Welcome to the party, pal

With this post, I welcome fellow University of Chicago alum Dr. David Kessler, MD JD, to the ongoing University of California scandals. Dr. Kessler was recently fired as Dean of the UCSF school of medicine. According to this story, Dr. Kessler's firing was preceded by his noting, and documenting, allegations of financial improprieties on the part of the University. He also apparently alleged a coverup regarding those financial improprieties.

When he was fired, according to the linked article, "Kessler said he was surprised." Well he might have been. Though I happen to know, through this blog, of many others who've been forced out of the University of California after uncovering various "improprieties," many of those people never go public. Kessler probably didn't know in advance just what kind of organization he was dealing with. He should have read this blog.

To his credit, Kessler has now gone public with his complaints, and he's perhaps saved other naive University of California recruits from surprise similar to the one he had. So, David Kessler, I salute you. Welcome to the party, pal.

So where is the FBI?

Due to an interest in the news from the University of California, I seem to have developed a theme on this blog, one which I didn't intend. However, now that the theme has developed, people tell me about events that fit that theme. A few days ago, for example, I got a call to tell me about this story. (addendum: the previous is a dead link. A live link to another version of the story is here).

To me the interesting part are the implications that the University of California is essentially selling residency spots in a federally funded training program. Put that together with the knowledge developed by the "unauthorized compensation" scandal of 2005, and what you have is the likelihood that University of California officials were using a federally funded program as a private piggy bank.

Once again, I have to wonder, "where is the FBI in all this?" Where were they when UC Irvine, in conjunction with UC San Diego personnel, claimed to have a liver transplant program that didn't actually have a full time surgeon, transplant-certified anesthesiologists, or other factors that were nominally required to have a transplant program?

I'm not going to belabor this point. I don't know where federal law enforcement officers were during these scandals. I do, however, know where at least one, very powerful and highly placed federal legal official was during the Neuchterlin-Gitlin experiments¹, and during the UCI infertility scandal². That federal official was in a (very nice) private room getting extremely large injections of euphorogenic drugs as a treatment for "backache.” To be more specific: this high ranking federal legal official would routinely come to UCLA for back pain that seemed to have no radicular component, was not postoperative, and seemed to cause no objective findings consistent with actual pain. He was treated with very large amounts of Demerol, a narcotic which is particularly well known for being a painkiller of relatively low analgesic potency, but high euphorogenic potency. Note that I was an anesthesia resident at UCLA at the time, and I, and other residents, all thought that the doses of narcotics this person was getting were at least unusually large. I believe that anesthesia personnel have a high barrier to the characterization of narcotic doses as "unusually large." Make of that what you will.

In any case, the clinical setting, and doses, and choice, of meds were weird to say the least. In fact, it might be, in my opinion, reasonable to rephrase what I just described as: “a high level federal legal official routinely came to UCLA to get drugs which are often used to get people high.”

Due to HIPPA rules, I can't name this official, or even name his position (gee, I wonder if such considerations might be part of the impetus behind HIPPA in the first place?), but it does answer the question as to what at least one high level federal legal official was doing while the University of California was arguably violating the law with impunity.

1In the Nuechterlein-Gitlin experiments, young people were apparently subjected to induced psychosis without their knowledge. This was run from UCLA until Tony Lamadrid, one of the apparently unwitting research subjects, apparently in an induced psychotic state, killed himself in approximately 1994. The program was then shut down at UCLA, and moved to the Westwood VA, which is run by UCLA.

2In the UCI infertility scandal, UC Irvine apparently ran a reproductive endocrinology clinic that stole embryos, sold them for research, fertilized women who'd come for reproductive help with the sperm of the clinic heads rather than the women's husbands or chosen mates, and, as of 2006, was still trying to hide from the biological parents the identities of at least 20 children who'd been born from stolen embryos.

A co-worker told me about this, and I've just spent a bit of time playing with it. Not surprisingly, if you've been reading my earlier posts, I've been looking at the costs generated by UCLA and UC Irvine. Here's an interesting table that I've generated.

