polls, losing their seats by a two-to-one margin. Now, a recall of Kumar has been certified by the Elections Office.

No date has been set for the recall vote.

The petitions calling for Kumar’s ouster were circulated by Citizens for Hospital Accountability, and the grassroots group’s statement of intent to recall was delivered to Kumar by Alberto Aguilar, a former member of TLHCD’s Bond Oversight Committee (BOC), at a meeting of the TLHCD just prior to the election.

Kumar did not respond to a request to discuss the recall.

‘Not an Honest Person’

“He is a very unethical person,” Aguilar said of Kumar. “He’s just not an honest person.”

As a member of the BOC, Aguilar was tasked in 2008 with monitoring the spending of $85 million in bond funding approved by voters three years earlier for the construction of the Tulare Regional Medical Center (TRMC) expansion project. He soon found discrepancies in the accounting and evidence bond funds were being spent on projects not involved with building the hospital’s new wing. Kumar and other board members, Aguilar said, were aware of irregularities and refused to provide the BOC with full documentation of how the bond money had thus far been spent.

Ironically, it was Kumar’s influence that put Aguilar on the BOC. Aguilar was appointed to the BOC by former board member Rosalinda Avitia, who resigned last year, but his membership was rejected by the TLHCD Board. Kumar wrote Aguilar a letter of recommendation, and the vote was reversed.

“Miraculously, I got the most votes and ended up on the Committee,” Aguilar said. “Once I got approval from the Board, I started asking questions. I wanted to know what kind of training the people on the Committee got, to see the prior audits, to see where the money was going. Within two months, I found out money was being spent on things it should not be spent on. Even the (outside) auditors said they weren’t spending the money where they should be.”

Aguilar presented those concerns to the Board at a meeting held on October 23, 2013, and the minutes show Kumar denied the accusations.

Federal Fines

Aguilar’s objections at that meeting included a discussion of the hospital’s corporate integrity agreement with the Office of the Inspector General of the US Department of Health and Human Services (OIG), as well as the possibility of OIG’s investigations of TLHCD being reopened.

Kumar said at the time Aguilar did not fully understand the inner workings of the BOC, and he said TLHCD had a good relationship with the OIG. To the best of his knowledge, Kumar told Aguilar, there were no issues with the OIG. The conversation is detailed in the TLHCD’s public records.

Yet in 2009, the District had agreed to pay a $2.4 million settlement after an OIG investigation found TLHCD had “submitted claims to the Medicare system as part of a scheme to illegally reimburse doctors who referred patients to Tulare Healthcare.”

The District was under investigation again in 2013 when a former TLHCD Board member contacted the OIG with accusations of illegal behavior by Kumar and improper contracts between Kumar and the District. Specifically, Kumar was alleged to have improperly earned more than $800,000 over a two-year period by seeing up to 64 patients during four-hour shifts at TLHCD’s Federally Qualified Health Centers (FQHC).

TLHCD admitted to no wrongdoing in the 2009 settlement. Kumar and his wife, Dr. Parul Gupta, both resigned their jobs with TLHCD’s FQHCs following the opening of the OIG’s second investigation.

The OIG began its investigations of TLHCD after its former CFO, Maria Lucy Reimche, alleged in a lawsuit that the TLHCD paid its physicians illegal kickbacks for sending their patients to TRMC for treatment. Additionally, a 2014 investigation by the OIG found TLHCD had overcharged Medicare by nearly $200,000 in 2011 and 2012. TLHCD has since repaid the feds and agreed to strengthen its control of its billing department.

‘They Were Aware’

Meanwhile, Aguilar remained dogged in his investigation despite Board resistance.

“They didn’t like me inquiring on why this money was being spent on this stuff,” he said. “They stopped giving me information. That’s basically been their M.O. under Dr. Kumar.”

