Wednesday, November 30, 2005

I’ve noticed, as have you if you’ve been reading this site, that the last few posts seem to revolve around the University of California. That’s not really what I had in mind when I wrote my June 16, 2002 post; I originally thought I was being a little bit more universal, and writing about residency / training programs in general. However, the title of the blog is "trying to make sense of (some of) it all," and perhaps this blog has helped me understand a little bit more of what I was writing about.

It’s become pretty obvious to me, after re-reading some of my posts on this blog, that there may be a problem at the University of California in particular. That became more evident lately when it emerged in a series of stories spearheaded by Charles Ornstein and Alan Zarembo of the LA Times that, over at least the last two years, the University of California, Irvine has been involved the worst crisis in medical ethics since the Tuskeegee Experiments. I’m going to replicate the gist of the news stories here, even though I don’t have any new information of my own to add.

According to these stories, since at least July 2004, the University of California has been running a sham liver transplant program, in which UCI:

recruited patients with liver disease
told patients that they were on the list for liver transplants
obtained federal funding for running a liver transplant program
presumably charged insurance companies for pre-transplant evaluations
… and didn’t actually have a full-time liver transplant surgeon available.

[the original version of this post stated that UCI didn't have a transplant surgeon available. I decided that was unclear, since they sometimes had a surgeon available. Therefore, I've changed this post a little bit to refer to the lack of a "full time" transplant surgeon, as opposed to the lack of "a transplant surgeon." ]

UCI had a website in which they named Dr. Marquis Hart and Dr. Ajai Khanna as their transplant surgeons, and did not mention that those two surgeons were actually on staff at UCSD, almost 100 miles away. Federal inspections of UC Irvine revealed that there was no liver transplant surgeon "in the immediate vicinity of the hospital."

UC Irvine did make their facilities available on an occasional basis to transplants, doing 8 transplants each year from 2002-2004, and five transplants in 2005 (as opposed to the federal requirement that at least 12 transplants be done each year by a liver transplant program in order to maintain certification), with a 2002-2004 1 year survival rate of 68.8%, as opposed to the near-85% national 1-year survival rate. Meanwhile, UCI recruited more patients with liver disease (28 in 2005), refused organs made available to those patients (apparently since there was generally no surgeon available to transplant those organs) and, except for the occasional transplant recipient, allegedly waited for everyone else on the list to die. In fact, according to the LA times, at least 30 patients died over the last 2 years while waiting for liver transplants. The livers were apparently available (contra what had been told to the patients). It was the transplant itself -- in particular, a transplant surgeon -- who was not.

The story came to light due to a lawsuit filed by Elodie Irvine, who had fruitlessly been on the UCI waiting list for years before moving to Cedars-Sinai, where she got a transplant. During the time that Ms. Irvine was at UCI, UCI turned down 38 livers and 57 kidneys on her "behalf," while telling her that UCI was simply waiting for organs for transplant. "They left me to die," said Ms. Irvine.

Well, that’s most of the story. However, I am certain that, during the time that Ms. Irvine was on the "transplant" list at UCI, she was attended to (and billed for):

Gastroenterologists for GI symptoms
Nephrologists for renal symptoms
Anesthesiologists / pain management specialists for her pain
General internists for non-hepatic non-renal problems
Fellows, residents, interns, and medical students
Nurses, nursing assistants, phlebotomists, and lab techs
Multitudes of administrative personnel including "transplant" coordinators and billing specialists

And apparently, except for one eventual, apparently informal, referral to Cedars Sinai, not one of those people happened to mention to this old woman on the "transplant" list, nor to anyone else "waiting" for a transplant … "hey, you know … UCI doesn’t really have a full-time transplant surgeon. If you’re waiting for a transplant, that’s something you’d like to keep in mind."

Once, I would have wondered how that could be possible. If you’ve read my earlier posts, however, particularly the June 16, 2002 post, you already have a good idea as to how that could happen. I objected to the apparently needless (but profitable) hospitalization of not-really-sick people during my internship through UCI, and I was told to shut up and do my job. I told people the risks of anesthesia at UCLA, and they rearranged my residency schedule so I would not have any contact with liver transplant patients, then forced me out. One of the trustees at UCI objected to the University’s defense of the reproductive endocrinology program that stole the eggs of patients, and, according to him, he had little choice but to resign. The whistleblower who notified the HCFA (health care financing administration) that the UC medical centers were billing for services provided by attendings who were not in the hospital was apparently fired, blackballed, and was involved in lawsuits for years. There’s a pattern there. It's not the pattern I originally thought it was, but I think I’ve figured it out now. You are welcome to do the same.

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