What's going on here? One will note that some institutions charge more than others per day in the hospital. Sometime, that makes sense. The University of Chicago, for example, treats the sickest of the sick, has generated a large number of Nobel prizes in the process of learning how to treat the sickest of the sick, and has pioneered healthcare procedures used elsewhere. All that would be expected to cost more per day of hospitalization. Another way to put this is from the medicare / insurance companies point of view: payers are generally willing to pay more for specialists, and treating hospitalized patients with a lot of specialists is expensive.

(Of course, I'd like to point out that it's interesting that UC Irvine has such a high reimbursement rate per day, denoting a lot of work done by specialists. After all, this is the institution where the chair and vice chair of the Department of Cardiology were not board certified in anything, including internal medicine or cardiology, and did not have California medical licenses. It's also the institution that fired and allegedly blackballed the whistleblower who pointed out that they were billing for procedures allegedly performed by doctors who were documented not to be in the hospital at the time the procedures were performed. Do the specialists for whom UC Irvine is charging really exist?)

With some exceptions, it's reasonable to assume that that high inpatient reimbursement per day implies actual high use of specialists. Of course, the whole point of using medical specialists for inpatient care is to get people better quickly, so they can go home. Despite treating the sickest of the sick, the U. of Chicago keeps people in the hospital for only about the same time as the national average. It appears that the U. of IL, UCLA, and, to a lesser extent, UC Irvine, keep people in the hospital much longer than the national average. Other tertiary care centers (such as the U. of Chicago, and UCSF) don't do that. Why is that? Does the terrible weather in LA and Orange County mean that people have to be kept in the hospital, and thus out of the weather, longer than if they were in Chicago or San Francisco?

My guess as to the reason for the higher than average days of hospitalization generated by some hospitals can be intuited by reading about my experiences working for UC Irvine described in part II of this post. The kind of behavior I wrote about there could easily be responsible for the fact that UCLA (as well as other institutions) kept people in the hospital for almost 1 1/2 times as much time as the national average during the last 2 years of life. And, of course, that, combined with high billing rates, leads to a large income for the hospitals involved, without the benefit (to the patients) of getting better quickly and going home.

Just a thought.

An open letter to the American Bar Association:

Ladies and Gentlemen,

I am writing to you today in regards to the upcoming application of the University of California, on behalf of it's Irvine Campus, for accreditation as an American Bar Association approved law school. There are a few factors regarding the University of California and of it's subsidiary at the University of California, Irvine that you may wish to consider when making your accreditation decision.

Others have already pointed out that the recently newsworthy process of hiring, then firing, Edwin Chemerinsky as the Dean of a putative law school at the University of California, Irvine calls into question the propriety of opening that law school in the first place. At least one author has noted that this process may have violated the Federal and California constitutions and violated ABA standards for accreditation¹.

I am writing this letter to point out that, as if such violations were not enough, there are many other events to consider as they relate to the University's fitness to operate a law school. Those reasons relate to the history of the University of California overall and to it's subsidiary at the University of California, Irvine.

Over the last decade, the University of California overall has been an embarrassment to American academia. A 2005 audit by the The (California) Bureau of State Audits found that “UC administrators sometimes circumvented the university's compensation policies, resulting in questionable forms of compensation and improper payments^2.” These improper payments went to university managers, including the president of the University.

The estimated amounts of that questionable compensation vary, with at least some of the variance apparently due to the secrecy in which that compensation was delivered. However, all accounts agree that the unauthorized compensation was very large. According to a story in the San Francisco Chronicle, $871 million in “extra compensation,” above regular salaries and overtime, was delivered to UC employees³. California auditors reported such extra compensation in the amount of $334 million⁴.

Despite University policies mandating disclosure of such compensation to the Regents of the University, and despite clear IRS rules mandating disclosure to the IRS, neither the Regents nor the governor nor the legislature nor the IRS were fully notified of this compensation⁵. In this case, “questionable compensation” appears to be academic code for embezzlement, and “failure to notify the IRS” appears to be code for tax evasion. With the amounts involved being well into the hundreds of millions of dollars, this episode was a national disgrace.

It is also worth noting that the University has also presided over almost routine damage to US national security. A long list of such security leaks is maintained by the project on Government Oversight⁶ for the (University of California managed) Los Alamos National Laboratories. I will not reproduce that list here, though there is a reference in the footnotes. Suffice it to say, the University of California has apparently run a national laboratory in such a way as to place the national security of the United States at risk.

