Press release from the California Department of Public Health:

SACRAMENTO – The California Department of Public Health (CDPH) announced today that 13 California hospitals have been assessed administrative penalties of $25,000 per violation after a determination that the facilities’ noncompliance with licensing requirements has caused, or was likely to cause, serious injury or death to patients.

There were 355 hospitals (nonfederal, short term, general, and specialty hospitals whose services and facilities were open to the public) in California in 2007, the latest year for which I have an accurate count. There are 5 main University of California medical centers. Of the 14 episodes of noncompliance with licensing requirements that "caused or [were] likely to cause serious injury or death to patients," four of those episodes were at University of California main medical centers. A fifth episode was at the Harbor-UCLA medical center, which, while not one of the main UC medical centers, is run by UCLA.

This means that the five main UC medical centers, in addition to Harbor-UCLA, were over 32 times more likely than all other California hospitals to generate an episode of "noncompliance with licensing requirements that caused or was likely to cause serious injury or death to patients." Something to keep in mind if you are hospitalized. Well, something to keep in mind if you want to live, anyway.

As a visual aid to the disproportion involved, here's one asterisk: *

compared to 32 asterisks: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

If the one asterisk represents a chance that a California, but non UC, hospital generated an episode of "noncompliance with licensing requirements that caused or was likely to cause serious injury or death to patients," then the 32 asterisks represent the chance, based on the data above, that a UC hospital generated such an episode.

Further, of the institutions listed in the press release, the one with the largest history of penalties for such episodes of noncompliance was Harbor-UCLA (four such penalties so far). According to the press release, UC Irvine was the only institution to merit two such penalties in this reporting period. Wow.

addendum: well, if you die at UCLA, at least there's historical precedent for your still being involved in the process of commerce. A businessman accused of selling body parts from corpses donated to UCLA medical school in a scandal that tarnished the reputation of the university's willed body program was found guilty today in Los Angeles Superior Court of conspiring to commit grand theft, embezzlement and tax evasion.

Update 03/19/11 regarding the "willed body" scandal:" http://www.latimes.com/news/local/la-me-banks-20110319,0,6741888.column

Update 05/20/10: No University of California hospitals were on the California Department of Public Health most recent list of "hospitals [that] have been assessed administrative penalties after a determination that the facilities’ noncompliance with licensing requirements has caused, or was likely to cause, serious injury or death to patients." Good news. On the other hand, on (just about) the same day, the Federal Centers for Medicare and Medicaid Services announced two cases of "immediate jeopardy" at U. California, Irvine.

An interesting (though old) series about institutional punishment of whistleblower physicians.

I so want to retire this blog. I am tired of seeing the same patterns show up at the University of California (UCLA in this case). Elements of those patterns include:

1. "a culture of noncompliance with the law," (in this case, noncompliance with work safety rulings and OSHA findings)
2. refusal to address risks (in this case, apparently not warning their employee of the risk of her work, and not training her to ameliorate the risks)
3. billing for services not performed (government grant awards to run research labs generally include a section to fund proper training, which training was apparently not done)
4. and possible coverup (claiming safety training had occurred when there was no documentation of such training, when the putative trainee denied receiving such training, and when evidence strongly suggests that no one in the lab had received adequate training)

I am particularly disappointed when these patterns seem to directly cause the death of a 23 year old talented young lady. Ms. Sheri Sangji is only the latest victim of these patterns.

The lack of attention to safety at UCLA does not surprise me in the least. It's apparently routine for lab workers at both UCLA and UC Irvine (the two labs where I've had the most contact) to work without safety equipment in place.

When I was a resident at UCLA, the lack of attention to basic safety protocols for most people was evident. This lack of attention did not extend, of course, to higher ranking personnel. For example, I remember doing anesthesia cases on people who were having extremely bloody surgery done with power tools. Blood spattered well away from the surgical field, and it seemed to be in the air as well. While I was protected only by hospital-issued scrubs, gown, and paper facemask, the attendings either stayed only very briefly in the room (anesthesia attendings), or wore full "moon suits" with battery-powered respirators (surgical attendings). In fact, on the topic of differential safety precautions and infectious disease, I believe it is relevant to point out that one study showed that approximately 20% of low-level health care workers (nurses and residents) seroconverted for tuberculosis every year worked at the Harbor-UCLA ER, while almost none of the attendings did. Not that I'd want more attendings to seroconvert; it's just that seroconversion was obviously preventable for the attendings, and not for others. I think that's a relevant point to make in the context of Ms. Sangji's apparently preventable death.

I don't think that there's any significant American institution, other than the University of California, which could have caused a similar toll of death, ruined lives, large scale fraud, waste and abuse, as documented in this blog and elsewhere over the years, and not experienced at least a major reorganization or perhaps even faded from existence. And yet, the University of California keeps on keeping on.

Update from the LA Times: allegations of possible illegal lab procedures before the fire, and possible evidence tampering after the fire, as well as allegations of a "shoddy investigation." Who would have thought that a story about a 23 year old burning to death could possibly get sadder?

