No lateral moves allowed between health systems: an illegal conspiracy in North Carolina--or the future of medicine that UCSD is aggressively seeking in California?

Is this the future in California if UCSD wins its poaching lawsuit against Dr. Paul Aisen regarding Aisen's decision to transfer his Alzheimer's study to USC? Is it unlawful restraint of trade? Science magazine reports on what happens when health systems collude to stop their employees from moving to other institutions.

“[L]ateral moves of faculty between Duke and UNC are not permitted.”
–UNC's chief of cardiothoracic imaging

An academic 'poaching' lawsuit from a scientist who didn’t move
By Beryl Lieff Benderly
Science
September 10, 2015

In August, we reported on the lawsuit brought by the University of California, San Diego (UCSD), against the University of Southern California (USC) in Los Angeles, in an effort to stop USC’s alleged attempt to bring a multimillion-dollar Alzheimer’s disease research project along with its new recruit, neuroscientist Paul Aisen, from UCSD to USC. We noted that though some observers view universities’ efforts to bring major researchers to their campuses from elsewhere as effective recruiting, others see it as harmful poaching.

In North Carolina, meanwhile, another scientist’s effort to move from Duke University in Durham to the University of North Carolina (UNC), Chapel Hill, has also resulted in a lawsuit, but for an entirely different reason. Danielle Seaman, an assistant professor of radiology at Duke, claims that “an illegal conspiracy” among Duke, UNC, and the two universities’ health systems not to raid each other’s talent barred her from consideration for an advertised opening at UNC, according to the complaint filed with the court.

Allegedly, the institutions’ goal was to “suppress the compensation of their employees,” according to the complaint. “Without the knowledge or consent of their employees, [Duke’s] senior administrators and deans entered into express agreements [with UNC] to eliminate or reduce competition … for skilled medical labor” by not “hir[ing] or attempt[ing] to hire” from each other. This deal, the complaint argues, constitutes an unlawful restraint of trade...

Read more here.

One-fourth of bed alarms were broken before UCSD patient wandered away to his death

When Thomas Vera wandered away from UCSD to die in a nearby canyon in May 2013, executives across the University of California Health System were cutting positions of staff members who dealt directly with patients.

But those positions weren't cut because there was no money. The money was being shifted to administrators. It seems that the University of California's priorities have been shifting away from patient care to profit over the past several years.

But the greed of the executives and doctors at UC isn't the only factor at play in tragic patient deaths. I see another problem here, and we're all to blame for it. It's our refusal to talk about what should be done for terminally ill or injured patients. Sometimes hospitals are held hostage by families who demand miracles for their dying relatives. Losing a loved one is difficult, and some people can't accept the inevitable. They demand every test and treatment that might possibly give some short term benefit, and they even threaten to sue when their 95-year-old grandmother dies.

Few people want to talk about how to apportion health care dollars. The major exceptions to this are the vocal advocates of leaving large numbers of Americans without health coverage. In other words, these individuals want to let economics decide who should live and who should die. The advantage of this position is that it insulates its adherents from making specific choices about who should suffer or die. They want to let the market choose. Of course, the market is increasingly controlled by wealthy corporations and individuals who are taking a bigger and bigger share of the economy each year. The wealthy and their advocates apparently believe that fewer and fewer people should have health care.

Currently we spend an inordinate amount of money on the elderly during their last year of life, and, in particular, their last month of life. The truly disturbing aspect of this enormous outlay of healthcare dollars is that those who receive expensive hospital care during their final months have a lower quality of life than those who receive hospice or home care.

In the Archives of Internal Medicine, a study asked if a better quality of death takes place when per capital cost rise. In lay terms...the study found that the less money spent in this time period, the better the death experience is for the patient.

--Why 5% of Patients Create 50% of Health Care Costs?
Michael Bell
Forbes
1/10/2013

Obviously, if UCSD can keep the latest high-priced medical equipment in good repair, then it's perfectly capable of keeping bed alarms working. The California DHHS recently revealed some facts about the case of Thomas Vera, a UCSD patient who wandered into a nearby canyon and was found dead several days later:

State inspectors said the hospital failed to routinely test the buttons and failed to repair them when broken.

Prior to Vera’s disappearance, the most recent test had revealed more than 1 out of every 4 panic buttons at UCSD’s two main hospitals didn’t work.

--Broken Bed Alarm Blamed for Walkaway Patient's Death
By Steven Luke
NBC 7 San Diego
Sep 15, 2014

Is this the best that all these high-priced UC administrators can come up with? A patient dying of hunger, thirst and exposure in a nearby canyon? Obviously, UCSD can do better than this. AFSCME notes: "Care providers are forced to give special treatment to VIPs—so-called because of their wealth or relationship to UC administrators—at the expense of other patients."

It seems quite possible that Thomas Vera might not have recovered from his head injury even if he hadn't wandered away. He had apparently been in the hospital for weeks, too ill for surgery, and suffering from the delusion that he was being held captive in a garage in Texas. Perhaps he would never have become a good candidate for surgery. Would this man have had a better quality of life in his last days if he'd been in hospice care, or at home? It seems clear that he would have.

And would another person have benefited more from being in that hospital bed? It's hard to see how anyone could have benefited less than Thomas Vera did.

Perhaps UCSD administrators engaged in a chain of thought similar to these musings of mine when they created the situation that allowed Thomas Vera to wander off and die of exposure in a canyon. Did UCSD make a conscious decision to maintain expensive medical technology while neglecting low-tech life-saving gadgets for certain rooms?

The University of California has an enormous amount of political clout. Why not use that power for something besides making billions in profits from its health care system? Why not lead the discussion about how much of our health care resources should go to the terminally ill or injured?

