Perhaps the best way to characterize the blue-ribbon committee’s report on the UC Irvine Medical Center’s liver transplant program is to call it anticlimactic.
Chancellor Michael Drake appointed the five-member panel of experts to form the review committee last fall immediately after the transplant program was shut down. Their goal was to learn more about the failures which resulted in the hospital rejecting liver offers while waiting-list patients died.
But by the time their report was released last week, many of the problems the committee identified in its investigation were already known to the public through various federal and state health agencies and news sources.
The narrowly focused report, which only investigated the liver transplant program, overlooks recent developments and more comprehensive government audits that have shown that problems were not simply unique to the liver transplant program.
Other programs have been criticized for failing to meet federal standards, including the hospital’s bone marrow transplant program and kidney transplant program.
In addition, a former anesthesiologist is suing the university, claiming that he was fired for whistleblowing and complaining about safety issues. Acceptable, yet rare among doctors, two heads of the cardiology department are not board-certified. In addition, the university is conducting an internal investigation to see if nepotism rules were violated when the hospital hired relatives of executives. But these problems were probably unknown to Drake and the committee at the time of its creation.
Nonetheless, the committee’s findings provide an honest appraisal of the hospital. Unsympathetic in their criticisms, they identified several major factors that contributed to the liver transplant program’s failure, including a failure of leadership, lack of accountability and a clear strategic plan or effective reporting structures, slow and incomplete responsiveness to regulatory agencies, inadequate standards and procedures for quality assurance, inconsistent or insufficient communication with patients and poorly managed personnel issues.
The five-member board was particularly concerned with the lack of accountability among hospital administrators, calling their attitude toward red-flag warnings ‘laissez faire.’ The university already took action before the report was released; Ralph Cygan resigned from his post as chief executive officer of the UCIMC on Jan. 31.
The committee concluded that in no way was the hospital malicious despite its negligence. The report said that ‘the committee strongly believes many of the problems involving the UCI liver transplant program … occurred with good intentions, and ambitious plans for growth exceeded both the financial and management resources available to assure quality and success.’
Although it was frank in its critique, the report offered very few specific recommendations to improve the management of clinical programs at UCI. Major recommendations included a campuswide review of all clinical programs, prioritization of goals, strategic planning and focus.
Drake, in a statement released last week, said that the lack of specific instructions was not the fault of the committee.
‘The blue-ribbon committee report looks at the broader structural, cultural and administrative contexts that must be addressed if we are to fulfill our mission of continually improving patient care,’ Drake said. ‘Recent reviews and audits by regulatory agencies such as the Center for Medicare and Medicaid Services, the California Department of Health Services and the United Network for Organ Sharing have provided valuable information on specific failures and areas needing improvement.’
However, a former UCIMC employee believes it will be difficult for the university to improve. Since the fertility scandal in the mid-1990s, many recommendations have fallen on deaf ears at UCI.
Iris Ingram, hired in 2000 to supervise regulatory compliance at the UCIMC, told the Orange County Register last week that ‘what UCI is good at is lofty aspiration. What they are bad at is implementation. … It doesn’t do much good to give someone a set of recommendations without the resources to fully implement them.’
The X-factor in all this is the new chancellor; perhaps what will determine the success of the hospital this time around is the leadership of Drake. The chancellor said he is committed to change and that the steps the university is taking now will only be the beginning of change within UCI Health Sciences.
‘We must be true to our values. The actions we’ll be taking in response to the report are only our first steps. More will be taken as we fully consider the recommendations and confront the challenges we face. We are committed to meaningful changes that will resonate from this day forward,’ Drake said. ‘We will be tireless in our efforts to continually improve patient care in all of our clinical programs.’
The five blue-ribbon committee members included former UC Regent Meredith Khachigian; former UC San Francisco chancellor Haile Debas; University of Texas, San Antonio medicine professor Steven Wartman; president emeritus of the Institute of Medicine of the National Academies Kenneth Shine; and Ken Janda, chair of the Irvine Division of the UC Academic Senate.