Wednesday, November 08, 2006

"Tall People Don't Look Good in Orange" - New Allegations of Kick-Backs at UMDNJ

The indefatigable Newark Star-Ledger has uncovered yet another story about mismanagement at the embattled University of Medicine and Dentistry of New Jersey. The university now is operating under a federal deferred prosecution agreement with the supervision of a federal monitor (see most recent posts here, here, here, here and here.) We had previously discussed allegations that UMDNJ had offered no-bid contracts, at times requiring no work, to the politically connected; had paid for lobbyists and made political contributions, even though UMDNJ is a state institution; and seemed to be run by political bosses rather than health care professionals. (See posts here, and here, with links to previous posts.)

Below is the narrative in the words of the Star-Ledger's story, somewhat re-ordered when necessary.

UMDNJ was struggling to save the cardiac surgery program, which is run out of University Hospital. At the time, the state was threatening to shut the program down because the hospital was not performing the state-mandated minimum number of 350 surgeries required to maintain accreditation -- and its mortality rate was too high.

The failing program threatened the core of the university's medical mission. University Hospital is one of only three state-licensed Level I trauma centers in New Jersey, which deal with the most critically injured. Without a heart surgery program, the trauma designation was also at risk.

According to [former chief of the Division of Cardiology Rohit] Arora, soon after the state issued its warning about the surgery program, the university embarked on a plan to enlist local cardiologists with large practices who could bring more patients to University Hospital.

On its Web site, the university describes the part-time faculty members as a group of dedicated cardiologists who practice in the community:

'These physicians are leaders in their field and hold academic appointments at the New Jersey Medical School and often teach classes. They have unique access to the cutting edge technologies and protocols available at University Hospital and are invited to attend weekly grand rounds and conferences.'

Arora, who was represented by attorney Robert Smith of Shrewsbury, said in an interview that the doctors did nothing in return for their faculty appointments.

'They had pseudo-contracts in my opinion,' he said. 'If you look at their résumés and CVs, these were not doctors who were academic. They were never teachers. They may have done research in their training, but they are not researchers as you get in academic medical centers. They're private practitioners with offices. So the claims on their contracts that this is what they would be doing, and also fulfilling some clinical responsibilities -- these guys were not doing anything.'

Arora said when he complained the program was illegal, he was told by one top administrator, 'we have many lawyers.' Shortly after that, he said, he was denied tenure and demoted. His contract was not renewed.

Others in the cardiology department, though, continued to raise doubts about the new assistant professors.

'I was concerned that these cardiologists were not on campus,' testified Merwin Richard, who worked under Arora and then be came interim director of the catheterization lab after Arora left. 'My concerns were what they were going to do in the division.'

Richard, who later left UMDNJ as well, said he did not know what the local cardiologists were doing, other than bringing in their patients.

In his deposition, Richard said the cardiologists who were hired never taught classes, and ignored invitations to attend grand rounds and conferences. He also testified UMDNJ did not establish any criteria on any teaching obligations for the newly minted clinical assistant professors.

Of 20 cardiologists initially approached, at least nine signed contracts with New Jersey Medical School. Some have since left while others have been retained. There is no evidence any of the physicians misrepresented themselves on their curriculum vitae. The cardiologists without teaching or research experience indicated as much on their résumés, and several university officials said in depositions that the main consideration in recruiting doctors for the program was the size of their medical practice.

[Yet,] the University of Medicine and Dentistry of New Jersey paid at least nine local cardiologists in private practice salaries and stipends as high as $150,000 to become 'clinical assistant professors' in an effort to increase the number of patients in the university's troubled heart surgery program.

The details of this unusual program emerge from sworn testi mony taken in a whistle-blower lawsuit against the school, interviews with former and current UMDNJ employees and internal documents obtained by The Star- Ledger through the Open Public Records Act.

The internal controversy over the cardiologists came to light after the university's former chief of the Division of Cardiology settled a whistle-blower lawsuit in state Superior Court in June, which charged that UMDNJ broke the law and then forced him out when he objected to the plan.

Rohit Arora, now a professor of medicine at Chicago Medical School, said what was going on at UMDNJ was 'immoral and totally unethical.'

Some university officials voiced concern over the criminal implications of the faculty appointments, and the possibility that they could lead to prison sentences under federal anti-kickback laws, or civil penalties under the federal Stark Law that could leave University Hospital ineligible for Medicaid and Medicare funding.

In testimony, one official recalled an offhand comment by a high-level UMDNJ official, who told him, 'Tall people don't look good in orange,' referring to prison jumpsuits.

So, in summary, the article alleged that UMDNJ paid a number of local cardiologists substantial amounts as supposed faculty members, even though they did almost no academics work, almost not teaching, and almost no research, and even though they had very few academic credentials, in the hopes that the cardiologists would refer patients to the university's cardiac surgery programs. The story also includes the now drearily familiar tale of a respected health care professional acting as a whistle-blower, who was then promptly dispatched after he questioned what the managers were doing.

Yesterday, the Star-Ledger reported that the New Jersey state Senate will open an investigation of these allegations, and that the federal monitor who is already overseeing UMDNJ has already been investigating them. Senate President Richard Codey (Democrat- Essex) said, "this is something that's unconscionable. You can't pay somebody to direct patients to your hospital. It's just unconscionable - morally, ethically, and it's criminal."

There isn't too much more to say. The ongoing story of mismanagement at UMDNJ just gets more mind-boggling. The university has become a poster-child for all that has gone wrong with the leadership of health care institutions.

The case of UMDNJ also remains a prime example of the "anechoic effect." As best as I can tell, it still has never been discussed in any major medical or health care journal, and so most health care professionals have likely still never heard of it.

1 comment:

Anonymous said...

Unfortunately, UMDNJ, is not being held responsible for dragging professional cardiologists into their scheme. It is unfair to say that the doctors who were paid salary as employees never performed ANY services. Doctors are not lawyers..perhaps they did not know about the Stark law and that what they were doing by referring some of their patients to the hospital was illegal. The govt. is going after the doctors for triple the medicare payments and salary..another case of the smaller guy going down..while the hospital still stands sans removal of the employees that began and fostered this whole mess. The oness should be on the hospital to pay the penalties..not the doctors.