A QUESTION OF PRIORITIES: Profits, Short Staffing, and the Shortchanging of Patient Care at UC Medical Centers
This report was written by AFSCME Local 3299 over the course of several months in 2012 and 2013. It is based on interviews with Local 3299 members employed at UC Medical Centers, reports by the California Department of Public Health, inpatient discharge data from the State of California’s Office of Statewide Health Planning and Development, as well as additional sources.

The public sees University of California Medical Centers as premier, world-class facilities. We rely upon them when our loved ones face the most serious illnesses because we expect them to provide the highest level of care. With the UC Medical System earning $6.9 billion in operating revenues and hundreds of millions in profits, it has the resources to do just that.

But recently, patient care advocates have witnessed something else: administrative decisions that prioritize UC’s profit margins over patients’ health. These decisions reflect a shift in values that reached a tipping point with a system-wide policy in 2011 that decentralized UC budget practices, and turned each medical center into an independent profit center.

This culture change is evidenced by a sharp rise in management salaries and compensation, excessive management costs, and unprecedented borrowing to construct new buildings.

Since 2009, management at UC Medical Centers has grown by 38 percent, adding $100 million to the annual payroll cost of management.

Debt service payments have almost quadrupled since 2006.

This diversion of patient care dollars results in management’s need to capture “efficiencies” to bolster profit margins.

While “efficiencies” can be positive, they can also have serious negative consequences. Often taking the form of aggressive cost-cutting measures, some translate into chronic short staffing, over scheduling of operating rooms, prioritizing “VIP” patients over everyone else, shortchanging charity care, and outsourcing essential services.

These degrade the medical centers’ core mission.

Care providers are painfully aware of administrative priorities that too often leave them unable to provide the care that patients deserve. Patient care workers suffer unnecessary stress and fatigue, and at times work without adequate training on the use of hazardous materials used to sterilize patient care areas. Some report being so rushed in their work that dirty patient care areas may not be properly sanitized before new patients arrive.

While workers are already feeling squeezed, the University is threatening to cut staff. At UCSF Medical Center, management recently announced its plan to reduce 300 hospital workers, or 4 percent of its full-time workforce. These reductions are being proposed at a time when the medical center is only just recovering from having to ration respiratory care services in January 2013 because of inadequate staffing levels. To make matters worse, the hospital’s CEO admits that, in his view, these cuts are needed, at least in part, to free up resources for new construction...

Frontline care providers give examples of how UC policies degrade safe staffing and patient care.

Patients often fall trying to go to the bathroom by themselves because short staffing delays staff response times. In one instance, a patient classified with “altered mental status” did not receive one-on-one attention and was found standing on a windowsill.

Chronic short staffing creates excessive workloads and stress. One nurse’s aide reports being afraid to take breaks because it would increase the ratio of patients to CNAs from 10:1 to 20:1.

The UC health system seeks to “re-align” Medicare and Medicaid patients to non-UC hospitals under the assumption that they often do not require the level of care UC provides.

Care providers complain about dirty patient care areas. An operating room assistant sees dried blood and fluids in the crevices of an operating table month after month...

Profitable high-level procedures get overscheduled, causing stress and exhaustion for care providers and delays for patients.

The State of California provides significant funding for the University’s Health System. In the fiscal year 2012-2013, it will provide approximately $300 million in public dollars for health sciences instruction....[Read more here.]


Broken Bed Alarm Blamed for Walkaway Patient's Death
Thomas Vera died after he became disoriented and walked away from his hospital room at UCSD Medical Center in May
By Steven Luke
NBC 7 San Diego
Sep 15, 2014

California Department of Health and Human Services records obtained by NBC 7 shed new light on what went wrong inside UCSD Medical Center when a disoriented patient walked away from his supervised room into a nearby canyon.

The [May 2013] lapse in hospital security led to a tragic search which ended when ...Thomas Vera’s body was found [several] days later less than a mile from the hospital entrance in Palm Canyon.

Family blames the hospital for allowing 58-year-old Thomas Vera, suffering severe head and neck injuries as well as [delusions], to leave the facility...

According to the CHHS investigation, Vera’s bed alarm never sounded. Vera was under video surveillance, and when nurses were notified, the report states they “attempted to contact security by paging security twice with no response and then pushing the panic button twice with no response.”

The panic button was “broken for 8 days,” according to the report.

State inspectors said the hospital failed to routinely test the buttons and failed to repair them when broken.

Prior to Vera’s disappearance, the most recent test had revealed more than 1 out of every 4 panic buttons at UCSD’s two main hospitals didn’t work.

“That’s incomprehensible to me. This is a big time, generally well thought of medical facility, and it’s like clown school” said legal expert Joel Brant, an attorney who specialized in elder care law.

[Maura Larkins comment: I don't believe they're clowns. They're clever, and they're calculating. The buttons were not a priority. UCSD pays huge amounts of money to maintain the equipment it wants to keep maintained. Were the walkaway patients paying full price? Were they a drain on UCSD financially?]

UC San Diego Health Sciences director of communications Jacqueline Carr released this statement in response to the incident:

“UC San Diego Health System underwent extensive internal and external investigations to identify the reasons that led to this tragic event...”

Fifteen months after the incident, CHHS says no fine or penalty has been issued as a result of the mishap...

Read more here.


Missing Hospital Patient's Body Found in Canyon: Officials
By Monica Garske and Dave Summers
NBCSanDiego
Jun 1, 2013

The body of a missing hospital patient was discovered by search and rescue officials in a canyon Friday evening after an extensive search.

Chula Vista resident Thomas Vera, 58, had been missing since Monday. For the last several weeks, he had been a patient at the UCSD Medical Center.

Vera was admitted to the hospital after falling down the stairs at his home. He suffered a concussion and broken collar bone, according to his family, and was awaiting surgery...


