Update to April 07, 2008 post.

The headline says a lot, but click through to the underlying medicare report for even more:

UCI doctors faked surgical records


Update:

UCI doc accused of negligence, incompetence

State board says former head of anesthesiology falsified records.

The "culture of noncompliance with the law" (a quote from the investigation of the Neuchterlin-Gitlin experiments) arises again:

"Report on Suspected Malfeasance in UCLA Admissions and the Accompanying Cover-Up", Tim Groseclose, (U.C.L.A. professor of political science, recently resigned member of U.C.L.A. Committee on Undergraduate Admissions and Relations With Schools) August 28, 2008

Linked from Freakonomics

It's almost as if the University of California wants to sow the seeds for another scandal.

Comment 8 on that story begins "I am not saying someone who was fired due to “financial irregularities” (i.e. fraud) should not be offered a job. Even an ex-convict deserves a second chance.."

That's completely reasonable, in my opinion.

The problem here was not in offering Dr. Jonathan Lakey a job. In my opinion, the problem with UCI hiring Dr. Lakey is that the University of California has taken no serious steps to compensate for past scandals before bringing on a researcher with even more baggage. Perhaps it would be better for all concerned if the University of California had demonstrated a stronger committment to stamping out fraud before hiring someone with an alleged history of fraud. Firing the people who were responsible for "fraudulently conceal[ing] information" (see the link here) in the ongoing (apparently since the 1980s!) fertility clinic scandal might have been a sign that the University of California is actually aiming for cleanliness. By contrast, the University did fire Dr. Glenn Prevost, the anestheologist who, in my opinon, tried to fix one of the problems that made up the liver transplant scandal. And now they've hired Dr. Lakey, who was recently allegedly fired elsewhere for fraud.

It's not about hiring Dr. Lakey. It's about the whole pattern.

Hiring Dr. Lakey may be questionable, but I'm certainly not writing that Dr. Lakey should not have been hired. What I am writing is that Dr. Lakey's hiring, in the absence of serious attempts to fix the University's "culture of noncompliance with the law" (a quote from an NIH investigation) illustrates, again, how the University's priorities clearly do not seem to include serious attempts to avoid future scandals.

Refusing to hire someone with baggage, like Dr. Lakey, certainly might not have been the best plan to address the issue of UC scandals. The fact, however, that Dr. Lakey was hired brings attention to the fact that the University of California appears to have implemented exactly no serious plans to address it's ongoing problems.

Why has the University of California set its priorities so? I don't know. As before, the title of this blog is "trying to make sense of (some of) it all." I'm trying to make sense of all this, but I'm really not suceeding.

So, today the LA Times has a story about alleged recurrent fraudulent hospitalization at City of Angels Hospital. There are two doctors listed in that story as being linked to alleged fraudulent hospitalization: Dr. Rudra Sabaratnam, and Dr. Frederick H. Rundall. There is one Dr. Sabaratnam listed on the California medical board web site; that Dr. Sabaratnam went to medical school in Ceylon. I couldn't find out more about Dr. Sabaratnam.

As for Dr. Frederick H. Rundall: he graduated from the University of California, Irvine. One of my experiences during my University of California, Irvine internship is, I believe, relevant to the question of where Dr. Rundall may have learned about the propriety of hospitalizing people who may not actually need hospitalization.

There was a related story about fraudulent hospitalizations at other hospitals in the LA Times last week: 3 Southern California hospitals accused of using homeless for fraud. The only person, other than Drs. Sabaratnam and Rundall identified as a physician in that story, and about whom I could find out anything with a quick web search, was Dr. Kenneth Thaler. Dr. Thaler has also been linked to alleged fraudulent hospitalization. Based on a web search, Dr. Thaler apparently did his residency at the Harbor UCLA Medical Center.

There it is again: the University of California (UCLA is the University of California branch of Los Angeles). Based on what I know about UCLA (see previous posts), I believe that it's clear that Dr. Thaler may have learned poor medical ethics from the Harbor UCLA medical center.

Just another pair of data points.

That ...
IS ....
GEORGIA!


The title of this post should say it all, but I'm not quite as laconic as some of my forebears. Therefore, I'll make it more clear. Georgia, a democratic, peaceful republic has been invaded, and it's people slaughtered, by forces seeking to recreate what previous generations referred to as the evil empire. What we of the West do in response, will guide the flow of history. I pray that we fight the Evil Empire and that we are victorious.

