A DOCTOR AND HIS CRITICS

Dr. Forest Tennant's medical practice centers on a nonprofit organization called Community Health Projects Inc. (CHP), which he founded in West Covina, Calif. in 1974. The operation now comprises two dozen storefront clinics in Santa Barbara, Fresno and the Los Angeles area. They serve as many as 2,000 patients a week, one third of them for drug dependency. Over the years, CHP has been in hot water with various state and county agencies. In '86, Dr. Irma Strantz, the director of the office of drug abuse programs in Los Angeles County, with which CHP had a contract to dispense methadone to recovering drug addicts, wrote to Tom Hibbard, the senior deputy of the First Supervisorial District, detailing what she called "significant problems related to CHP."

"Almost from the inception of the contract, County drug program monitors were hard-pressed to elicit an acceptable level of client services from this agency [CHP]," Strantz wrote. "The litany of problems are as follows...use of unqualified personnel to perform physical examinations;...inappropriate use of research drugs...; unwillingness of management/administrative staff to comply with County contract and state methadone requirements...; lack of compliance with Medi-Cal treatment standards...; billing...in conflict with both federal and state law and regulations...." Strantz has written several other letters critical of Tennant's operations to various government administrators.

Former employees have shown SI several memos from Tennant that they considered improper. In 1985, Tennant sent the administrators of all of his clinics this memo: "If an NP [Nurse Practitioner] or PA [Physician's Assistant] has done the physical exam and signed it, the physician will sign underneath this and will date it exactly as the same date as the NP or PA.... The physician has the perogative [sic] of signing the physical exam several days after the examination was actually done and still sign the same date because he was supervising on that date." Regulations allow a physician to countersign the report of a physical exam as many as 72 hours afterward. But Tom Yanger, chief of prosecutions for the California attorney general's Bureau of Medi-Cal Fraud and Patient Abuse, told SI, "This is still not signing on the date that he says he's signing. Falsification of a medical record—a misdemeanor."

On Jan. 28, 1985, Tennant wrote to the staff of one clinic: "I do not believe you are utilizing the more lucrative aspects of the methadone program: pulmonary function testing; psychological testing." And to the directors at another clinic, Tennant sent this memo on Dec. 22, 1986: "You will simply have to arrange for the charts to show that the urinalysis was taken prior to the day of admission."

Another CHP memo was sent to clinic directors and program managers on Dec. 17, 1984: "Please make every effort to write 2 diagnoses on each patient's Third Party Payment Sheets. The 2 diagnoses ensure maximum payment and expedite receipt of payment. Help us keep those payments rolling in!" Informed of the contents of this memo, Yanger said, "That's fraud.... Fraud has to be a false statement of a material fact. That's an interesting enough statement to me that I'd like to take a look." However, Yanger, whose office investigated CHP in '85—without access to such memos—now says no further investigation is planned because the alleged violations, which occurred between '84 and '86, are too old.

The 1985 inquiry fizzled after a magistrate denied a request for a search warrant to examine CHP's files. The attorney general's office turned the case over to California's Department of Health Services, which found that CHP had engaged in "improper billing practices," among other violations. CHP was ordered to repay $101,720 to the state, one of several occasions when CHP had to pay reimbursements for overcharges.

Another damning memo was sent by Tennant to 13 of his clinic directors and program managers on May 4, 1987. It named 43 CHP patients who had tested positive for the AIDS antibody in tests conducted as part of a National Institute on Drug Abuse study. At least one recipient of the memo was outraged by the apparent breach of confidentiality: Clinic directors around the state found themselves with the names of 43 people who had tested positive, most of whom they had never treated and never would treat. In the same memo Tennant advised the clinic administrators to "not encourage" patients who tested positive to be retested elsewhere. A patient testing positive for the AIDS antibody might understandably wish to seek a second opinion, but, Tennant wrote, "I do not have any confidence in local health departments or hospital laboratories relative to accuracy." He added that another test, if it "refuted" the first test, could expose CHP to "a great deal of liability."

