UCI Medical Center’s Troubles Broadening

In the unfolding controversy surrounding UC Irvine’s medical programs, the anesthesiology department has emerged as another trouble spot.

In the last three years, administrators at UCI Medical Center in Orange have been confronting a string of doctors’ resignations, faculty complaints of risks to patients, a wrongful-termination lawsuit by a former professor, and potential sanctions for the department’s pain-management program, according to records and interviews.

“It’s just a big mess,” said Dr. Raafat Mattar, an assistant professor who resigned in frustration three weeks ago.

Faculty discontent took a dramatic turn in April 2003 when 13 of the department’s 26 professors signed a letter to the department chairman, saying “the direction of the department has been radically altered to achieve financial goals at the expense of academic goals.”

The professor who circulated the petition, Dr. Glenn Provost, said in a lawsuit that he was wrongfully fired a year later for calling attention to questionable medical practices, including efforts to cut costs by rushing patients into operating rooms without charts. His lawsuit also alleges that nurses’ signatures were forged on pre-operation records and that hospital officials sabotaged his attempts to find new employment and got him fired from a job at Kaiser Permanente in Anaheim.

UCI officials said privacy rules and legal considerations prevented them from commenting on specifics about the anesthesiology department, but the department chairman, Dr. Peter Breen, defended his unit.

“I am confident that, when all the facts come out, this department will be shown to have acted appropriately, maintained patient safety and demonstrated no retaliation toward anybody,” Breen said.

Hospital officials conducted two investigations of the anesthesiology department in 2003 and found “no evidence of compromise in patient safety,” according to an internal memo. Provost’s job was eliminated because of “tight economic constraints,” according to a letter he received from Dr. Thomas C. Cesario, dean of the medical school.

In September, another anesthesiology professor questioned patient safety, saying there was inadequate orientation for nurses, poor maintenance of anesthesia machines and missing equipment on anesthesia carts, according to an e-mail Breen sent to the entire department. The professor was not named.

As he had in 2003, Breen asked a faculty panel and Dr. Eugene Spiritus, the hospital’s medical director, to investigate.

Breen declined to comment on the memo or the investigations, citing confidentiality rules. He said disgruntled employees may be taking advantage of the bad publicity UCI’s medical programs have been receiving and “using your newspaper to vent.”

The hospital has been beset by controversy since November, when The Times reported that 32 liver-transplant patients had died while its doctors turned down viable donor organs. The program has been shut down.

Other problems include poor performance in the bone marrow and kidney transplant programs. The medical school is also investigating whether the son of a donor to the radiology department received preferential treatment when he was appointed to the residency program. And the hospital’s top two cardiologists are drawing criticism from colleagues for not holding state medical licenses or U.S. board certification.

UCI has suffered a string of medical center controversies since 1995, when it was reported that fertility doctors stole eggs and embryos from patients and implanted them in other women. Later, it was found that a donated-cadaver program failed to properly handle human remains.

Since at least 1997, the anesthesiology department’s pain-management program has been repeatedly warned about its academic deficiencies by the Accreditation Council for Graduate Medical Education. It is still on probation. A spokeswoman for the council said there was no limit for how long a program could receive warnings before having its accreditation revoked.

The next accreditation inspection is scheduled for Feb. 23.

If the pain-management clinic loses its accreditation, it won’t be able to hire graduate students and would forfeit some federal grants, said Mattar, the physician who recently quit.

UCI officials refused to comment on the accreditation matter, citing confidentiality regulations. In 1997, the Orange County Register reported that the pain program had been warned because accreditation investigators found “no publications or evidence of research by full-time faculty in the past five years.”

The accreditation team also questioned whether a scheduled pain-management lecture series took place.

Mattar said he was hired 18 months ago to fix shortcomings listed in 2000 and 2004 accreditation reviews. The deficiencies included lack of equipment, failure to hire a director with medical board certification, and inadequate coordination with related disciplines, such as psychiatry and physical therapy, he said.

Some of the problems have been resolved, Mattar said. He said, however, that the program didn’t have enough X-ray machines or access to exam rooms, forcing cancer patients and others in pain to wait as long as two months for treatment. Some UCI doctors have referred patients to outside physicians because of the delays, Mattar said.

Department supervisors promised to solve the problems, but nothing was done, he said.

Breen declined to comment.

Other former and current anesthesiology department professors The Times contacted declined to comment or didn’t immediately return messages.

Over the last three years, at least nine professors have left the department. Four departing doctors had signed the 2003 petition complaining about department practices.

Mattar said the short-staffed pain clinic had been particularly hard-hit by resignations, losing seven doctors in the last decade.