Thursday, February 16, 2006

Trouble in the OC Continues - More on UC-Irvine

The University of California - Irvine just cannot stay out of the news. We last posted about the multiple problems at the UCI medical school and medical center here.

More Revelations About Previously Revealed Problems

The Los Angeles Times dug into some of the older scandals at UCI. These included the “fertility scandal,” in which doctors “had stolen eggs and embryos from women and implanted them in other patients,” “misplaced cadavers, the sale of cadaver body parts without consent, and research violations at Chao Cancer Clinic.” In these scandals, the Times revealed a pattern of managers trying to stifle complaints and intimidate whistle-blowers. Regarding the fertility scandal,
Whistle-blower complaints, state Senate committee hearings and internal
investigations exposed UCI's efforts to limit the investigation and punish those who
reported problems. It was a pattern that would be repeated.
Whistle-blowers said they were warned not to talk publicly and threatened with dismissal.
Three whistle-blowers were paid a total of $900,000 in settlements that required them not to talk about the fertility clinic problems.
'They threatened me not to go to the federal or state government, not to go to the press,' former senior hospital administrator Debra Krahel said. 'They threatened that they would sue me. They go through this pattern of alienating, discrediting, demoting and threatening you.
It's pure harassment, and they've done it over and over. It's never been corrected.'
UCI's attorneys repeatedly tried to limit investigations and public release of information, former employees said.
Andrew Yeilding, at the time UCI's chief auditor, was widely quoted as saying that Diane Geocaris, legal counsel to the chancellor, told him he should not press doctors hard for information. Other administrators told three internal auditors not to set foot on hospital grounds- or even exit the freeway near the Orange facility - or they would face termination, according to depositions and interviews.
In several cases, public comments by administrators were misleading and, occasionally, false. Geocaris, who remains the chancellor's legal counsel, urged the spokeswoman for the hospital, who later quit in frustration, to delay release of records as long as legally possible, according to reports in the Orange County Register.
University attorneys also minimized the number of victims and filed court documents that contained false information
In most of the scandals that have beset the university, employees who tried to uncover wrongdoing suffered consequences.
Several former employees said they had been forced to quit or were fired. Some, like Krahel, said they were labeled troublemakers, portrayed as frequent complainers or deemed substandard workers.
UCI auditors Robert Chatwin and Hebeish, whose jobs were to investigate complaints and scrutinize university programs, said the attitude on campus changed after the fertility scandal. The work environment evolved from 'free, open and supportive' to 'completely hostile and negative,' Chatwin said in a deposition as part of later litigation over UCI's Willed Body Program.
UCI touted a massive overhaul of the program. It hired Iris Ingram as the administrator to provide oversight and ensure that rules were followed. But Ingram said in an interview that people resented her when she tried to enforce regulations. Once UCI was 'in the clear,' she said, her position was eliminated.
The Orange County Register summarized a series of instances in which UCI managers issued misleading statements or “misrepresentations.” The article includes a handy table of six different misrepresentations, which includes the original statements and UCI sources, their refutations and their sources. In its introduction, the article quoted David Magnus, of the Stanford Center for Biomedical Ethics,
If a car company makes a misleading statement about how great a car is, that’s called sales. If a hospital does it, its more like fraud.
We last discussed allegations of problems within the UCI anesthesiology department here. The previously discussed allegations that the leadership of the UCI cardiology division lacked the usual credentials. The Orange County Register reported that its Associate Chief is stepping down from his leadership position as a result. The official announcement was “Dr. [Mani] Vannan has stepped down in an effort to help unify the Division of Cardiology. We appreciate his cooperation with this effort.”

Vannan has no California medical license, and has no sub-specialty board certification in cardiology from any country, according to the Register

We have previously discussed problems besetting the UCI kidney-transplant program here. The Los Angeles Times revealed a new report on the program by the US Center for Medicare and Medicaid Services (CMS) that showed the program “did not ensure nurses and others completed their training or that their training was comprehensive.... The report also faulted the hospital for failing to review the care provided to transplant patients.... One member of the medical staff explained to an inspector that ‘there was no member of the medical staff who either had the expertise or competency’ to do the reviews.”

New Problems

The Los Angeles Times revealed additional problems in the UCI nesthesia Department, this time, in its pain management program. Issues going back to 1997 have left the Department on probation by the Accreditation Council for Graduate Medical Education (ACGME) since then. The Department hired Dr Raafat Mattar 18 months ago “to fix shortcomings listed in 2000 and 2004 accreditation reviews.” However, Dr Mattar “resigned in frustration three weeks ago.” He said the pain progam still “didn’t have enough X-ray machines or access to exam rooms, forcing cancer patients and others in pain to wait as long as two months for treatment.” “Department supervisors promised to solve the problems, but nothing was done, he said.” Nine other faculty have left the Department in the last three

The Los Angeles Times uncovered new allegations about possible nepotism at UCI. (Previous allegations of nepotism at UCI were discussed here.) After UCI medical center CEO Dr Ralph Cygan resigned, Ms Maureen Zehntner, a registered nurse, “formerly second in command” at the medical center, was appointed interim CEO. The Times reported that her brother, Bruce V McGraw Jr, works for UCI as a “network development liaison,” her sister, Veronica J. Hogues, works for UCI part-time as an assistant in the medical school, and her cousin, Kimberly Becker, also works in some capacity at UCI. The Times, consulted Kerry Fields who teaches business law and ethics at USC,
'Why UCI doesn't have a policy against [such hires] is beyond me,' said Kerry Fields, an assistant professor of business law and ethics at USC's Marshall School of Business. 'It saps staff morale and adversely affects recruiting because it sends a clear message that who you know is more important than how you perform.'
What Went Wrong and What To Do About It

In its report on previous scandals at UCI, the Los Angeles Times
provided some opinions,
'We can all be forgiven for occasional lapses of judgment, but the rapidity and extensiveness of this would suggest that there's an endemic management problem,' said Kerry Fields, who teaches business law and ethics at USC's Marshall School of Business. 'There's just too many examples of poor ethical decision-making.'
Former internal auditor Mohamed Abo-Hebeish said UCI 'has lost its conscience, its sense of social responsibility as a public institution.'
Fields, the USC business law and ethics professor, says UCI is looking for quick solutions and not looking deeper into the corporate culture.
He says the university needs a full-time inspector general who will review the organization top to bottom.
He said university officials are using the 'moral minimum' to guide their decisions, doing only what the law compels. 'It's a very shallow application of ethical standards,'
Fields said. 'The law merely states what you have to do. Ethics are what you should

I can only hope that the now numbingly extensive catalog of mismanagement at UCI will prompt a really close look into why such poor leadership was allowed to go on for so long, and some intense thinking about how to prevent such problems in the future.

Clearly, more representative, transparent, accountable, and ethical governance is needed at UCI, and probably throughout the UC system.

And although the details of the problems at UCI are unique, concentration and abuse of power are rampant throughout health care.

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