Four days after The Times published a story about drug use by the then-dean of USC's medical school, the university announced it was moving to fire Dr. Carmen A. Puliafito and said it was "outraged and disgusted" by his conduct.
USC Provost Michael Quick said the university decided to act because it had been shown "extremely troubling" information that same day about Puliafito's behavior. Quick provided no details. But he said it was "the first time we saw such information firsthand."
"I know many people wanted us to act on allegations and hearsay, but we needed actual facts," Quick wrote in a letter to the faculty.
It remains unclear when top USC officials first learned about the allegations involving Puliafito. But The Times made repeated inquiries over the last 15 months about Puliafito, in some cases describing information reporters had gathered about the dean.
More than a year of questions
USC's leaders never responded to the inquiries. Numerous phone calls were not returned, emails went unanswered and a letter seeking an interview with USC President C.L. Max Nikias to discuss Puliafito was returned to The Times by courier, unopened.
Only after The Times published its report Monday did USC address the matter publicly. By Friday, officials deplored Puliafito's conduct and said they had engaged a law firm to look into the administration's handling of the matter.
Medical ethicists said USC had a duty to look into allegations about Puliafito immediately, even if they were incomplete or uncorroborated. A prompt internal investigation was necessary, they said, regardless of whether the university decided it could answer The Times' questions.
Dr. Daniel Sulmasy, a Georgetown University professor of biomedical ethics, said the need for a swift inquiry was especially pressing because of Puliafito's role as an overseer of faculty members, clinicians, students and research grants. "These professionals are held to a higher moral standard than other persons," he said.
"The allegations are so serious, he could put patients at risk," said Art Caplan, founding head of the Division of Bioethics at New York University's Langone Medical Center. "I would say if you're not going to fire him outright because you're waiting to get confirmation of the facts, I would be at least moving to suspend him and figure out what's going on here."
The Times report, published Monday, described in detail how Puliafito kept company with a circle of criminals and drug addicts and used methamphetamine and other drugs while serving as dean of the Keck School of Medicine. The article cited photos and videos reviewed by The Times that showed Puliafito and his friends, who were in their 20s and 30s, partying in 2015 and 2016.
The images include some in which Puliafito's companions are seen holding drug paraphernalia during an after-hours visit to the dean's office at USC.
An abrupt resignation
One member of Puliafito's circle was a 21-year-old woman who overdosed in his presence at a Pasadena hotel three weeks before he abruptly quit as dean in March 2016, in the middle of the spring term.
USC has not said whether the incident was related to Puliafito's resignation.
After stepping down as dean, the Harvard-educated Puliafito, a renowned eye surgeon, remained on the Keck faculty, continued to accept new patients and represented the university in public as recently as last weekend.
On Tuesday, a day after The Times report was published, Nikias said in a letter to the campus community that USC would "examine and address" the accounts but also suggested the school had not determined whether they were true. His statement did not say whether the university had known about the details before the article was published.
"Our university categorically condemns the unlawful possession, use, or distribution of drugs," the president wrote. "We are concerned about Dr. Puliafito and his family and hope that, if the article's assertions are true, he receives the help and treatment he may need for a full recovery."
On Friday, Nikias released a strongly worded statement, saying "we are outraged and disgusted by this individual's behavior." The same day, Quick told the faculty that Puliafito had been barred from the campus and from "any association with USC."
The Times investigation began with a tip about the Pasadena hotel incident. Paramedics rushed the woman, Sarah Warren, to a hospital, where she recovered. A police report said officers found methamphetamine in the hotel room. No arrests were made.
A witness to the incident told the newspaper of phoning Nikias' office, giving two employees an anonymous account of the overdose and demanding that USC take action against Puliafito.
Phone records reviewed by The Times showed the witness made a six-minute call to Nikias' office on March 14, 2016, 10 days after the overdose. The tipster said he did not expect a call back but had told the USC employees he would go to the media if action wasn't taken.
Last week, Puliafito's successor as dean, Dr. Rohit Varma, told a gathering of scores of students that USC had found "no evidence, particularly, of that phone call." Varma told the students that Puliafito had appeared drunk at off-campus events and had sought treatment for alcoholism. He said details in the story came as a shock.
The Times first contacted USC about Puliafito the month after the overdose. In response, Puliafito said in an April 20, 2016, email that he resigned as dean to take a position in the biotech industry. He never again replied to interview requests or written questions.