The University of California has also acted in ways that are not consistent with the claimed traditions of academia. In September 2007, an invitation extended to Lawrence Summers was revoked due to political pressure apparently brought to bear against the University, and against Summers, by those opposed to his questioning of gender-role orthodoxy in the academy. This was an international embarrassment for American academia overall, as it demonstrated a major American academic institution actively suppressing reasonable questions about the relationship between gender and other aspects of human endeavor. To be clear: the University of California has a history, as exemplified by the Summers debacle, of actively impeding questions into controversial topics. The tolerance of this behavior calls into question the utility of American academia in general, and is thus an embarrassment to academia.

All these are reasons enough, in my opinion, that the certification of any new school that involves the public trust should be seriously considered when the University of California is involved. In the selection of campus for the proposed new law school, however, the University of California has provided a particularly strong example of it's apparent inability to avoid rewarding unethical and criminal behavior.

The University of California, Irvine, is the putative site for the new law school. That same University of California, Irvine, has been a routine embarrassment to American academia, and to academic medicine in particular, for well over a decade now. UC Irvine's active abuse of the trust placed in it has resulted in a national scandal in the 1990s involving the theft and sale of embryonic humans. It was in 2006 that it became public knowledge that some of those stolen embryos have now developed into young adults, and that the University, after a decade of denying the existence of those now young adults, still refused to inform the biological parents of those young adults as to the identity of their children . Presumably, those children were also not being told of the identity of their biological parents. This is an ongoing national disgrace within the medical community.

In another case, from 2003 to 2005, UC Irvine, in conjunction with personnel from UC San Diego, incorrectly advised hundreds of patients with end stage liver disease that UC Irvine had a liver transplant program that could save the lives of those patients. The UC Irvine Dean of Medicine, the CEO of the hospital, and Dr. Marquise Hart, a transplant surgeon from UC San Diego, all inaccurately certified to the United Network for Organ Sharing that UC Irvine would have a full time transplant surgeon available. In fact, for that time, there was no full time transplant surgeon.

Before and during the 2003 to 2005 time frame, the number of transplants done at UC Irvine was well below both federal and state minima required to maintain certification, the few transplants that were done had a low survival rate, and half the members of the department of anesthesia signed a petition acknowledging that they were not adequately trained to perform transplant anesthesia. From 2003 to 2005, thirty-two individuals who were on UC Irvine's notional liver transplant waiting list died even though there were livers available to these patients.

The patient who apparently tired of waiting for a transplant, and whose lawsuit and discovery brought these events to light, had 95 organs offered to her by the United Network for Organ Sharing, while UC Irvine advised her that there were no organs available to her. Apparently UC Irvine was simply waiting for her to die. All the while, UC Irvine was apparently collecting payments for the medical services provided to these patients while they waited for transplants that were never going to come.

The list of UC malfeasance goes on and on. Suffice it to say that the University of California, and it's Irvine subsidiary, have brought shame and dishonor upon fields in which they already provide services, including reproductive endocrinology, transplant surgery, and medicine in general. Based on this history, it is reasonable to believe that accreditation of a law school at UC Irvine may eventually embarrass the entire legal profession.

In fact, the process of such embarrassment has already begun, even in the earliest stages of the accreditation process, with the hiring, and firing, and re-hiring of Edwin Chemerinsky.

I'd like to expand on some of the points made by others regarding this matter. The initial, and thus far most substantive, public explanation given for the firing – that the firing was forced by unnamed conservative forces – was improper on many levels. For one, it is likely that no large group in America has less influence on UC Irvine's decisions than conservatives. It appears to many observers that Chemerinsky's firing may have been blamed on scapegoats (conservatives) who appear to be minimally influential at the University of California, in an attempt to deflect questions about the real reason for Chemerinsky's firing. As for the nature of that real reason: it's probably nothing that suggests good things about the University.

On the other hand, if the real reason is in fact that Chemerinsky was fired for simple political reasons, then that itself is of concern. The implications are too obvious to belabor, so I leave it to you to decide what it means when a law school dean can be unceremoniously removed solely due to opposition from anonymous persons who are not even willing to come forward and make a direct case against the dean.

