In the last post, I mentioned that there was a pattern regarding the University of California and its tolerance of anything that might threaten its funding streams. To reiterate my own experience: as a resident, I had been asked by the residency program director that if a patient refused a surgery based on what I had told him, "don’t you realize that you would be responsible?" In context, (see my Sunday, June 16, 2002 post) I thought that was a pretty clear, though misguided, warning not to tell patients the risks of anesthesia.

Such a rhetorical question was not, apparently, clear enough for UC Irvine. According to the LA times, Dr. Sean Cao, at the time the only UCI transplant surgeon, actually wrote an email regarding talking to potential transplant patients. Dr. Cao apparently distributed a confidential memo that stated "Anyone who spreads the rumors [that he was turning down organs] ," would be subject to discipline for "professional misconduct" and held "liable, especially if the patients … find out something and decide to take legal action."

The thing is that these "rumors" were apparently true. In 2003, UCI performed just 8 liver transplants, as opposed to the minimum of 18 required by the state to maintain certification, or the minimum of 12 transplants required by the feds. Only 16.2% of patients who had joined the waiting list between July 1998 and June 2001 had received a liver three years later, as opposed to the nationwide average of 42% of patients who got a liver within three years. In any case, I find it interesting that UCI, in the person of Dr. Cao, threatened staff in writing with "liability" if "patients … find out something and decide to take legal action." Wow. Simply wow.

In my last post (the one just below this one) I mentioned how remarkable it was that none of the UCI empoyees happened to mention to "transplant" patients that there was no transplant surgeon generaly available from July 2004 onwards. (Dr. Cao left the program, and was not replaced, so UCI had no full-time transplant surgeon. Transplant candidates were not notified, however.) I think that this memo might indicate the source of the problem. After all, what sort of highly educated, trained, and mobile professionals would stay with the program after getting those sorts of email threats? For that matter, what sort of people would stay working at UCI after the long string of scandals? Answer to both questions: the sort of people who are working there right now. Related answer to both questions: largely the sort of people who will be there as the next scandal occurs. I think that says a lot.