That's about as laconic as I can get.

Civil rights take a step from the brink

As everyone reading this blog probably knows, the US Supreme Court, in an opinion written by Justice Scalia, opined that the right to keep and bear arms is, in fact, an individual right. I think this ruling was the best possible outcome of the Heller case.

Bottom line: the civil libertarians won one. I'm a hardcore civil libertarian, so I'm naturally overjoyed. At the same time, the 5-4 decision illustrated just how precarious our civil rights are. The closeness of that decision will likely motivate a lot of people with an interest in civil rights to come out and vote in the next election.

I think that the vast majority of Americans are pro-civil rights, though many allow other factors to influence their decisions. However, if civil rights can be emphasized soon before an election, then it is more likely, in my opinion, that the pro-civil rights candidates will win.

In the short term, this ruling was bad for the Obama campaign. Obama has had to flip-flop on his earlier support of DC gun control laws; his credentials as a constitutional scholar are somewhat dimininshed since he opposed what has now become the Supreme legal opinion; the closeness of the ruling will likely emphasize civil liberties (not Obama's strong suit) as a campaign issue.

McCain certainly has civil liberties problems, such as the McCain-Feingold bill, but Obama probably won't be able to make an effective issue out of McCain-Feingold, given his (Obama's) strong stated support for "campaign finance reform," (i.e. incumbent-protection laws) in the past. In my opinion, the civil liberty on which McCain and Obama have the strongest disagreement, and for which it's therefore the easiest to separate the two, is the right to keep and bear arms. By putting this particular civil liberty front and center in the news, and by illustrating just how close we came to having the government try to remove an enumerated right from the Constitution, the Heller case and it's outcome is a disaster for Obama's electoral prospects.

Oh, and by the way, there is a University of California angle in the story of the road to Heller, largely in the person of Michael A. Bellesiles, BA UC Santa Cruz, and PhD UC Irvine. Given the emphasis of this blog over the last several posts, I just thought I would point that out.

Brushing events under the rug begins

From the NY Times: Senator Asks About Surgery on Gangsters.

So, Senator, Charles E. Grassley, Republican of Iowa, wrote a letter to the University of California, Los Angeles, requesting details regarding the transplants referenced below. Here's the key sentence that reveals the likely depth of investigation:

" 'While surgeons do not seek to pass moral judgment on the patients they treat, Americans hope at the very least that foreign criminal figures wait in line along with the rest of us,' Mr. Grassley wrote."

Uh huh. I'm an American. My very least hope, when reading about beyond-extraordinary services ¹ , provided by a US state and federally tax-funded program ², at a facility operated by government ³, is NOT "that foreign criminal figures wait in line along with the rest of us." In fact, "that foreign criminal figures wait in line with the rest of us," is not really a hope of mine at all. An investigation that proceeds from the assumption that Americans hope "that foreign criminal figures wait in line along with the rest of us," is probably going to miss the point, in my opinion.

Oh, by the way: it appears that those Americans who do hope "that foreign criminal figures wait in line along with the rest of us," already have reason for disappointment. To me, it seems that the University of California had a dramatically different waiting line for alleged Yakuza, who got livers at UCLA in a matter of a few months, compared to the law-abiding Americans in the University of California "transplant" program (based at UC Irvine, with surgical services nominally provided by UC San Diego personnel), discussed elsewhere on this blog. That other University of California "transplant" program allegedly didn't have a surgeon generally available, nor transplant-qualified anesthesiologists. This program for law-abiding Americans allegedly largely consisted of recruiting people with liver disease to join the wait list, then waiting for those recruits to die over a period of years. Meanwhile, the University of California allegedly collected federal funds for running a transplant program, and the dying patients thought they were waiting for a transplant. As I've written before: the disparity is striking, to say the least.



(1) transplants are extraordinary enough; this particular set of transplants involved trans-Pacific house calls to a Japanese prison

(2) transplants are funded partly by state and federal programs

(3) the University of California is overseen, operated, and funded by the State of California, as well as being the recipient of multiple federal grants

Will I never be able to retire this blog?

The University of California news had been a bit quieter lately, mostly consisting of follow ups from previous events.

