At the University of California, More Controversy at a University That "Hates Controversy"

We have posted quite a bit, most recently here, about management troubles at the University of California (UC), and about some of the specific problems afflicting the University of California-Irvine Medical Center.

The San Francisco Chronicle published a long investigative report about how problems with the structure and function of the UC Board of Regents may relate to these troubles. These problems included:

• The Board, consisting of politicians and citizens appointed by the governor, tends towards cronyism. The Chronicle quoted Prof Bruce Fuller of UC-Berkeley, "it used to be a good old boys club of big men who contributed to the governor (and) who would rubber stamp any proposal put before them by the university."
• The Board has no staff of its own, and depends on the University President for support.
• The Board has a culture that tends to suppress dissent. Former Regent Ward Connerly wrote, "most regents value the appearance of collegiality more than any other attribute and can be quite unforgiving of any regent who betrays that trait." Connerly recalled that "staffers from the Office of the President would pass him questions to ask during public meetings that would generate an answer that would bolster the case for the president's cause." Summarizing, he said, "the university hates controversy. There's alwasy been this sheltered culture." State Assembly Speaker Fabian Nunez, who is an ex-officio member of the Board, according to the Chronicle, "find the regents 'orchestrated' [and] agree that the desire to avoid disagreement is damaging the credibility of the body."

Of course, organizations that try to suppress controversy often end up deluged in it. So, meanwhile, the Los Angeles Times reported on more signs of poor management at the UC-Irvine Medical Center.

• A UC review "confirmed allegations that officials at UCI Medical Center had misled regulators about the hospital's now shuttered liver transplant program...." The review focussed on a meeting that included Dr Ralph Cygan, the hospital's CEO, and Dr Thomas C Cesario, the Dean of the Medical School. The UCI contingent told the United Network for Organ Sharing (UNOS) that UCI had a full-time transplant surgeon, whereas the surgeon in question was based at UC-San Diego and only commuted to UCI at times. The review did excuse Cesario in a way, by implying he was uninformed: there was "no evidence" that he "was involved in or understood the significance of any decision about communications" with UNOS. (See Times article here.)
• Another Times report noted that "three children of top executives in UC Irvine's medical programs have received jobs with the hospital and medical school in recent years...." Dr David Cesario, the son of Dr Thomas Cesario, was hired by UCI's cardiology division. Dr David Brodsky, who was in charge of electrophysiology in the division, charged that he was driven out to make room for the younger Cesario. The younger Cesario also apparently was the one to suggest hiring Dr Jagat Narula as chief of the cardiology division. We had previously posted about the appointment of Narula, who has no California medical license or US cardiology board certification, here. Dr Kristen M Kelly, Cesario's daughter, also was hired as an Assistant Clinical Professor of Dermatology by Department Chair Gerald Weinstein, who reported directly to the elder Cesario. Former hospital CEO Dr Ralph Cygan's daughter, Anne Cygan, was hired by the hospital as an interpreter, and then promoted to work in patient relations. The Times quoted Professor Kirk O. Hanson from the Markkula Center for Applied Ethics at Santa Clara University, "where there is a pattern of relationships between relatives of senior management and the organization, you have to ask yourself whether senior management is tone deaf to the concerns of conflicts of interest."

The problems at UC, and specifically, at UC-Irvine, remind us of the pervasive, bad effects of unaccountable and conflicted management of health care organizations.