UCI Medical Center’s ambitions have far outpaced its ability to successfully care for its patients, according to an unusually frank assessment of the chronically troubled university hospital released Thursday.
A panel of five experts, formed after a scandal forced the closure of the Orange hospital’s liver transplant program in the fall, described clinical programs with “marginal staffing and inadequate resources.”
They “frankly were trying to do too much,” said panelist Dr. Kenneth Shine, executive vice chancellor of health affairs for the University of Texas system and former president of the national Institute of Medicine.
The report also raised questions about UC Irvine’s plans for a new $371-million hospital, in the early stages of construction, and whether it was designed with the right services in mind.
Though the 24-page document was unsparing in its general criticism, it offered strikingly few specific recommendations. It called for every program to be fully reviewed and for leaders to be held accountable, but it did not name the problem departments or suggest discipline for any officials. It also did not identify the services the new hospital should offer, saying that was beyond the panel’s mission.
Furthermore, the report did not address why major problems repeatedly have occurred at UCI Medical Center, across disciplines and departments, over the last decade. The spate of scandals began in the mid-1990s, when three doctors were found to have stolen eggs and embryos from patients and implanted them in other women, some of whom gave birth.
In 1999, UCI fired the director of its donated-cadaver program, amid suspicion that he had improperly sold spines to an Arizona research program.
More recently, the hospital has faced allegations that it accepted too few livers and kidneys as patients languished on waiting lists and that its bone marrow transplant program did not perform enough procedures to meet state standards.
The report repeatedly cited an alarming lack of accountability among several medical school and hospital executives. Sometimes, the officials passed the buck or failed to take responsibility; on other occasions, they misled regulators or tried to minimize the seriousness of problems, the panelists found.
In particular, the experts called into question the leadership of the medical school dean, Dr. Thomas C. Cesario, and the former chief executive of the hospital, Dr. Ralph Cygan. They said that the two leaders had a “very strong working relationship” but that this “comfort level” ironically stood in the way of addressing serious problems.
Cygan resigned under pressure Jan. 31 and did not return a phone call seeking comment. Cesario, who has been dean at UCI for more than a decade, remains in the position but was out of town and could not be reached.
The expert panel, appointed by UCI Chancellor Dr. Michael V. Drake, included one member from UCI and three others with ties to the UC system.
Shine said the campus should close programs found to be beyond repair and ensure that those remaining are rigorously reviewed on a regular basis to detect problems in quality.
He said whistle-blowers should never be targeted for intimidation and punishment, as some faculty say has occurred at UCI. “Legitimate complaints of people were not necessarily addressed in an appropriate way,” Shine said. In some cases, he added, when the actions of some staff were challenged, they took it as a personal affront, and “that is unacceptable.”
Drake, who took over as UCI chancellor in July, said he planned to implement the panel’s recommendations. He is recruiting a top administrator to oversee both the hospital and the medical school, hiring an ombudsman to report directly to the chancellor and bringing in consultants to review the hospital’s performance over the last four years.
Although he did not announce any disciplinary measures Thursday, Drake said, “I would expect that there might be personnel changes.”
Although the report made passing reference to earlier scandals, it was most specific when it discussed the liver transplant program, which UCI closed Nov. 10. That day, The Times reported that more than 30 patients died on its waiting list in 2004 and 2005, even as the hospital turned down scores of organs that might have saved some of them. For more than a year, UCI did not have a full-time transplant surgeon but misled regulators and the public into believing that it did, the panel said.
The panel found that UCI did not directly address fierce staff infighting. It described a hostile relationship between Dr. David Imagawa, who led the program from its 1993 inception until 2001, and his successor, Dr. Sean Cao.
“Their open disagreements spilled over to the staff, creating what some interviewees consider to be a hostile work environment,” the report said.
In response, UCI assigned an experienced nurse “to manage the personality differences and provide some level of mediation between the physicians and the staff.”
It didn’t work. Cao departed UCI in July 2004, leaving the hospital without a full-time transplant surgeon until November 2005, when the program closed. Neither Cao nor Imagawa could be reached for comment.
The report also faulted UCI’s former chairman of surgery, Dr. Samuel E. Wilson, for ongoing attempts to “downplay the significance of problems and to avoid bringing them to the attention of the administration.” The panel said he “was not held accountable for his lack of leadership” during this period.
