Donor’s Son Got UCI Residency

A young Orange County physician was accepted into a newly created residency position in radiology at UCI Medical Center the same month his father pledged $250,000 to the radiology department, according to records and interviews.

Alfred Sein was not chosen by UCI during the regular selection process that determines where most medical school graduates do their residency to become a specialist.

UCI officials said there was no connection between the gift and Sein’s admission, that the son was well-qualified and that the university followed proper procedures in filling the spot.

“He is a one-of-a-kind applicant -- one of the best residents in the group,” said Dr. Fong Tsai, director of radiology who accepted the son into the program.

Sein is the only resident whose salary is paid out of a fund the radiology chair controls, which is separate from the money his father donated. Tsai said that was because the department needed an additional resident immediately, and this enabled him to pay the salary of about $40,000 annually.

Radiology is the second-most difficult residency program to get into in the nation, behind only orthopedic surgery, according to the National Residency Matching Program.

Sein’s appointment and the timing of his father’s donation have raised questions at UCI about the appropriateness of the arrangement.

“In areas of medicine, it’s especially important that expertise and merit drive decisions,” said Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania. “It looks like the prospect of donations may have shaped their assessment of the candidate’s admissibility. I hope not, but it looks that way.”

Frances Miller, a law professor at Boston University who has written about the residency programs for the Journal of the American Medical Assn., agreed: “This seems unethical,” she said.

The father, Dr. Michael Sein, chief of staff at Coastal Communities Hospital in Santa Ana, who teaches in UCI’s radiology department on a volunteer basis, pledged the gift to the department to honor Dr. Tsai, according to a university spokeswoman, Farnaz Khadem.

Alfred Sein signed a contract for the residency position in November 2004 and started in January 2005, according to Tsai.

The father’s donation went to a fund for a women’s imaging center in the radiology department, which Tsai created to help pay for better equipment and staff recruiting. Tsai said he donates $3,000 per month of his salary toward the effort.

Tsai and the elder Sein denied the donation was given in exchange for the son’s residency position. Tsai said he had long wanted to increase the number of residents and finally was able to do so last year.

Michael Sein said he began discussing a donation with Tsai in early 2004. He said he and Tsai discussed his son’s desire to join UCI’s residency program but never in connection with the donation. He said he realized the circumstances appeared questionable, but that he never intended to influence the outcome of his son’s application -- and noted that he could have made his donation anonymously if he wanted to hide his involvement.

“I would never do something like that,” he said. “It never even crossed my mind, that I would buy a residency. Even if my son wasn’t there, I would donate to UCI.”

Khadem, the university spokeswoman, said Michael Sein had made two $25,000 payments toward his pledge.

Alfred Sein did not return calls requesting comment.

UCI’s medical programs have come under scrutiny in recent months after revelations that its liver, kidney and bone marrow transplant programs fell short of federal and state standards. The disclosures are the latest in a string of problems that have plagued the university hospital in the last 10 years.

The Times has reported that UCI turned down large numbers of kidneys and livers, even as patients waited for them, at times because it did not have surgeons to perform transplants. In both programs, patients died before they could receive the organs.

The four-year residency program is part of the training medical school graduates receive, allowing them to be supervised by doctors while earning their licenses and gaining experience.

Tsai said he interviewed several people for the new residency slot, including Alfred Sein. He said he chose Sein because he agreed to fill a specialty position in ear, nose and throat radiology that Tsai wanted to create.

Tsai said the creation of the position and the selection of Sein were approved by Thomas C. Cesario, dean of the College of Medicine. Tom Vasich, a spokesman for the medical center, said Cesario was traveling and unavailable for comment.

Tsai said he created the extra position because he felt his staff was stretched too thin and he wanted to expand the program. But records show the radiology program has not created any additional positions in subsequent years.

After receiving his medical degree from Boston University in May 2003, Alfred Sein completed a one-year internship at a nearby hospital, according to his father.

Michael Sein and Tsai acknowledged Alfred Sein did not “match” with UCI through the National Residency Matching Program, a ranking system that pairs medical school graduates with residency programs. Michael Sein said his son ranked UCI among his choices, but he did not initially obtain a position through the matching process. More than 90% of applicants secure their residencies through the matching program.

In every academic year since 1999, UCI has had approval for only 22 residency positions in the radiology department, according to the American Medical Assn. and the Accreditation Council for Graduate Medical Education.

There is some confusion about when UCI received approval for the Sein slot, which brought the number of residents to 23. The council said it approved the position in August 2004. Tsai said he did not receive approval until January 2005. He could not explain the discrepancy. UCI’s payroll department said Sein started as a resident physician on July 1, 2004.

The council examines residency programs and approves the number of training spots based on several factors, including number of patients, funding and number of faculty. The council must OK increases in residency positions. In some cases, the agency will sanction a school if it fills more residency positions than it has approval for.

Tsai and Michael Sein said Alfred Sein worked in an unofficial, unpaid position in UCI’s radiology department throughout the last half of 2004 in order to learn more and to spend time at the school.