UCI Medical Center's ambitions have far outpaced its ability to successfully care for its patients, according to an unusually frank assessment of the chronically troubled university hospital released Thursday.
A panel of five experts, formed after a scandal forced the closure of the Orange hospital's liver transplant program in the fall, described clinical programs with "marginal staffing and inadequate resources."
They "frankly were trying to do too much," said panelist Dr. Kenneth Shine, executive vice chancellor of health affairs for the University of Texas system and former president of the national Institute of Medicine.
The report also raised questions about UC Irvine's plans for a new $371-million hospital, in the early stages of construction, and whether it was designed with the right services in mind.
Though the 24-page document was unsparing in its general criticism, it offered strikingly few specific recommendations. It called for every program to be fully reviewed and for leaders to be held accountable, but it did not name the problem departments or suggest discipline for any officials. It also did not identify the services the new hospital should offer, saying that was beyond the panel's mission.
Furthermore, the report did not address why major problems repeatedly have occurred at UCI Medical Center, across disciplines and departments, over the last decade. The spate of scandals began in the mid-1990s, when three doctors were found to have stolen eggs and embryos from patients and implanted them in other women, some of whom gave birth.
In 1999, UCI fired the director of its donated-cadaver program, amid suspicion that he had improperly sold spines to an Arizona research program.
More recently, the hospital has faced allegations that it accepted too few livers and kidneys as patients languished on waiting lists and that its bone marrow transplant program did not perform enough procedures to meet state standards.
The report repeatedly cited an alarming lack of accountability among several medical school and hospital executives. Sometimes, the officials passed the buck or failed to take responsibility; on other occasions, they misled regulators or tried to minimize the seriousness of problems, the panelists found.
In particular, the experts called into question the leadership of the medical school dean, Dr. Thomas C. Cesario, and the former chief executive of the hospital, Dr. Ralph Cygan. They said that the two leaders had a "very strong working relationship" but that this "comfort level" ironically stood in the way of addressing serious problems.
Cygan resigned under pressure Jan. 31 and did not return a phone call seeking comment. Cesario, who has been dean at UCI for more than a decade, remains in the position but was out of town and could not be reached.
The expert panel, appointed by UCI Chancellor Dr. Michael V. Drake, included one member from UCI and three others with ties to the UC system.
Shine said the campus should close programs found to be beyond repair and ensure that those remaining are rigorously reviewed on a regular basis to detect problems in quality.
He said whistle-blowers should never be targeted for intimidation and punishment, as some faculty say has occurred at UCI. "Legitimate complaints of people were not necessarily addressed in an appropriate way," Shine said. In some cases, he added, when the actions of some staff were challenged, they took it as a personal affront, and "that is unacceptable."
Drake, who took over as UCI chancellor in July, said he planned to implement the panel's recommendations. He is recruiting a top administrator to oversee both the hospital and the medical school, hiring an ombudsman to report directly to the chancellor and bringing in consultants to review the hospital's performance over the last four years.
Although he did not announce any disciplinary measures Thursday, Drake said, "I would expect that there might be personnel changes."
Although the report made passing reference to earlier scandals, it was most specific when it discussed the liver transplant program, which UCI closed Nov. 10. That day, The Times reported that more than 30 patients died on its waiting list in 2004 and 2005, even as the hospital turned down scores of organs that might have saved some of them. For more than a year, UCI did not have a full-time transplant surgeon but misled regulators and the public into believing that it did, the panel said.
The panel found that UCI did not directly address fierce staff infighting. It described a hostile relationship between Dr. David Imagawa, who led the program from its 1993 inception until 2001, and his successor, Dr. Sean Cao.
"Their open disagreements spilled over to the staff, creating what some interviewees consider to be a hostile work environment," the report said.
In response, UCI assigned an experienced nurse "to manage the personality differences and provide some level of mediation between the physicians and the staff."