As troubling as the putative reasons for Chemerinsky's firing, however, was lack of attention paid by UC Irvine to a legitimate reason for the firing. On September 14, 2007, California Chief Justice Ronald M. George Bob Smith, noted that Chemerinsky had .... made a "gross error" that was "very troubling" to the court⁷ in an Aug. 16 article⁸ written by Chemerinsky. Given the named reasons for the firing, I find it worth noting that a “gross error” noted by the California Chief Justice was not cause for firing, and, in fact, has been no obstacle to Chemerinsky's re-hiring.

This suggests that flaws in Chemerinsky's work sufficient to generate comment by California's chief justice were of such little concern in the hiring and firing decisions as to be completely buried by concern over possibly fictional opposition from anonymous conservatives. This suggests a lack of concern over the quality of work to be done by the members of the proposed law school. I am certainly not suggesting that lawyers, including prominent professors, cannot be mistaken on points of fact. I am suggesting that the decision to totally ignore such errors, while granting enough weight to political considerations as to result in a firing, is a reversal of the claimed priorities of academia and of the law.

I, like many Americans, am somewhat disgusted by the failure of the legal profession over the last several decades to guard against abusive and self-serving manipulation of the law by many of the most prominent members of the profession. However, the legal profession still maintains a certain, though dwindling, amount of public trust. That public trust allows the legal profession to provide an acceptable method of mediating disputes, and thus serves as a bulwark against anarchy. I have no love for the legal profession, but I am certain that anarchy is to be avoided at almost all costs.

Accreditation of a law school (of all types of schools) at the University of California, Irvine (of all campuses) will send the message that apparent institutional violation of the constitution, large scale embezzlement, theft of national security secrets, censorship, various types of sometimes lethal fraud, dishonesty or whimpering acquiescence to transient political pressures are no bar to the education of lawyers. Even before the real scandals start (and they will), such an accreditation will continue to reduce public respect for the law, and be one step towards anarchy. If you have children, whether or not they follow your footsteps into the law, this future erosion of respect for the law is something that you may realize will have a negative impact on the world those children inhabit.

You may also wish to consider that there may be an intermediate step resulting from accreditation of this new law school: the recognition that ABA accreditation may not correlate with ethical standards. Such an intermediate step might reduce the influence of the ABA in the future. I leave it to you to determine how such a reduction of influence should affect your decisions.

A decision not to accredit the University of California law school, on the other hand, will be a positive step for the legal profession overall and for the ABA. Such a decision not to accredit will send the message that the American Bar Association has some standards of ethics and behavior below which it will not allow it's would-be members to fall. By maintaining the ethical standards of legal education, the American Bar Association would increase respect for the law, and for the ABA itself.

The decision is yours. For the sake of America, I hope you make the right choice. For the sake of your own organization and profession, and for the sake of your children, I believe you might make the right choice.

Sincerely,

Peter T. Banos, MD, MBA

1http://writ.lp.findlaw.com/commentary/20070917_moss.html

2http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/05/03/MNGTUIJNTJ1.DTL

3http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/11/30/BAGGQFVT7L1.DTL&type=printable

4http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/05/03/MNGTUIJNTJ1.DTL

5http://www.latimes.com/news/local/la-me-ucaudit25apr25,0,2277667.story?coll=la-home-local

6http://www.pogo.org/p/environment/eo-losalamos.html

7http://www.latimes.com/news/local/la-me-uci15sep15,0,1791213.story?coll=la-home-center

8http://www.latimes.com/news/opinion/commentary/la-oe-chemerinsky16aug16,1,5884838.story?ctrack=2&cset=true

Addendum: I think this story: UCI makes dubious claim about prominence of its law school, is relevant to the above post.

Well, that's one way to keep people quiet:

Below, I mentioned how remarkable it was that the University of California mistreated patients, bodies, and money, and that, for the most part, no one ever talked. Well, here's a story of someone who had apparently begun to talk.

