Wednesday, November 16, 2005

The University of California -Irvine Shuts Down Liver Transplants

While the San Francisco Chronicle was looking into lavish salaries, benefits, and perks paid to top management in the University of California system (see previous post here), the Los Angeles Times has been busy uncovering problems at one of its campuses, the University of California-Irvine (UCI).

The problems became apparent when the US Center for Medicare and Medicaid Services (CMS) announced it would stop paying for liver transplants at UCI. The transplant program had been performing very few transplants, refusing livers for transplant at a high rate, and had an unusually low survival rate for its transplant recipients. Therefore, patients had remained on the transplant waiting list for long periods of time. (See this link.)

The hospital then announced that the program would be closed. Chief Executive Officer (CEO) Dr. Ralph Cygan announced that the problems would be investigated, noting, “However disappointing this is, our first commitment is to our patients.” (See this link.)

Investigation by the Times revealed that liver transplantation problems at UCI actually started as early as 2001. Through 2000, the program had three full-time transplant surgeons. But in 2001, one left, and its director, Dr. David Imagawa “suffered a heart attack. He returned to work but stopped performing transplants. This left Dr. Sean Cao as the only full-time liver transplant surgeon.” However, Cao “appeared focused on liver and pancreas surgeries that could be scheduled - and not transplants.” An attempt to bring in another surgeon failed after he clashed with Cao. A review by two outside surgeons suggested procedural changed, but these did not affect the refusal rate. Only eight transplants were conducted yearly in 2002 and 2003. In 2004, hospital CEO Cygan admitted trouble recruiting transplant services. Nonetheless, the hospital kept recruiting patients for the transplant waiting list. Later that year California ended its certification of the program, so that the state Medicaid program would no longer pay for transplants there. Cao then left UCI. Since then, the only liver transplant surgeons available at UCI were two based 90 miles away at University of California - San Diego. After the closure of the program, UCI Chancellor Dr. Michael V. Drake commented, “If we look back now, it’s easy to see that plans put in place turned out not to be successful. It’s harder to see that in the present than to see it in hindsight.”

The first lawsuits against UCI, alleging negligence, fraud, and conspiracy, have already been filed. (See this link.)

UCI Chancellor Drake held a meeting with faculty and confessed his prior ignorance of the transplant unit problems, “I was surprised. And I am extremely disappointed I was surprised. I don’t like it at all.” UCI CEO Cygan, on the other hand, offered, “Our goal was to build the best liver transplant program in the West. We felt we were this close to achieving those goals.” (See this link.)

UPDATE (11/17): Again according to the LA Times, UCI CEO Cygan was just put on paid administrative leave. UCI Chancellor Drake announced the formation of a "blue ribbon committee" to investigate the failure of the transplant unit. In reference to Cygan, Drake announced, "this happened on his watch. The buck had to stop someplace."

The Times noted that the transplant debacle was hardly the first scandal at UCI. In 1995, a team of fertility doctors were accused of transplanting eggs without patients’ consent, conducting research without informed consent, and prescribing unapproved drugs. Two fled the country, and one was convicted of fraud. In 1997, a UCI research laboratory was found to have violated federal and university regulations by charging Medicare for experimental drugs. The laboratory closed and its director resigned. In 1998, a researcher was charged with using blood samples with patients’ consent. In 1999, the director of the medical school’s Willed Body Program was found to have sold parts of cadavers, misappropriated money, conducted unauthorized autopsies, and used inappropriate procedures on laboratory animals. He was fired, and the program was taken over by the UC Office of the President. In 2004, a cancer researcher was accused of mis-spending funds. The matter is still under investigation.

Thus, it appears that the UCI liver transplant program was badly managed and run, probably unnecessarily delaying patients’ transplants. Although UCI administrators seemed to be aware of the programs failings, their efforts to improve matters were, at best, ineffectual. The problems in the management of this program come after a series of other controversies that also seem plausibly related to poor management.

Yet, top managers of UCI seem not to have suffered financially for their apparent poor management abilities. Based on the San Francisco Chronicle’s data-base of the highest-paid UC employees, in 2004, the previous Chancellor of UCI made $477,278. Presumably, current UCI Chancellor Drake makes more. In 2004, the UCI hospital director, Ralph W. Cygan, made $404, 649. Furthermore, the Chronicle’s investigation suggested that most top administrators have luxurious perks on top of their salaries. For example, most chancellors live in fully-staffed mansion, rent-free. (See this link.)

UPDATE ( 11/17): I have to note that Cygan has paid a penalty, at least to his reputation, by being suspended with pay. He has not yet paid a financial penalty. And Drake, the top official at UCI, has determined that "the buck has to stop someplace," but not on his desk. Thus, I have to give credit to UCI for establishing some management accountability, but that accountability does not appear to extend to the highest levels of management.

So let us consider the comments made by University of California Regent John Moore to justify the luxurious salaries, benefits, and perks dished out to top UC managers (reported by the San Francisco Chronicle).

The senior folks at UC are under market, and there are a lot of bad things that can happen from that. You don’t get to look at the best people in the market. It is almost like there is a Marxist notion that it is bad that we give raises to bring people to the market rate.
Despite the lavish spending on top management, however, “a lot of bad things” did happen. Well-paid managers at UC- Irvine presided over a series of scandals and controversies since 1995, culminating in the latest, the shut-down of the liver transplant program.

A California State Senator, Jackie Speier, charged,

What we see here is a lack of transparency, a lack of candor, and a sense of entitlement that really troubles me. There are gross inequities that need to be addressed.
(See this link.)

Moore also likened his critics to “Marxists,” yet by constructing a system in which the top managers of the University of California, a government institution, have become the nomenklatura, living in luxury, apparently at the expense of faculty, students, patients, lower-paid staff, and tax-payers.

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