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Transplant Scandal Puts CEO on Leave

Times Staff Writers

UC Irvine placed the chief of its medical center on paid administrative leave Wednesday, less than a week after shutting down the hospital’s scandal-stricken liver transplant program.

Dr. Ralph Cygan, chief executive officer of UCI Medical Center in Orange, will remain off the job while a committee of experts explores why the hospital turned down scores of donated organs even as patients on the waiting list were dying. Most of the organs were used by other hospitals for patients on their waiting lists.

“This happened on his watch,” said Dr. Michael V. Drake, chancellor of UC Irvine, in an interview. “The buck had to stop someplace.”

Drake’s move came after he acknowledged to UCI staff on Monday that he had not known of problems in the program until The Times asked about them last week.

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But interviews and documents show that some UCI administrators, along with doctors and nurses, had known about them -- and had been unable to fix them -- for at least four years. It is not clear exactly when Cygan learned of the problems, but documents show that he knew for at least three years.

Even so, he and his staff did not close the program or quit, adding patients to the waiting list until last week.

Drake, an ophthalmologist who became UCI’s chancellor in July, said he had great admiration and respect for Cygan, who began his medical career at UCI, worked his way up the ranks and repeatedly won teaching awards.

But, asked whether Cygan would return to his leadership post when the review was completed in about 90 days, Drake said, “We will wait for the outcome of the review and then we will make the appropriate decisions.”

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Maureen Zehntner, chief operating officer for UCI Medical Center, will serve as acting director in Cygan’s absence.

Cygan could not be reached for comment Wednesday, but at Monday’s hospital staff meeting he defended the program and pointed out that patients throughout California die while waiting for liver transplants.

Since the liver transplant program was started in 1993, Cygan said, the university has devoted “an enormous amount of resources to make this project work for the community. ... Our goal was to build the best liver transplant program in the West.

“We felt we were this close to achieving those goals,” Cygan said, holding his fingers an inch apart. “Unfortunately, events overcame us.”

As a result of the program’s closure, the 106 patients on the liver transplant waiting list at UCI must be moved to lists at other hospitals.

Drake, who is scheduled to brief the UC Board of Regents on the scandal today, also announced the formation of a “blue ribbon committee of internationally prominent experts” to study what went wrong and ensure that it does not recur. The panel will be chaired by Meredith Khachigian, former chairwoman of the UC regents.

“I’m troubled by a lot of things, but I’m kind of reserving judgment until I get a chance to meet with people and do the investigation,” said Khachigian. “I think that on the surface, at least, the thing that troubles me the most is that Chancellor Drake wasn’t informed ahead of time, that he found out about this last week.”

Other members of the committee are Dr. Haile T. Debas, former medical school dean at UC San Francisco; Dr. Steven Wartman, president of the Assn. of Academic Health Centers; Dr. Kenneth Shine, executive vice chancellor for health affairs for the University of Texas system and president emeritus of the national Institute of Medicine; and Ken Janda, a UCI chemistry professor who chairs the Irvine Division of the UC’s Academic Senate.

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Regent Sherry L. Lansing, who heads the regents’ committee on health services, applauded Drake’s actions. “I don’t know all the facts yet,” she said. “But I’m extremely satisfied with the steps Chancellor Drake has taken at this point. What I want is a full, complete investigation, so that something like this never, ever happens again.”

At least one relative of a patient who died on the waiting list was relieved that UC Irvine was holding top officials responsible. “Someone has to be accountable for all these lives that were lost or damaged,” said Audrey Degenhardt, whose husband died last year. “These are actual people’s lives. It’s not like we’re just playing with something little.” This week, Degenhardt was listed as a lead plaintiff in a class-action lawsuit filed by patients and families against UCI.

The problems with the transplant program had been building for years and appear to be linked to staffing shortages, according to interviews and documents obtained by The Times.

In 2001, the program’s founder, Dr. David Imagawa, had a heart attack and stopped performing transplants. Under the direction of his successor, Dr. Sean Cao, UCI Medical Center turned down a higher percentage of offers for donated livers than any other hospital in the region. And since Cao left last year, UCI has not had a full-time liver transplant surgeon and has depended on intermittent coverage by two surgeons from UC San Diego, 90 miles away.

Cygan told The Times last week that although he had been aware of problems in the program, he felt that the hospital was taking appropriate steps to correct them.

Regulators were unsatisfied. In early 2004, the state Department of Health Services said the liver program did not perform the minimum of 18 transplants per year required to maintain proficiency. As a consequence, the agency threatened to revoke the program’s ability to treat patients on Medi-Cal, a state-federal public insurance program for the poor.

In a Feb. 11, 2004, letter to Medi-Cal, Cygan suggested that the problems were, in part, a result of the hospital’s difficulties in hiring a second liver transplant surgeon.

He predicted better numbers “as a result of the improvements we have made and are continuing to make,” including adding support staff.

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Not swayed by Cygan’s letter, Medi-Cal decertified the program.

Seventeen months later, the statistics had not improved. In August this year, federal inspectors weighed in, finding that the program did not perform enough transplants to meet separate national standards and that the patients’ survival rate with new livers was below par.

In a letter, Cygan assured the government that “my entire management team has been working diligently to ensure that we increase the number of transplants ... and improve the quality of our outcomes.”

“We believe we are on the road to success with the new steps we have already taken,” Cygan wrote.

The death knell for the program came Nov. 10, when the U.S. Centers for Medicare and Medicaid Services decertified it, cutting off federal funding for the transplants and all but forcing the program’s closure.

At UCI Medical Center on Wednesday, several employees said they fully supported an investigation to determine why UCI fell so far below state and federal standards.

“I don’t think that trying to cover anything up is ever a good idea,” said Dr. Joseph Robinson, a radiology resident.

“It’s definitely bad for the hospital,” Robinson said. “It gives the hospital a black eye.”

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Times staff writers Rebecca Trounson and Alan Zarembo contributed to this report.

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(BEGIN TEXT OF INFOBOX)

Dr. Ralph Cygan

Major professional appointments

September 2000 to present: CEO, UCI Medical Center

1999-April 2000: President, UCI medical staff

1973 to present: Clinical professor of medicine, Department of Internal Medicine, UCI medical school

1995-April 2000: Vice chairman for clinical affairs, Department of Medicine, UCI medical school

1992-April 2000: President, UCI Primary Care Medical Group, UCI Medical Center

Selected awards

and honors

1996 and 1998: Named to “Best Doctors in America -- Pacific Region” for general internal medicine and obesity

1985, 1989 and 1993: Department of Medicine Outstanding Clinical Teaching Award

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Source: UCI Medical Center

Los Angeles Times


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