The numbers and documents he had on hand, along with information from other sources, was enough for him to put together a detailed report of how the bond money had been spent, and apparently misspent. It was also enough for him to know the accounting was being deliberately obscured, he said.

He made sure the Board knew he knew.

“I hand-delivered my report to their homes,” Aguilar said. “Dr. Kumar sat at every (BOC) meeting, as was the Board president. They were aware it wasn’t being spent the way it was supposed to be spent.”

Change Orders

One of the first irregularities Aguilar noticed was a high number of change orders for the project. He found at least dozens recorded, but the real number was much higher, he said, and those orders included spending on projects that had nothing to do with the expansion. The information came from Healthcare Conglomerate Associate’s (HCCA) construction manager, Aguilar said. HCCA is a private company that now manages TRMC and the TLHCD.

“I asked how many there had been since the start of the project. They (hospital officials) said 66,” he said. “Then I asked the project manager, and he said more than 660.”

The changes Aguilar reviewed included orders to upgrade construction trailers and to construct a new marquee sign for TRMC. Each project expended more than $100,000 in bond money earmarked for the still unfinished tower expansion.

Foundation Funds

The BOC had also been tasked with overseeing spending on the tower that did not come from bond sales, including a $3 million commitment from the Tulare Hospital Foundation and its community supporters. Hospital employees were asked to give as well.

“They (the Foundation) had a flier asking employees to donate one hour of their salary toward the construction of the tower,” Aguilar said.

Aguilar found other ways bond funds had been misspent or mishandled. The District paid medical supplier Siemens $5.5 million for equipment for the tower that was never delivered. The money, he said, may have been returned, but without accounting there’s no way to be sure. The District also stockpiled furnishings and supplies for the tower, so much that a two-week inventory was required when hospital management changed hands.

“My concern is money is being spent on things that have nothing to do with the project or its intent,” Aguilar said. “That’s still my concern.”

Aguilar’s attempt to reverse some of the damage has been rejected by management, he said.

“One of the things that was recommended at the last Bond Oversight Committee meeting in August of 2015, all of the stuff that was bought that was paid for from the bond money, why isn’t money put back from the general fund?” Aguilar said. “That’s really a simple solution.”

‘He Blatantly Lied’

Aguilar is focused on recalling Kumar because he says the wrongdoing is ongoing. He points to the recent $800,000 loan taken out by TLHCD and what Kumar and the Board told the public about it.

“I was at a Board meeting when he (Kumar) went ahead to put on the agenda about the line of credit that was $800,000. Usually, the resolution says what the intent is. What they had was just a line of credit,” Aguilar said. “People were asking questions. He (Kumar) indicated it was just a line of credit. He blatantly lied to us. They knew that money had already been dedicated.”

Once the loan was authorized by the bank, the funds were immediately used to pay off an outstanding debt. The payoff had apparently been in the works for weeks, internal TLHCD documents reveal. They are available at the Valley Voice website, ourvalleyvoice.com.

Kumar is also accused of receiving $650 an hour for being on call, a figure Aguilar says is much higher than fees received by other physicians for the same work. He said Kumar has charged the District for time when he was not physically present in Tulare County.

“How can he be on standby at $650 an hour when he’s not even there?” Aguilar asked. “I hear the other doctors only get $150 an hour.”

Nothing Personal

Despite his distaste for the situation at hand, Aguilar says he has no grudge.

“There’s nothing personal,” he said. “All we want is accountability and transparency. We’ve got to have the truth about what’s really going on. If there are changes to be made, let’s make them for the benefit of the community. People are lining their pockets.”

Aguilar cited the outcome of voting on Measure I, a request by the District for an additional $55 million in bonds to complete work on the stalled tower project that was voted down harshly, as an indicator of how the recall will proceed. He also pointed to the outcome of Bell and Gadke’s reelection campaigns and their failure as evidence Kumar won’t be around much longer.

“I’m so glad the people in those districts turned out and voted the way they did,” Aguilar said.