This summer marks 1 year since the death of Denise Denton, the chancellor of UC Santa Cruz. Chancellor Denton had been involved in the "unauthorized compensation" scandal described below. She had been authorized to receive $275,000 per year from the University of California, but it appears that she was actually receiving aproximately 1 million dollars a year in total goods and services while she was the Chancellor of UC Santa Cruz.

Investigators were apparently talking to Chancellor Denton. She was 45 years old, and in a promising academic career. She did have a history of depression, for which she'd been hospitalized, but,on June 23, 2006, she'd apparently been assessed as not a danger to herself or others . As stated above, she was apparently being questioned by investigators regarding her role in the "unauthorized compensation" scandal that was then being investigated. It is unknown how forthcoming she was with those investigators.

Then she fell off a building.

On June 24, 2006, Denise Denton fell 40 stories from the Paramount apartment building where she maintained a San Francisco residence. The official cause of death is suicide.

Read the posts below this one, and, as always, make up your own mind.

Another set of UCLA data points – both obvious and obscure.

OK, today’s LA times has a story about Benjamin Houghton, who had the wrong testicle removed by a UCLA resident surgeon in June 2006. The LA Times makes the obvious points: the proximate cause of the wrong surgery apparently included failure to correctly obtain consent for the planned procedure, failure to mark the correct testicle for surgery, and so on. It’s a catalog of errors, but by themselves this set of errors appears due to simple human failings (although if you read the posts below this one, you might get the idea that the University of California seems to have more simple human failings than might be expected).

The part that appears to have been unremarked on by the LA Times however, is this:

“The VA surgeon, fifth-year UCLA medical resident John T. Leppert, was supposed to remove Houghton's left testicle and perform a vasectomy on his right side for birth control purposes, according to medical records that Houghton and his attorney gave The Times.”

And that sentence says something a little more insidious about UCLA’s attitudes about it’s own interests. As stated in the article, Dr. Leppert is a resident. He’s not the surgeon in charge. He’s supposed to be supervised by an attending physician. There is no doubt that an attending physician billed for services rendered in this case, even if only for supervision (although when I was a resident, the University of California apparently “routinely misbilled” procedures done by residents as if the procedures had been done by attendings. The University agreed to pay $22.5 million in that case, but their billing practices may still be flawed).

It’s the ATTENDING who is ultimately at fault for this wrong surgery. That’s why he’s called an “attending.” From the fact that there’s no mention of an attending, it’s a pretty fair bet that UCLA has left Dr. Leppert to twist in the wind. Note that Dr. Leppert has just been through medical school, and has been working for at least the last 5 years at wages that probably don’t allow him to pay the interest on his medical school debt. In other words, it’s going to be very difficult for Dr. Leppert to hire his own attorney, if he needs one. If UCLA is already attempting to foist the blame on Dr. Leppert, as opposed to one of it’s attendings, then it’s a pretty good bet that Dr. Leppert will need his own attorney. Too bad he might not be able to get one.

For what it’s worth, when I had a patient die from anesthetic misadventure at UCLA, my attending had never had time to leave the room, since the patient had cardiac arrest just after induction. I suspected then, and now believe, that if there had been any way to pin that death on me that the case would have been more vigorously addressed. Once it became clear that only my attending, not the resident (me) could have been responsible for that death, the case seemed to “disappear." There was no formal attempt known to me to determine or address the cause of death.

Anyway, one of the reasons I think it's so sad that Dr. Leppert is apparently being left to twist in the wind is that his part in the chain of errors is exactly in keeping with UCLA practice. According to the story, when it came time to get consent for the surgery, this is what the patient recalled:

"The surgeon said, " 'This is what we talked about before. Just sign here and here' ""

Now that is, in my opinion, a typical UCLA "consent" procedure. Multiple times, when I was at UCLA, I was told that the goal of obtaining consent was to get the signature on the paper. When I tried to do more, I was critisized. Of course, I knew that the actual legal goal (different from the UCLA goal) of obtaining consent was more than simply getting a mark on a piece of paper, but it's easy to believe that Dr. Leppert, after 5 years at UCLA, had internalized the UCLA beliefs. That's why it's so sad, and ultimately pointless, for Dr. Leppert to be the fall guy for this error. At least part of the problem is that he did what he had been trained to do.