And then, this, from the LA times:

Four Japanese gang figures got liver transplants at UCLA

I read this story, and thought about what to write about it. I've written earlier that, when I tried to tell UCLA patients the risks of anesthesia, my schedule was rearranged so that I wouldn't have any contact with the liver transplant patients. At the time, the rumor among the UCLA surgical and anesthesia residents was that the UCLA living-donor liver transplant recipient survival rate was zero percent in the post-operative period, i.e. that zero percent of the recipients lived more than a year or two after the procedure, if they survived the procedure at all. Some of the residents had a joke about it: they claimed that the mortality rate was only 50% since the living, healthy donors all lived. It was only the recipients of the liver transplants who (according to the rumor) all died. Yeah, OK, it's not really a funny joke. What do you expect from a bunch of chronically sleep deprived science nerds?

Just as a point of reference, successful living donor liver transplants were pioneered by Broelsch, Emond, Thistlethwaite and Heffron at the University of Chicago about half a decade before I was at UCLA. The University of Chicago team had apparently achieved a five year recipient survival rate of near 95% at the time that the rumored UCLA 1 to 2 year recipient survival rate was 0%. Note that I don't have any documentation to verify the UCLA survival rate; just the rumor. However, in light of other rumors that have turned out to be true regarding University of California transplant programs (for example, the rumors that the UC Irvine transplant program was inappropriately turning down organs), I believe it is possible that the rumor I heard at that time was true.

So, I thought my demonstrated willingness to tell people about the risks of, and alternatives to, the procedures they were contemplating, and the location in which they were contemplating them, might have been the reason that my schedule was rearranged to keep me away from the transplant patients.

Now, it appears there might have been another reason. Going back to 2000 (admittedly, after I left UCLA, but that may just be a function of record rot), it appears that UCLA has been selling liver transplants to high ranking Yakuza. (link is to the wikipedia page on Yakuza).

I'm going to write that again: it appears that UCLA has been selling liver transplants to high ranking Yakuza. I am certainly no expert on the Yakuza, but it's my understanding that, in order to become a high-ranking Yakuza, one must be involved in large scale murder, torture, theft, drug sales, and more. And the State of California, through the University of California, has been selling liver transplants to these people.


I've noted in the past that residency programs can demand unethical or arguably criminal behavior from their residents. Entering into a business arrangement with the Yakuza takes that to a whole new level.

And, there's resident and staff safety to consider. If you work at UCLA, wind up working on a Yakuza, and something goes wrong, what exactly do you think will happen to you and to your family? Do you think the Yakuza handle their disputes through malpractice court? I thought it was bad enough when a street gang found the UCLA operating suites, and tried to get in to finish the job against someone they'd tried to kill. This adds another element. One of the senior anesthesia residents in the year I was at UCLA was allegedly found dead in a hospital bathroom. This connection to the Yakuza adds another set of possible reasons for that unexpected death.


Finally, I can't help but note the disparity in treatment between what the University of California offered to these alleged Yakuza (including rapid transplant, and including house calls, from Los Angeles to Japan, for alleged Yakuza in Japanese prison) and the University of California treatment of people with liver disease in the UC Irvine / UC San Diego transplant program (where the surgeon listed as UC Irvine's transplant surgeon was actually on staff at UC San Diego almost 100 miles away, and was allegedly not generally available to the patients at UC Irvine). The disparity is striking, to say the least.

So, as I noted, I've been thinking about this newly documented connection between UCLA and the Yakuza. Though I've just written this post on the topic, I still feel that the right words to describe all the implications of this may not exist. So, I'm just going to repeat this:

The State of California, through the University of California, has apparently been selling liver transplants to the Yakuza.

It just keeps on getting weirder and weirder.

Update: an interesting perspective on Yakuza in the Washington Post: This Mob is Big in Japan.

News regarding the University of California:

Not really good news for the University. And not so much good news for anyone else as it is news about the reversal of earlier bad news.

From the Orange County Register:

"Eight families who say their eggs were stolen by a UC Irvine fertility clinic may continue pursuing damages from the University of California, a state appeals court said, overturning a 2006 ruling that the lawsuits weren't filed in time."


As noted previously, the University had been arguing that the statue of limitations had expired on this case, in which, as above, a UC Irvine fertility clinic had allegedly stolen eggs from women who had come for fertility treatments. Why did the court rule that the statute had not yet expired?