Family, Cops Search for Missing Hospital Patient
By Brandi Powell, R. Stickney and Monica Garske
NBC 7 San Diego
May 31, 2013

A Chula Vista man, suffering from a head injury and broken bones, walked away from a San Diego hospital wearing only a hospital gown four days ago.

On Friday, San Diego police officers and family members spent all day searching canyons near Mission Valley for any sign of the man who officials say was likely disoriented and confused...

His daughter Tanya said Thomas last spoke with his wife on Sunday night.

"These are his words - he was being held in a garage in Texas - we're from Texas so he's thinking he's in Texas - that people were holding him against his will and drugging him, and so he was crying and telling my mom he was very scared," she said...

Financialization of universities: Judge Rules the Che Cafe at UCSD Gets a Stay

Sometimes we don't see what's happening in medicine because it's all wrapped up in critical issues of life and death. We can't believe that medical systems would be putting financial gain above patient well-being.

So perhaps it might be good to look at how universities are financializing other parts of their operations.

Judge Rules the Che Gets a Stay and the Struggle Continues  

FOR IMMEDIATE RELEASE

July 10, 2014

The Che Café Collective, a world renowned cultural icon and UCSD landmark that operates as an all-ages music venue, performance space and cafe, will not be so easily uprooted by University officials after over three decades of continuous operation and huge support from students and the public. 

In a hearing today on a temporary restraining order, a judge ruled to keep the Che in possession of the space and preserve the status quo until a more full hearing on the merits can be held. This preliminary injunction hearing is scheduled for August 1, 2014. If the Che prevails in the injunction hearing, it will maintain possession of the space until a final resolution is reached in the breach of contract lawsuit filed by Che’s legal counsel, Andrea Carter, against the University Regents and by extension, the University of California San Diego (UCSD) on July 7, 2014. 

The lawsuit takes issue with University breaches of the Space Agreement lease signed in 2006 and whether the University is able to give a Notice of Termination pursuant to the terms of the Agreement.  It also contests the University’s actions in denying dispute resolution and avoiding the grant of an extension to the Che.  It further alleges the University has  acted in bad faith by seeking or instigating lease violations or other reasons to displace the Café.  

The Che Café is one of four largely student-operated cooperative nonprofits on campus. It was founded in 1980, when students pushed for the Facility to become a student-run space, rather than a faculty club, since student fees pay for building maintenance. The name CHE is an acronym for “Cheap Healthy Eats;” initially an all vegetarian restaurant.  The organization began hosting music performances which made it famous in the mid-1980s and gave many now well-known musicians their start.  Like the other student cooperatives (co-ops), the Che has had continual extensions of their lease or new leases drafted and signed for the past 34 years.

The University officially gave its Notice of Termination for the lease due to the failure of the Graduate Student Association (GSA), one of two representative student government bodies charged with certifying that the all the campus cooperatives are financially sound and in the best interests of students, to certify the Che. These determinations are to be used for extending the lease and as measures for determining student support for the venue’s continued functioning. However only the GSA Board passed a resolution not to endorse the Che’s continued operation. The Associated Students (AS), the representative undergraduate student governance body did not pronounce on the matter.  The GSA decision was arrived at after considerable involvement and influence from University administrators and legal counsel, who helped draft the resolution.

The University also continues to avoid full disclosure of its rationale for seeking the closure and displacement of the Café, which so many view as a legendary jewel and valuable asset to the University. It has offered many pretextual reasons and concerns that defy common sense or are matters that cannot be quickly addressed and remedied without terminating the Café’s possession and lease.

 

In public statements, UCSD administrators have alleged that the decision to terminate and close the Facility involves matters of  health and safety, citing a 2012 Fire Marshal recommendation that upgrades be made to the building.  These include an overhead fire sprinkler and fire alarm system. If these upgrades were actually vital, they would have been deemed mandatory rather than recommended, and the Fire Marshal would have ordered the venue closed. Instead, the Fire Marshal signed off on the cafe for the year in a follow up inspection of April 17, 2014. Further, the building has been in use by the Che Café and other university affiliates before it for nearly fifty years without any safety incident or any expression of safety concerns by UCSD administrators.  As well, the Che Café has insurance and a full indemnification agreement with the University.

The Che Café points to a long history of UCSD administrators falsifying estimates for building maintenance costs and purposely misleading student government and student centers’ boards which oversee the annual operating budgets. UCSD currently estimates that over $700,000 of repairs are needed. However, independent estimates amount to less than ten percent of that amount.

UCSD waited to give termination notice until the end of the Spring term, as students were leaving campus for the summer. Despite UCSD's underhanded tactics, students continue to campaign on behalf of the Che Café. To date, it has amassed huge support from its attendees and musicians.  This is evidenced by the outpouring of public comment and letters of support addressed to the University, not to mention the over 11,500 signatures on an online petition. The online comments posted by petition signers show a broad base of students, alumni, campus staff and faculty and the surrounding community in strong support of the Che. The Che Cafe is one of the few affordable entertainment and live music venues not to serve alcohol.  It  promotes a safe, respectful space that all people can enjoy and often offers local and independent or student-programming.  All this is extremely rare in San Diego and increasingly everywhere in the U.S.  

  

Arguably, the real reason for the lease termination is economic.  And this is why non-students and the broader community should care and join this push to preserve the venue, even if you have never attended or heard of it before. The University administration has shifted to decisions rooted in valuing revenue-generation and profit-seeking above all else. The Che Facility does not bring in windfall profits for the University.  It stands in contrast to a Starbuck’s licensed cafe, or a parking lot where each space brings in hundreds of dollars,  or even to a new science building that can house researchers securing grant dollars from which the University can take a sizeable cut. The social spaces the University seems to prefer are privately operated, profit-driven and not dedicated to providing practical educational opportunities, self development and creative expression and growth that more traditional spaces like the Che Cafe affords.

