UCI Tightens Loose Reins on Medical School

UC Irvine officials announced a series of moves Thursday to strengthen oversight and tighten management at the scandal-plagued medical school, including unannounced audits and a review panel with outside members.

Chancellor Ralph J. Cicerone, in his first public comments since problems with the Willed Body Program came to light two weeks ago, wrote to College of Medicine faculty and staff that “there is much at stake in these efforts,” an apparent admission that after four scandals since 1995, the medical school cannot afford another misstep that could affect its reputation and ability to attract top-flight students and professors.

The latest scandal might have been headed off, Cicerone said in an interview, “if we’d had more of us looking over each other’s shoulders.”

In a separate letter, medical school Dean Dr. Thomas C. Cesario emphasized the importance of the new measures. “Our responsibilities to uphold the public trust are no less important than our responsibilities to care for patients and to discover new knowledge.”

The moves place more responsibility on department heads to ensure rules are followed, and their “management ability will be a key factor in the evaluation of their performance and in consideration of reappointment,” Cesario wrote.

He and Cicerone admitted that the medical school had not been paying enough attention to administration. “We need to put more effort into running things,” the chancellor said.

Cicerone, who became UCI’s top official in July 1998, said he was angered by allegations that the mortician who ran the Willed Body Program profited from the use of body parts. “The trick,” he said, “is channeling the anger into something constructive and rational and analytic.”

The new measures mean department heads will have to walk a delicate line between regulation and academic freedom, said Tony Mazzaschi, assistant vice president at the Assn. of American Medical Colleges. “It isn’t like a factory where you have cars going down an assembly line,” he said. “There is only so much a chair can do to monitor faculty. But there are things you can do, and by making this explicit, it certainly sends a message to faculty.”

No two medical schools are alike, making it difficult to compare the way administrations oversee faculty and staff, experts said.

“There are other schools that have such explicit guidelines and explicit layers of responsibility, including how chairs are judged,” Mazzaschi said. “I am not sure very many have the history that UCI has had.”

A key element of the reforms is the “external review group,” which will consist of five to 10 people from both inside and outside UCI. The members will include ethicists and doctors, along with those experienced at running a medical school or medical center and longtime department heads.

“We want broad experience, knowledge of the national scene and a record of distinction,” Cicerone said.

The group will advise the administration on additional steps UCI should take to improve oversight and “whether there are any underlying, systemic impediments” at the medical school, Cesario wrote.

The medical school also will establish a new position, an associate dean for administration, who will be in charge of turning academicians promoted to department chairs into managers and who will serve as the place where people can report wrongdoing.

Reaction on campus was favorable. Dr. Michael Prislin, a professor of family medicine and associate dean for student affairs, said the reforms will place more responsibility on the departments.

“Everyone should be able to tolerate scrutiny,” Prislin said, “and if it improves things, so much the better.”

Poor oversight has plagued UCI in the controversies that have erupted since the fertility scandal in 1995. In that instance, doctors stole eggs and embryos of patients and implanted them in other women. Two years later, cancer researchers improperly charged patients for experimental treatments, and in one instance gave a girl an unapproved treatment. Last year, a professor used patients’ blood samples for research without seeking permission.

The university fired or disciplined administrators or professors responsible for the problem research or those who supervised them.

In addition, an outside audit of five departments unrelated to the scandals found that oversight was a major problem at the medical school.

The latest imbroglio involves Christopher S. Brown, director of the Willed Body Program, who was fired amid allegations he had financial ties to companies that profited from the program and that he pocketed the payment for body parts the program sold.

UCI’s announcement was applauded in the Orange County medical community, where several people agreed with Cicerone that the scandals had shaken the public trust and that the reputation of the university is at risk. Besides being Orange County’s only medical school, UCI also runs one of the county’s largest hospitals.

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Preventive Measures

UC Irvine College of Medicine will do the following to improve oversight:

* Appoint an associate dean for administration who will oversee the medical school, specifically training department chairs in management and investigating allegations of wrongdoing.

* Create a high-powered, external review panel to advise university officials on how to improve management and oversight.

* Make department heads’ evaluations and reappointments contingent not only on academic and scholarly achievement but also on management ability.

* Institute periodic, unannounced reviews of departments and programs by the associate dean.