And the experts criticized the hospital’s chief medical officer, Dr. Eugene Spiritus -- a pulmonologist, not a surgeon -- for failing to act in the face of evidence that Cao was turning down a higher-than-expected number of organs offered to UCI patients.
Spiritus declined to comment through a spokeswoman because he hadn’t read the report. Wilson, still listed as a professor of surgery and associate dean of UCI’s medical school, could not be reached for comment.
The report cautioned UCI against reopening the liver transplant program, saying such a decision should be scrutinized in light of previous problems and the hospital’s priorities.
Elodie Irvine, a liver patient whose lawsuit led to public discovery of the liver program’s failures, said she thought the report did not fully address, among other things, why patients died or who was responsible for the program’s failings.
“I think this is a good first draft, but they have a lot more work to do,” said Irvine, who was on UCI’s liver waiting list for nearly four years before getting a transplant elsewhere. “They’re not exposing everything. They need to come out and put all the cards on the table.”
Lawrence S. Eisenberg, the lead lawyer in 50 lawsuits involving the liver program that have been consolidated, said the report may have been kept vague to avoid giving plaintiffs’ lawyers ammunition in court.
“The generalities regarding a failure of leadership, non-responsiveness to regulatory agencies or the lack of quality assurance mechanisms is nothing new,” he said. “These are the same issues that have plagued UCI for more than 10 years.”
“It’s an impressive litany of woe,” said Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania School of Medicine. “The general compilation all in one place of the errors, omissions, failure of leadership and outright inattention to patients’ welfare is sad, disconcerting and disturbing, almost. I think it’s all here. I don’t think they hid anything.”
Martha Mecartney, chairwoman-elect of the UCI Academic Senate, declined to comment on the report because she hadn’t had a chance to read it but said the faculty had “a lot of confidence” in Drake.
In addition to Shine, other members of the panel were Meredith Khachigian, former chairwoman of the UC regents; Dr. Haile T. Debas, former medical school dean at UC San Francisco; Dr. Steven Wartman, president of the Assn. of Academic Health Centers; and Ken Janda, a UCI chemistry professor and chairman the Irvine Division of UC’s Academic Senate.*
Times staff writer Kimi Yoshino contributed to this report.
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Trail of trouble
Notable controversies in the last decade at UCI Medical Center:
1995: In May, UC Irvine accuses Ricardo H. Asch, Jose P. Balmaceda and Sergio C. Stone, a team of fertility doctors at its Center for Reproductive Health, of stealing patients’ eggs or embryos, implanting them into other patients and conducting human-subject research without permission.
1997: After the Food and Drug Administration launches an inquiry, UCI finds that a research lab at its Chao Cancer Clinic in 1995 and 1996 violated university and federal regulations by charging patients and Medicare for experimental drugs without authorization and soliciting donations from patients trying to get into clinical trials.
1998: Dr. Darryl See resigns after UCI says he violated procedures by using patients’ blood samples for research without their authorization and using inappropriate procedures on laboratory animals.
1999-2000: The university finds that Christopher Brown, director of the medical school’s Willed Body Program, has sold parts of cadavers, misappropriated money, conducted unauthorized autopsies, improperly solicited cash donations for the program and overcharged travel costs.
2004: UCI officials say a cancer researcher, Dr. Hoda Anton-Culver, misspent as much as $2.3 million in state and federal funds on unauthorized software instead of cancer research.
Nov. 10, 2005: UCI shuts down its liver transplant program after federal Medicare funding is withdrawn and the Los Angeles Times reports that 32 people died awaiting livers in 2004 and 2005, even as doctors turned down organs that were successfully transplanted elsewhere.
2006: Reports surface of underperforming kidney and bone marrow transplant programs. In addition, UCI’s cardiology chief and associate chief draw criticism from staff and regulators for not holding state licenses or U.S. board certifications, the anesthesiolgy department faces possible sanctions, and possible ethical lapses are reported, including suspected violations of nepotism rules in hiring. The Times also reports that a young Orange County physician was accepted into a newly created residency position the same month his father pledged $250,000 to the radiology department.
Source: Times reports