This financialization-based shift and near unilateral focus in deciding and stewarding our common and public resources is happening not just at UCSD or in many campuses across the U.S. but within many institutions, municipalities, and entities charged with safeguarding or managing our collective resources and rights. Who will watch the watchers? When these transgressions and power plays occur, the University and Regents are making it increasingly difficult to exercise free speech and protest on campus if you are not a student or staff through its policies, most recently, PPM 510.1 Affiliate Free Speech Policy. Do not wait until all our rights and spaces are stripped from us. Stand up and defend this space with us. A loss here is not just a loss of the Café and its attendees, but a diminishment of all of us who enjoy access to independent creative expression, entertainment, healthy food and authentic culture and community.      

A fundraising campaign has been launched and the Che Café is requesting donations to cover legal expenses, improvements and maintenance to the building which the university has failed to provide, and mitigation of lost income from disruption of the concert schedule. Supporters of the Che can contribute to these expenses in any of these ways:

·          Online at http://www.gofundme.com/b4hda8

·          Attend the Che Café during a scheduled concert

(see schedule at http://thechecafe.blogspot.com/p/shows.html)

·          By mail at:

CHE Café

9500 Gilman Drive M/C 0323

La Jolla, CA 92093-0323

For further information contact:

Rene Vera GRVeraXXX@gmail.com 

Andrea Carter andrea@amcarterlaw.com or  619-887-4529

Chris Burnett, chris@indymedia.org UCSD graduate, Host of 'Indymedia On Air' on KPFK 90.7 FM Los Angeles

or support@checafe.ucsd.edu

Supporters are also encouraged to express their concerns about UCSD's course of action to the administrators responsible. Letters of support can be sent to these individuals, at these email addresses:

 ·          Chancellor Pradeep Khosla chancellor@ucsd.edu

·          Vice Chancellor Gary Matthews: gcmatthews@ucsd.edu  

·          Vice Chancellor Alan Houston: ahouston@ucsd.edu

·          Associate Vice Chancellor Gary Ratcliff: grratcliff@ucsd.edu

·          UCEN Director Sharon Van Bruggen: svanbruggen@ucsd.edu

·          Associated Students President: aspresident@ucsd.edu

·          Graduate Student Association President: president@gsa.ucsd.edu and vpinternal@gsa.ucsd.edu

Please also "cc" your support letter/email to the CHE Cafe at support@checafe.ucsd.edu

-30-

ADDITIONAL MATERIALS:

Petition and comments

 https://docs.google.com/document/d/1r1qlvkylW0OkcQHD3pI7TQn4xFUaPTmfqzSEUVjMCAs/edit

UPTE open letter to Chancellor

 https://docs.google.com/document/d/1tL0ZkAqVjUFvaVVWmGUC5uipA_1it8MMd4RdIJKve2s/edit

Save the Che Cafe! Letter of solidarity from Zack de la Rocha

http://la.indymedia.org/news/2014/06/264713.php

Want a souvenir DVD of your colonoscopy? So did I.

 Update June 13, 2014 : If UCSD were telling the truth about not having enough room on its hard disk to save digital colonoscopies, then it would have all the more reason to provide DVDs of the procedure.  UCSD wouldn't allow me to pay extra to get my colonoscopy saved.  

When I got my colonoscopy yesterday (at somewhere other than UCSD), the doctor showed me the small device for recording DVDs that attaches to the colonoscopy machine.  

"How much did that cost?"  I asked.

"Two hundred dollars," he said.  "But you can get it for $150 on E-bay."

Ahem, UCSD?  Do you want to stick to your story that prohibitive cost is the reason you (allegedly) don't save digital colonoscopies?


See all posts re UCSD.

I was scheduled for a routine colonoscopy at UCSD last month.  Nothing controversial about that, right? 

I had had a bizarre experience at Kaiser three years ago when I paid Kaiser $10 for a DVD of the digital video of my VUCG (or "VCUG").  Then suddenly the radiology imaging department claimed that there were no digital images of the procedure--even though the X-rays were done at the brand new Garfield Specialty Center advertised as having all-digital X-rays.  Kaiser said that it only had a few odd thermal paper images of the June 15, 2011 procedure.

So naturally I wanted to make sure that the same thing wouldn't happen at UCSD.  A couple of days before my colonoscopy I called to make sure that I would be able to get a DVD of the procedure.

UCSD's gastroenterology department told me that they don't save any of the digital data generated during colonoscopies.

This is what UCSD claims:

1. The patient can't get a second opinion from any doctor who wasn't watching the computer monitor during the procedure.

2. UCSD is very vulnerable to lawsuits; it can't prove that it wasn't negligent if the patient develops colon cancer that was missed.

3. UCSD can't learn from its mistakes.  It can't go back and see what it was they missed so they can do a better job in the future.

4. A few seconds after the patient leaves, the doctor (and patient) are out of luck if the doctor suddenly thinks, "Hey, what was that I was looking at?  Maybe that was something important.  I'd like to see that again."  Nope.  No chance.   According to UCSD, the images have been flushed from its computers.

5.  UCSD says they don't save the images because it takes up too much space on the hard drive.

Yeah, right.  Digital memory is getting cheaper by the month, so why would UCSD have suddenly stopped saving digital data recently?  They used to give patients DVDs, and before that they gave VHS tapes of colonoscopies.  Those tapes were a lot more expensive and bulky than digital memory.

I asked if I could pay extra to get my procedure saved, but they said NO.  The procedure costs $1300 minimum.  You'd think that would cover a bit of space on the hard drive, wouldn't you?  Well, of course it does.  They just don't want patients to see the images.