SI interviewed eight former employees of Tennant's. One of them, Charlotte Moore, who was Tennant's secretary, lauded him as a "wonderful human being" and "very professional." The other seven expressed strong disapproval of Tennant's ethics. Two of these ex-employees were fired by Tennant and five quit. Most of them would not allow themselves to be named, expressing fear of retribution by Tennant. In 1987 Lindley Murray, who was fired as director of one of Tennant's clinics after confronting Tennant about what Murray considered unethical practices, sued Tennant and CHP in Los Angeles County Superior Court for wrongful termination and accused CHP of "defrauding Medi-Cal and the county of Fresno" and of "carrying on substandard medical practices." Tennant settled the suit by paying an undisclosed sum to Murray and by agreeing to regard his dismissal as a resignation.

Another former employee fired by Tennant, Gordon Griffith, whom SI retained as a consultant in the early stages of preparing this report, was Tennant's chief assistant in administering the NFL program. On June 21, 1988, 19 days after praising him in a letter of recommendation to the director of the California Department of Corrections, Tennant dismissed Griffith; Griffith says that Tennant had asked him to keep tabs on the conduct and choice of companions of NFL and Dodger players and was unhappy when Griffith became uncomfortable with the ethics of this assignment. Griffith is the defendant in a criminal harassment action in Los Angeles County Municipal Court in which Tennant, who claims that Griffith threatened him on the phone in an effort to collect back pay, is the complainant. The case is scheduled to go to trial on Aug. 7. Griffith's attorney, Suzanne Tom, says Tennant telephoned her on April 17 and 18, offering to withdraw the complaint against Griffith—the trial originally had been scheduled for April 18—if Griffith would sign a statement saying that he agreed to disavow anything he may have told SI in connection with this report. Griffith refused.

Tennant is accused by former employees of, among other things,

1) Signing blank dosing sheets, which are similar to prescription forms, for issuing methadone to patients.

2) Instructing a bookkeeper to submit trumped-up bills to Medi-Cal, the state medical assistance plan, and to bill the state for medical tests for detoxification patients "whether that patient needs the test or not." (One former employee says Tennant called this "creative bookkeeping.")

3) Giving patients high dosages of methadone. ("This was conducive to keeping up revenues," says one source. "Some were so loaded, you wondered how they were going to be functional.")

4) Providing inadequate counseling sessions to methadone patients and misrepresenting the extent of such sessions in patients' records. (One former employee says, "Dr. Tennant said to make up things for the counseling notes.")

5) Meeting government staffing requirements by submitting a budget indicating that a CHP clinic had more trained counselors than it actually had, and by promoting a courier to lab technician even though the courier lacked proper training.

6) Telling employees that "there's no such thing as confidentiality in a drug program. They all know each other," and entertaining members of his clinic staffs with gossip about athletes he was treating for drug use. ("At lunch or in the office, he would tell the staff what players were doing what," says one former employee. "He named names.")

7) Giving law-enforcement officials information they sought about CHP patients, an apparent violation of federal regulations governing confidentiality. ("You always tell the police whatever they want to know," a former employee quotes Tennant as saying.)

In a 1986 arbitrator's hearing, NFL commissioner Pete Rozelle said the league hired Tennant because of "the research that my staff had done" and because he was "highly regarded in the field." Last week NFL officials said they had no knowledge of allegations of wrongdoing leveled at Tennant by anyone. Told by SI of Tennant's difficulties with government agencies and of abuses cited by former employees, NFL publicity director Joe Browne said, "Charges are a dime a dozen." Executive vice-president Jay Moyer said that the league was satisfied with Tennant's performance and that the drug adviser "has done a lot of good things."

But a physician who once worked for Tennant disagrees. "I consider him unethical and hypocritical," he says. "I found that his medical practice was guided by what money could be brought in."

PHOTO

BOB CONNELL