Another update from the LA Times: Cal/OSHA chief to oversee criminal investigation of fatal lab fire. That story contains this statement about Kevin Reed, UCLA Vice Chancellor for Legal Affairs "Reed also accused the family of sending Cal/OSHA a letter 'ghost-written by plaintiffs lawyers' in an 'effort to get some big judgment at the end of the rainbow here.'
Naveen Sangji, a Harvard medical student, told The Times that she wrote the letter."

So, just when I thought this story had reached the limits of reasonably believable tragedy, it just keeps on getting worse. Accusing the bereaved family of ghost writing in order to get a big judgment? I can imagine how that statement would play to a reasonable jury, if the case ever gets to trial. Besides, if those sort of accusations are what Chancellor Reed's states in public, then what is the likely tone of the conversations in the administrative suites overall? Based on Chancellor Reed's public statements, is it likely that safety concerns are paramount in those internal conversations in the UCLA administrative suites?

Update 03/13/10: The bounds of tragedy may have been breached, and UCLA may be well into criminal territory here. Serious lab accident at UCLA in 2007 was not reported. Not only was there a serious burn BEFORE Ms. Sangji was burned to death, but the previous serious burn was not reported to Cal/OSHA, and there are documented episodes of continued unsafe practices BEFORE and AFTER Ms. Sangji burned to death.

The failure to report the previous serious burn to Cal/OSHA suggests collusion by two different groups within UCLA. Firstly, UCLA, as the employer, is obligated by law to report serious workplace injuries to Cal/OSHA. Secondly, the doctors who attended to the burned patient would have been required by law to document that this case was a "reportable" (i.e. required to be reported to Cal/OSHA) case. A workplace burn that required hospitalization -- or, indeed, that required anything other than non-prescription treatment and a single follow up visit -- would have been required to be designated by the attending physician as something that would be required to be reported to Cal/OSHA.

The fact that the reporting was not done, even after an injury serious enough to require hospitalization ... well, it appears that the "culture of noncompliance with the law" is alive and well at the University of California.


Update 12/28/11: looks like criminal charges may actually be filed. UCLA calls these charges for events which led to Sangji's burning to death, "outrageous."

Update 7/28/12:

UC regents strike plea deal in UCLA chemistry lab death

Update on UC Irvine alum Dr. George Steven Kooshian: Doctor admits skimping on AIDS patients' meds. Dr. Kooshian allegedly sold saline, or dramatically diluted meds, to AIDS and hepatitis patients. This is a case in which payment was sought and received for goods and services not actually rendered.

That pattern has come up a lot in the news recounted on this blog.

Sentencing is apparently in May 2009.

UC admits misleading public about buyout-taker

Apparent fraud ... by the person responsible for "whistle-blower complaints and public records requests" at her campus, no less. The comments are interesting, in my opinion.

Incongruous headline of the day: do you think the headline to this story really gives the most accurate short version of the story?

And to give you a taste of the linked story, here's an excerpt:

"In a psychiatric seclusion unit, a patient complained to inspectors that she had urinated on sheets in her room because she couldn't communicate her need for a bathroom. The patient's medical record said she refused offers to go to the bathroom, which were made every two hours. Inspectors tested the audiovisual equipment that monitored patients in seclusion and found the video worked but the sound did not. When loose wires were found disconnected from the intercom, staff was unaware how long the equipment had been nonoperational, the report says"

Besides the obvious, you may wish to note the Orwelian overtones of referring to a room in which one is locked, alone, for an extended period of time, in which room one cannot be heard, but only watched at the convenience of those outside, as a "seclusion unit." The only thing that differentiates a psychiatric seclusion unit from the solitary confinement type of torture is careful and caring oversight of the inmates. UCI personell didn't even provide enough oversight to save the patient above from having to urinate on her sheets. In other words, it appears that UCI did not provide careful and caring oversight. Therefore ... well, the conclusion is obvious.

It's good, in my opinion, that Medicare is looking into these things. Once again, the University of California has been accepting payment for services (adequate monitoring of solitary patients in this case), and then apparently not providing the service. It's a pattern.

However, the question almost asks itself: where is law enforcement? In this particular case, the failure to provide the services which differentiate between "psychiatric seclusion unit" and "solitary confinement" suggest that abuse of a dependent person (the psychiatric patient in this case) may have occurred. What would it take to make UC administrators and staff actually perform the monitoring that they are paid to do? Would it take a death? In December 2005, a psychiatric patient with a known suicidal history was was monitored so ineffectively as an inpatient at UC Irvine that he managed to kill himself. So, it appears that death due to inadequate monitoring is not enough to justify adequate monitoring going forward, nor even to preclude disconnection of basic monitoring equipment. There may be a pattern here beyond financial irregularities, and that possible pattern should be investigated beyond the financial aspects.

The University of California "culture of noncompliance with the law" strikes again. From the SF Chronicle:

Activist group sues UC [the University of California], claiming illegal search.

(the search was of non-UC newspaper offices, no less)

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.