These days many doctors in the US are so dead set against patients seeing the images that they sedate everybody, even people who've had colonoscopies before without sedation and didn't have any problem.  They'd rather take the risk of a bad reaction to drugs than to let patients see the video.  I watched doctors on You Tube showing the whole process, and the first thing they asked patients when they woke up was, "Do you remember anything?"  The patients all said NO. 

When I suggested that I didn't believe that UCSD flushed the digital data, UCSD suggested that I go somewhere else if I wanted a DVD.

So I found a doctor who would give me a DVD of my colonoscopy.

The new doctor wants me to get some lab work done, so I went to UCSD today to get blood drawn.

The nurse who drew my blood was very sweet, but it quickly became clear that she had been tasked with finding out who had agreed to give me a DVD of a colonoscopy.  Why would UCSD want to know that?

"Where are you going for your colonoscopy?" she asked.

I didn't want UCSD calling up the doctor and demanding that he not give me a DVD.

"I don't think I should say, since UCSD doesn't approve of patients getting DVDs," I told her.

"Oh, no," she said.  "It's not that.  It's just that we don't do DVDs."

Fine, I thought.  So we're all happy and relaxed about this situation.  I sat back in my chair and the nurse put a pillow on my lap.

"So are you getting it done at a hospital?" she asked.  It seemed that my nurse was not so happy and relaxed about the situation after all.

I didn't want to say YES and I didn't want to say NO.   I didn't want to tell the truth or tell a lie.  So I didn't say anything.  

I was afraid she'd be mad at me and poke me painfully with the needle, but she was very careful. I only felt a tiny pinch.  And then we said friendly good byes.

Message to UCSD: she tried.  She really did try.  But I had planned ahead of time that I wouldn't spill the beans.  So don't blame the very sweet girl who couldn't get the information out of me.

Want a souvenir DVD of your colonoscopy? So did I.

See all posts re UCSD.

I was scheduled for a routine colonoscopy at UCSD last month.  Nothing controversial about that, right? 

I had had a bizarre experience at Kaiser three years ago when I paid Kaiser $10 for a DVD of the digital video of my VUCG (or "VCUG").  Then suddenly the radiology imaging department claimed that there were no digital images of the procedure--even though the X-rays were done at the brand new Garfield Specialty Center advertised as having all-digital X-rays.  Kaiser said that it only had a few odd thermal paper images of the June 15, 2011 procedure.

So naturally I wanted to make sure that the same thing wouldn't happen at UCSD.  A couple of days before my colonoscopy I called to make sure that I would be able to get a DVD of the procedure.

UCSD's gastroenterology department told me that they don't save any of the digital data generated during colonoscopies.

This is what UCSD claims:

1. The patient can't get a second opinion from any doctor who wasn't watching the computer monitor during the procedure.

2. UCSD is very vulnerable to lawsuits; it can't prove that it wasn't negligent if the patient develops colon cancer that was missed.

3. UCSD can't learn from its mistakes.  It can't go back and see what it was they missed so they can do a better job in the future.

4. A few seconds after the patient leaves, the doctor (and patient) are out of luck if the doctor suddenly thinks, "Hey, what was that I was looking at?  Maybe that was something important.  I'd like to see that again."  Nope.  No chance.   According to UCSD, the images have been flushed from its computers.

5.  UCSD says they don't save the images because it takes up too much space on the hard drive.

Yeah, right.  Digital memory is getting cheaper by the month, so why would UCSD have suddenly stopped saving digital data recently?  They used to give patients DVDs, and before that they gave VHS tapes of colonoscopies.  Those tapes were a lot more expensive and bulky than digital memory.

I asked if I could pay extra to get my procedure saved, but they said NO.  The procedure costs $1300 minimum.  You'd think that would cover a bit of space on the hard drive, wouldn't you?  Well, of course it does.  They just don't want patients to see the images.

These days many doctors in the US are so dead set against patients seeing the images that they sedate everybody, even people who've had colonoscopies before without sedation and didn't have any problem.  They'd rather take the risk of a bad reaction to drugs than to let patients see the video.  I watched doctors on You Tube showing the whole process, and the first thing they asked patients when they woke up was, "Do you remember anything?"  The patients all said NO. 

When I suggested that I didn't believe that UCSD flushed the digital data, UCSD suggested that I go somewhere else if I wanted a DVD.

So I found a doctor who would give me a DVD of my colonoscopy...

This story has been moved to HERE.

UCSD gives consent for sharing medical records without patient approval

I got an interesting letter from UCSD three days ago. It told me that I had consented to share my electronic medical records.

The trouble is--I had NOT given my consent. I never signed a consent form. I never clicked a box on the Internet agreeing to share my records.

And the letter from UCSD did NOT arrive in my home mailbox or even in my email. It was purely by chance that I found it on MyUCSDChart—NOT among the MyChart emails. If it had been among the MyChart emails, I would have received an alert about it in my regular email.

UCSD was definitely NOT trying to make sure that I found out about my “consent”.

Today, each time I have clicked on the link about sharing electronic medical records on MyUCSDChart, I found myself unceremoniously thrown back to the sign-in page. Automatically signed out. They really don't like it when I click on the link!

UCSD seems to be remarkably fond of both signing me in and signing me out--without my involvement--whenever it feels like it.

I found this page on the UCSD site about sharing electronic records. It seems that I am now part of two databases: The San Diego Beacon Health Information Exchange, and something called Care Everywhere.

It's not that I want to keep my records secret. In fact, I think sharing electronic records is basically a good idea. It's just that I've had problems with health providers hiding my own test results from me, so I'm sensitive about doctors violating the law regarding medical records.