In May 2016, The Times left a phone message and sent an email to USC's senior vice president for university relations, Thomas Sayles. The email said, without going into detail, that the newspaper was aware of the circumstances preceding Puliafito's resignation and wanted to hear from USC about how it dealt with the matter. Sayles did not respond.
The next month, USC hosted a catered reception for Puliafito on a sun-splashed lawn at USC's health sciences campus in Boyle Heights. As dozens of Keck employees looked on, Nikias praised Puliafito's contributions to the school as dean.
The Times continued to gather information about the overdose. In a November 2016 email, a reporter asked to interview Nikias and Quick, saying an upcoming story would examine "in detail the off-campus events that preceded Dr. Puliafito's resignation." Again, there was no reply.
A sealed envelope unopened
Last January, a reporter visited Nikias' San Marino home. He was away, and the reporter gave a note for him to Nikias' wife. The note was in a sealed envelope; it similarly asked Nikias to speak to the reporter about the events surrounding Puliafito's resignation.
The next day, the envelope was returned unopened to The Times by courier, with a letter of complaint from Brenda Maceo, USC's vice president for public relations and marketing. The letter said the reporter had "crossed the line" by visiting the Nikias home.
The Times did more reporting. On March 2 of this year, the newspaper emailed an interview request and a list of questions to Nikias. It said a reporter had learned of the witness' call to Nikias' office. The email also said that the hotel room where the young woman overdosed had been registered to Puliafito and that meth was found in the room.
Attached to the email was a recording of the 911 call a hotel employee made to report the apparent overdose. On the recording, Puliafito is heard identifying himself as a doctor and saying the woman was his girlfriend. He told the 911 dispatcher that the woman "had a bunch of drinks and she's sleeping."
When the dispatcher asked if she had taken anything else, Puliafito said, "I think just the alcohol." A police spokeswoman later told The Times the woman had overdosed on the same drugs found in the room — methamphetamine.
Nikias did not respond to the March 2 email. Two reporters visited his office that day to ask for an interview. Nikias' chief of staff, Dennis Cornell, told them, "The president will not be speaking to The Times on this matter."
This month, Nikias did not reply to a final email from The Times requesting an interview before the newspaper's investigation was published.
Ann Fromholz, a Pasadena lawyer and USC law school alumna who has conducted hundreds of workplace investigations, said it's common for employers to launch investigations prompted by anonymous tips or inquiries from outside institutions.
"Even though the employer doesn't know the details of the complaining party, they are nonetheless obligated to investigate and determine if misconduct occurred," Fromholz said.
‘A deliberative and careful manner’
As outrage over the Puliafito revelations grew, Quick on Wednesday wrote the USC faculty a memo attempting to explain the university's actions.
"I want to reassure you that all along we have taken this matter very seriously, that we made what we felt were the best decisions we could make, as swiftly as could be done in a prudent and thoughtful manner, and given the information that we had at any given time," he wrote.
Responding to those on campus who asked why the university didn't take "unilateral actions" against Puliafito, the provost said it followed the rules.
"If any of us were in a similar situation, we would want the university to follow its established processes in a deliberative and careful manner," he wrote.
On Friday, Nikias announced that former federal prosecutor Debra Wong Yang would lead "a thorough investigation" into both Puliafito's conduct and "the university's response."
Nikias said that in this "process of examination," USC officials would "look to improve ways in which we could have recognized the severity of the situation sooner."
He called on all USC employees to "cooperate fully and swiftly" with the investigation.
Yang is a partner at Gibson, Dunn & Crutcher, a firm with close ties to USC.
The firm's managing partner, Kenneth M. Doran, is a graduate of USC's Gould School of Law and a former chairman of its board of councilors. He has also been a prominent fundraiser for the school. Gibson Dunn was cited on the USC law school website in 2014 for achieving "100% participation" by USC alumni at the firm in a fundraising drive.
Yang represented USC when it faced a wrongful-death lawsuit in 2012 filed by the parents of two graduate students who were slain off-campus. The suit was dismissed in 2013.
Yang's profile page on the Gibson Dunn website says she has worked as an adjunct professor at the USC law school. She last taught classes there in the late 1990s, according to a USC spokesman.
USC declined to comment further on Saturday, saying in a statement "it is imperative to let the inquiry by Gibson, Dunn & Crutcher run its course so as to not impede its progress or cloud the recollections of those who may have information to share. Our priority now is to obtain a clear picture of exactly what happened and to ensure the well-being and trust of our students at USC, the patients at the Keck School and our entire university community."
Times staff writer Harriet Ryan contributed to this report.