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UCI hospital put under state supervision

September 26, 2008|Kimi Yoshino | Times Staff Writer

UCI Medical Center has been placed under state supervision because of its anesthesiology department's "inability to provide quality healthcare in a safe environment," according to a federal report released Thursday.

Among the most serious failings cited by federal inspectors was doctors' practice of filling out medical records in advance, suggesting specific outcomes before procedures were done.

Officials with the U.S. Centers for Medicare and Medicaid Services said Thursday that they had accepted the department's plan of correction, but if the problems are not resolved, the hospital could lose its federal funding.

The Orange-based UCI Medical Center will remain under the oversight of the state Department of Public Health until a second inspection confirms that the corrections have been made.

The 30-page inspection report, based on a May visit that was prompted by a whistle-blower complaint, listed problems dating back at least three years. They included substandard equipment checks, inadequate staffing and shoddy record-keeping

In one case, a patient's blank anesthetic record had been signed by a doctor and marked "stable," one day before the medical procedure. In another case, a doctor had filled out forms in advance for procedures that were to be performed by a different doctor. Records for 10 out of 38 patients revealed similar problems.

Some of these problems had come to light in a 2006 external audit, and the report criticized UCI for not documenting any action to improve quality of care within the department.

"What we're talking about is sloppy and outrageous record-keeping," said David N. Bailey, UCI's vice chancellor for health affairs. "We were shocked when we saw that and heard about it. . . . Of course, that is a no-no. The medical executive committee is dealing very seriously with this right now and the people" involved.

Even so, Bailey said that patient care and safety have not been compromised and that most problems cited in the report have been resolved.

The department has been beset by controversy since at least 2003, when half of the 26 professors signed a letter alleging that "the direction of the department has been radically altered to achieve financial goals at the expense of academic goals." Over three years, nine professors left the department, including four who had signed the letter.

Other doctors complained about poor maintenance of anesthesia machines, inadequate orientation for nurses and missing equipment on anesthesia carts.

After a lengthy search, UCI on March 1 hired Dr. Zeev Kain, executive vice chairman of anesthesiology at Yale, as chairman of the renamed department of anesthesiology and perioperative care.

He hired six new faculty members, purchased more than $4 million in operating room equipment and monitors and insisted that the hospital install a new electronic anesthesia information monitoring system. It was the only one of its kind in Orange County and eliminates the opportunity to fill out records in advance.

"I want to clear the air," Kain said Thursday. "Yes, there was a troubled department. It's naive not to say that. . . . I was brought to clean up things, and I've cleaned up a lot of it already. . . . This is fixed. There's just nothing else to say."

Kain said that when he arrived, he could predict the issues that would be raised by federal regulators. Quality assurance and safety problems have been fixed, along with staffing issues, he said. And staff members have all signed a zero-tolerance policy: If they falsify records, they face termination.

"We are actually auditing all the charts ourselves," Kain said. "I want to make sure everything is kosher."

The federal inspection is the latest problem for the medical center, which has suffered high-profile scandals over the last 13 years. In 2005, the hospital shut down its liver transplant program after Medicare funding was withdrawn. The action came after The Times reported that 32 people died awaiting livers in 2004 and 2005, even as doctors turned down organs that later were successfully transplanted elsewhere.

In 1999 and 2000, the university's Willed Body Program came under fire after its director sold parts of cadavers and did unauthorized autopsies. And in 1995, a team of fertility doctors at the school's Center for Reproductive Health were accused of stealing patients' eggs or embryos and implanting them in other patients without permission. Some of the women gave birth.

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kimi.yoshino@latimes.com

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