Apparently the VA is also part of this system, but the VA has a more transparent consent process.

I've heard of falsified medical records, but this is the first time I heard of a falsified consent for release of medical records.



I found some interesting stuff about UCSD's informed consent process for patients in research projects:

iDASH Integrating Data for Analysis, Anonymization and SHaring

Informed Consent

Paper Consent versus Electronic Consent

Traditionally, paper-based consent has been the medium through which researchers and physicians conducted the informed consent process. The paper-based process consists of giving a hard copy consent form to a patient for him or her to review. Then a care provider answers any questions from the patient and in some cases assists the patient in reviewing the paper consent forms. The issues surrounding this procedure are that the paper-based consent form tends to be long and monotonous, and the retrieval of paper forms are often time consuming.

The new electronic consent forms use tablets or computers as the medium for communicating information and seeking consent from the patient...The iDASH team is also currently working on two systems, iCONS and iCONCUR, which are intended for such open source use in the future.

iDASH electronic informed consent management system

iCONS is a system currently being tested in a clinical trials environment at Moores Cancer Center Biorepository. The system supports informed consent electronically by enhancing the consent process for patients and researchers by acting as a consent broker and by adding multimedia aspects to the process. This consent process is opt-in, meaning no patient information is shared with researchers until the patient specifies what specific information he or she would like to share with researchers. The iCONS system creates a permission ontology to model the consent choices of the patient to assist in the process of releasing data and specimens to researchers for their consented uses.

iCONCUR is a pilot study within the University of California - San Diego Health System. This system transforms the sharing of electronic records from the opt-out system that is currently in place, meaning a patient’s record is automatically entered into the system unless the patient specifically requests to have their records taken out, to an opt-in system. The tool presents the patient with a taxonomy of his or her medical record allowing the patient to dictate what parts of the medical record to share and with whom it may be shared with.

HOSPITAL FAXED MEDICAL RECORDS TO PATIENT'S WORKPLACE

Tufts Medical Center sued for faxing patient records without consent
July 15, 2011
By Karen Cheung-Larivee
FierceHealthcare

Tufts Medical Center in Boston faces a lawsuit after a patient said the hospital faxed her medical records to her workplace without her consent, causing her embarrassment, reports The Boston Globe yesterday.

"I feel like I might have walked in (the office) naked," said patient Kimberly White.

White requested Tufts to send a form for a disability claim, but instead the hospital allegedly sent four pages of medical records about her hysterectomy to a shared fax machine at her workplace.

White filed a complaint in Plymouth County Superior Court. The hospital denies any wrongdoing, according to the article.

Tufts spokeswoman Julie Jette said, "In this matter, we complied with a patient's request to share information. We firmly believe we responded to the patient's request appropriately."

"I can't go back there," White said. "I am so embarrassed. ... I couldn't live with knowing what these people knew about me."

Earlier this year, another Boston hospital, Massachusetts General Hospital, faced accusations that an employee lost records of 192 patients on the subway. The hospital in February settled the federal case for $1 million, according to the article.

UCLA HIPAA VIOLATIONS

UCLA Health System pays $865G to settle HIPAA violation charges
July 8, 2011
FierceHealthIT
By Ken Terry

UCLA Health System has agreed to pay a fine of $865,000 and to develop a correction action plan to settle potential HIPAA privacy violations involving improper disclosures of medical records at its three hospitals, the federal Office of Civil Rights (OCR) reports.

OCR launched the investigation in 2009, following complaints by two unnamed celebrities that their medical records had been compromised. The government probe revealed that from 2005 to 2008, "unauthorized employees repeatedly looked at the electronic protected health information of numerous other UCLAHS patients," according to an OCR press release.

The Los Angeles Times reports that violations allegedly occurred at all three UCLAHS hospitals: Ronald Reagan UCLA Medical Center, Santa Monica UCLA Medical Center, and Orthopaedic Hospital and Resnick Neuropsychiatric Hospital, which are regarded as a single unit.

The hospital had disclosed in April 2008 that it had discovered that several employees had snooped into the patient records of dozens of celebrities, including Britney Spears, Tom Cruise and Maria Shriver.

When the alleged violations came to light in 2008, the California legislature passed a law that imposed escalating fines on hospitals for patient privacy breaches. The state fined UCLAHS $95,000 in 2009, reportedly in connection with the medical records of the late Michael Jackson.

The UCLAHS settlement with OCR is much smaller than previous HIPAA settlements, including those involving CVS Caremark ($2.25 million) and Rite Aid ($1 million).

As part of its settlement, UCLAHS agreed to institute new security and privacy policies, improve employee training, take action against employees who violate privacy rules, and designate an independent monitor to oversee compliance.

In a statement, UCLAHS said, "The UCLA Health System considers patient confidentiality a critical part of our mission of patient care, teaching and research. Over the past three years, we have worked diligently to strengthen our staff training, implement enhanced data security systems and increase our auditing capabilities."


MEDICAL ETHICS--RESEARCH ON MEDICAL RECORDS WITHOUT INFORMED CONSENT

J Law Med Ethics. 2008 Fall;36(3):560-6. doi: 10.1111/j.1748-720X.2008.304.x.
Research on medical records without informed consent.
Miller FG.

Observational research involving access to personally identifiable data in medical records has often been conducted without informed consent, owing to practical barriers to soliciting consent and concerns about selection bias. Nevertheless, medical records research without informed consent appears to conflict with basic ethical norms relating to clinical research and personal privacy. This article analyzes the scope of these norms and provides an ethical justification for research using personally identifiable medical information without consent.