"A three-judge panel unanimously agreed on Wednesday, saying the statute of limitations is not binding if the defendant [the University of California, in this case] has fraudulently concealed information.

'As aptly noted by some of the patients, their attempts to investigate the matter were thwarted by the Regents with incomplete medical records and reassuring phone calls,' the judges wrote."

Perhaps, a future step of actually finding out who and where their biological children are (discovery of which has similarly been "thwarted" by the Regents of the University of California) might someday become open to the families involved. For now, however, the ability to sue for damages for having their children (granted, in embryonic form, but at least one embryo in question is approximately 20 embryos in question are now known to be a teenage child teenage children whom his their biological parents have never been able to contact) stolen from them is at least again open to these plaintiffs. God knows what the now-open legal discovery process will uncover.

And then there are the obvious questions: was it not enough for University of California personnel to steal people's embryonic children? Was it not enough for them to arrange for those embryonic children to be sold for research? Was it not enough for some of these embryonic children (presumably) to be microtomed into paper-thin sheets, each slice trapped forever under glass? Was it not enough for some of these embryonic children (presumably) to be boiled with digestive enzymes for DNA extraction? Do University personnel believe they must still separate the children who survived this University of California clinic from their biological parents, and vice versa?

Clearly, the answers are no, no, no, no, these things were not enough; and yes, they do so believe. That part is clear. The part that defies explanation, at this point, is "why?" What has happened, or continues to happen, to the survivors of this University of California clinic, that the Regents of the University of California are willing to "fraudulently conceal information" from the survivor's families?

Yet another data point:

The LA times has had a number of stories lately about breaches of medical record confidentiality at UCLA. In my opinion, one of the key events in this series of events is buried in the middle of one of these LA Times stories.

After breaches of Brittany Spear's medical records became public knowledge, state officials apparently directly asked if there were other such breaches.

Before state officials conducted their own investigation, UCLA's chief compliance and privacy officer Carole A. Klove (who really should have known what breaches of privacy had occurred) was asked if there were other breaches of privacy. Ms. Klove denied knowing about any. The state then initiated it's own investigation.

The state's investigation is ongoing, but, at this point, it is known that at least 61 patients have had their records improperly accessed.

Here's an understated quote on this topic apprently from Kimberly Belshé, Secretary of California Health and Human Services Agency, as reported in the LA Times:

"UCLA assured us -- the state -- that the initial breach [of Spears' records] was an anomaly," Belshé said. "And we have since learned that, simply put, it is not anomalous."

Got that? It appears that the Secretary of California's Health and Human Services Agency is saying that she was unable to obtain accurate information from UCLA officials under direct questioning. If you, O Reader, are planning to interact with UCLA or UC officials as a patient, employee, contractor, student, supplier, or other, what makes you think you'll have better luck?

Addendum 11/08: based on this story, it appears that the state, now led by a celebrity governor who may have a personal interest in confidentiality at California health institutions, partially investigated this matter. A review of records only from the Resnick Neuropsychiatric Hospital at UCLA from between January 2004 and June 2006 indicated that there were over 1,000 patients whose privacy was violated by at least 165 different UCLA personnel.

First: Wow. Over 1000 patients violated only between Jan 2004 and June 2006 at only one UCLA facility. 165 UCLA personell. Violation of patient confidentiality is obviously pretty widespread.

Second: What is the purpose of having a chief compliance and privacy officer who not only didn't stop these violations of patient privacy, but assured the state (prior to the investigation) that such violations of privacy were "an anomaly?" It appears that the purpose of that position is not to actually ensure compliance and privacy, but to simply exist, so that UCLA can claim a commitment to compliance and privacy based on the fact that they have such an officer. I'm still trying to figure out if this is better or worse than the alleged practice that emerged during discovery over the lawsuits over the Neuchterlin-Gitlin experiments, when UCLA allegedly certified the existence of a federally required research compliance officer who didn't actually exist.

05/16/09
I haven't seen any mention of fines applied to UCLA over this matter. Compare that outcome to the outcome of this story in which only one patient's records were violated, no records were known to have been sold, the hospital involved (Kaiser) found out through an investigation done on it's own initiative, and the hospital involved punished its staff members without State intervention. Kaiser was fined $250,000. The disparity in apparent outcomes is simply stunning.