PMID: 18840249 [PubMed - indexed for MEDLINE]

UCSD Medical Center says doctor who concealed six-figure pay from medical device company and used that company's products on his patient did nothing wrong; UCSD paid $1.75 million settlement

Dr. William Taylor, UCSD, implanted screws from a company that paid him a six-figure income and in which he owned hundreds of thousands of dollars in stock options

I don't believe that Dr. Taylor intentionally made this woman suffer. I think he was simply blinded by his financial interest. He couldn't believe the screws he had implanted (and heavily invested in) could be causing harm. He had hundreds of thousands of reasons not to believe it.

This does not explain, however, why Dr. Taylor kept his financial interests secret. I'll take a stab at explaining that. Perhaps he had confidence in his own ability not to be influenced by his large income from the medical device company and by the possibility that his investment in the company would pay off grandly if the screws proved to be successful in treating patients. He kept his financial dealings with the company secret because he didn't trust others to have confidence in him.

And why doesn't UCSD crack down on its doctors who violate law and university policy in this manner? Perhaps because the doctors who are tasked with enforcing the rules are getting just as much money from outside companies as Dr. Anderson is.

Dr. William Taylor got his medical degree from UCLA, whose medical school seems have particular problems with conflicts of interest.

"It took longer to uncover some critical details that Dr. William Taylor, the surgeon, had not told the retired special education teacher or the university: He owned stock options worth hundreds of thousands of dollars in the company selling the spinal devices and had also collected six-figure annual fees from the same firm, the lawsuit said. Disclosure of such corporate payments is required by state law and university policy.

"A lawyer for UCSD said Taylor did nothing wrong and denied that any patients were harmed. But the university last year paid Kitrosser $1.75 million to settle the case."

UC system struggles with professors' outside earnings
Failing to report compensation from other sources leads to concerns about conflicts.
BY MELODY PETERSEN
OC Register
May 25, 2014

Doctors eventually solved the mystery of why Brenda Kitrosser suffered from unrelenting pain after her back surgery at a University of California hospital in San Diego.

A UCSD surgeon had implanted experimental screws and other hardware into her back, promising this would relieve her pain. Instead the devices pressed on her nerves endlessly, according to a lawsuit she filed later.

It took longer to uncover some critical details that Dr. William Taylor, the surgeon, had not told the retired special education teacher or the university: He owned stock options worth hundreds of thousands of dollars in the company selling the spinal devices and had also collected six-figure annual fees from the same firm, the lawsuit said. Disclosure of such corporate payments is required by state law and university policy.

A lawyer for UCSD said Taylor did nothing wrong and denied that any patients were harmed. But the university last year paid Kitrosser $1.75 million to settle the case.

The controversy over Taylor’s undisclosed compensation is not an isolated case. The University of California has repeatedly failed to discipline medical professors who did not disclose payments from drugmakers and medical companies.

Last month, after UCLA paid $10 million to settle a lawsuit that centered on undisclosed corporate compensation, the non-profit group Consumer Watchdog called on state Attorney General Kamala Harris to investigate how widespread the unreported payments have become.

In a letter to Harris, the Santa Monica-based consumer group said that evidence presented in the case had shown that the university’s policies were “either inadequate or unenforced.”

“Patients in UC hospitals deserve the most reliable surgical devices and medication,” the group wrote, “and they shouldn’t be treated as subjects in expensive experiments.”

Officials at UCLA and UCI said they have recently increased efforts to make sure professors comply with the rules. UCLA doubled its compliance staff and hired a chief compliance officer. UCI’s chancellor directed all medical faculty to certify they were in compliance with reporting requirements and not engaging in unauthorized outside activities.

Those changes came after a series of undisclosed compensation cases involving professors from across the UC system. In each case, the professors who received the payments were involved in promoting or encouraging the use of a company’s product at the same time they were treating patients. In all the cases except one, it was people from outside the university who discovered the undisclosed payments.

• In a Los Angeles courtroom last month, Dr. Robert Pedowitz, the former chair of UCLA’s orthopedic surgery department, testified that administrators retaliated against him after he tried to get surgeons to report their corporate payments – including one doctor who said he had received $250,000 from a device maker for just 20 days of work. Just before closing arguments, UCLA agreed to pay Pedowitz $10 million to settle the case. The university said administrators did nothing wrong.


Dr. Thomas Ahlering
FILE PHOTO: MARK RIGHTMIRE, ORANGE COUNTY REGISTER

• At UC Irvine, Dr. Thomas Ahlering received more than $100,000 since 2002 from a company selling a surgical robot, but put most of that money in his nonprofit foundation without disclosing it, the Register reported last year. University officials say they have since required Ahlering to turn over $4,000 of that money to the school.

• An investigation by U.S. Sen. Charles Grassley in 2009 found that UCLA spinal surgeon Dr. Jeffrey Wang had failed to report almost a half million dollars in compensation he had received from several companies. UCLA officials say Wang was required to turn over an undisclosed portion of that to the university.

Although some of the professors were required to return a portion of their undisclosed pay to the university, it’s not clear whether the universities disciplined them in any other way.

In Oakland, UC administrators said they have an obligation to encourage faculty to work with companies to develop new medicines and medical devices that can help the public. And they pointed to the policies that the university has long had in place to require faculty to disclose payments.

“We also recognize that more can be done to increase transparency and oversight,” said Steve Montiel, a spokesperson at UC’s Office of the President, “and we are reviewing our policies to determine how best to achieve these goals.”

* * *

Under state law, UC faculty who are leading research must disclose publicly any payments or gifts they receive from the companies or other parties involved in those studies. They must also disclose how much stock or stock options they hold in that company.

According to university policy, all faculty also must disclose on internal annual reports how much time they are spending on outside activities, as well as how much they were paid for that work...

Last year, a civil jury in San Diego Superior Court issued a verdict against NuVasive, finding that the company and UCSD’s Taylor had conspired to intentionally mislead patients considering spine surgery.

The jury ordered the company to pay $3.1 million to Kitrosser. A judge later ruled that the $1.75 million that UCSD had agreed to pay could offset the verdict against NuVasive. The company was also ordered to pay court costs. NuVasive has appealed the verdict.

Neither Taylor nor a NuVasive spokesperson responded to phone calls or emails seeking comment. Thomas Lotz, a lawyer who represents UCSD, said Taylor never got the chance to fully tell his story in court. Taylor has not exercised the stock options that were revealed by the lawsuits, he said.

UCSD settled the case, Lotz said, to avoid a lengthy legal fight.

Robert Vaage, Kitrosser’s lawyer, said he had repeatedly informed UCSD about Taylor’s failure to report the payments from NuVasive. “They haven’t punished him at all,” he said. “In fact, they’ve promoted him.”

Carr, the UCSD spokesperson, disputed that, but said she could not explain further because personnel matters must be kept private.

After the state Fair Political Practices Commission fined Taylor $12,000 in 2011 for failing to report his compensation from NuVasive as required by state law, UCSD officials called it “an administrative error.” They said then that they planned no further action against him, according to a report in The Guardian, the campus newspaper.

Dr. James Doty, a clinical professor at Stanford, testified that Kitrosser should not have had the surgery that Taylor performed in 2008 because she suffered from a high-degree of scoliosis, an abnormal curvature of the spine. Doty said that Taylor had an ethical duty to tell her about his financial relationship with NuVasive.

“It’s a big problem,” Vaage said of the large payments received by Taylor and other surgeons. “It’s something the public needs to know about.”...Read more HERE.


UCSD surgeon fined over research payments
By Tanya Sierra
SDUT
Jan. 19, 2011

A University of California San Diego neurosurgeon and professor has been fined $12,000 by the state’s Fair Political Practices Commission for failing to report his economic ties to a company that was funding his research project.

Dr. William Taylor, a specialist in minimally invasive spinal surgery at the UCSD Medical Center, did not disclose that medical device company NuVasive Inc. was providing funding for his research projects.

Taylor could not be reached for comment Wednesday. To the FPPC, he indicated he did not intend to keep information from the public and did not deliberately omit his income from NuVasive on his state- mandated statements of economic interest. He later took corrective action including discontinuing his participation in two projects.

Taylor was the principal investigator on four medical research projects that were being funded by NuVasive. In one case the company, based in Sorrento Valley, was providing $16,821 for Taylor’s project. Three other projects received an undisclosed amount.

Taylor taught workshops on behalf of the company and provided services as a consultant regarding product development.

He was quoted in The San Diego Union-Tribune last year as a specialist talking about the advantages of the NuVasive system.

Physician shortage and foreign-trained doctors are subject of talk

Physician shortage and foreign-trained doctors are subject of talk
La Mesa Courier
Apr 21, 2014

Challenges facing foreign-trained doctors eager to practice in California at a time when physician shortages are expected to get worse will be the topic of a forum sponsored by the Grossmont-Cuyamaca Community College District, the Grossmont College-based Welcome Back Center, and UC San Diego's School of Medicine on April 22 at UCSD.

The Association of American Medical Colleges has forecast a shortage of more than 91,500 doctors by 2020 and 130,600 by 2025, a shortage that could be exacerbated by the millions of Americans securing health insurance through the Affordable Care Act.

"Meanwhile, there are thousands of foreign-trained doctors that have scored well on U.S. medical exams but they cannot find residencies in the U.S., and there is little to no support for them to become doctors in this country," said Gail Patterson, program manager at the Welcome Back Center at Grossmont College, which was developed to aid internationally trained healthcare workers that have moved to California.

Speakers at the April 22 event include:

Dr. Wael Al-Delaimy, professor and division chief of Global Health at the UCSD Department of Preventative Medicine. Al-Delaimy practiced medicine in his native Iraq and then Jordan between 1991 and 1995 before finishing his Ph.D. from Otago University in New Zealand in 2000. He was a Research Fellow and Research associate at Harvard School of Public Health between 2000-2004, a scientist with the International Agency for Research on Cancer in 2003, and a faculty member at UCSD since 2004.

Dr. David E.J. Bazzo, a clinical professor in family and preventative medicine who has been named a Top Doctor in family medicine by the San Diego County Medical Society and San Diego Magazine every year since 2005.

Dr. Esmatullah Hatamy, assistant clinical professor of family and preventative medicine at the Global Health Initiative who graduated from Kabul Afghanistan Medical School in 1988 and has been a member of the Afghan Medical Association Board of Directors.

Dr. Dustin Lillie, a primary care physician who is an associate clinical professor of medicine at UCSD.

The April 22 forum is scheduled from 6 to 8 p.m. at the Medical Education and Telemedicine Building, Room 141, at 9500 Gilman Drive on the UC San Diego campus. Those attending can learn about what foreign-trained doctors need to do to secure residencies in the United States and discuss the general U.S. health care system's pending challenges.

UCSD Medical Center is interested in developing a program with the Welcome Back Center that would help foreign- trained doctors traverse the complex path of U.S. medical exams and residency applications that would increase their chances of getting a residency and becoming licensed to work in California.

The Welcome Back Center offers a wide range of services to immigrant healthcare workers who wish to obtain professional credentials. The Welcome Back Center is a division of the Health Workforce Initiative (HWI) program of the California Community Colleges. Ann Durham, based at Grossmont College, directs the HWI program in behalf of nine community colleges serving San Diego and Imperial counties.

Further information can be obtained by contacting Gail Patterson at (619) 644-7206 or administrative assistant Samantha Cardenas at (619) 644-7059.