Friday, September 26, 2008

UC Irvine in Trouble for Falsifying Patient Records

UC Irvine (UCI) Medical Center is being placed under the oversight of the State Department of Public Health because federal inspectors found that doctors were filling out medical records in advance and even putting patient's outcomes in the record before the procedures were done.

A whistle blower complaint preceded an investigation and a 30-page inspection report that listed problems dating back at least three years. They included substandard equipment checks, inadequate record keeping and falsified records by doctors. Anesthesiologists were found to fill out operative reports a day before the surgery was even done.

The Department of Anesthesiology had problems dating back to 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." Many of the doctors resigned over the next few years.

After a lengthy search, UCI hired Dr. Zeev Kain, executive vice chairman of anesthesiology at Yale, as chairman of the renamed department of anesthesiology and perioperative care. He began on March 1 and hired six new faculty members and installed a new electronic monitoring system that eliminates the opportunity to fill out records in advance.

Kain said he was brought in to "clean things up" and all staff members have now signed a zero tolerance policy for falsifying records. (amazing that it should even need to be addressed in a signed policy)

It would seem that something is seriously wrong at UCI. They have been involved in a number of large scandals over the last 13 years. They had to shut down their transplant program when Medicare funding was withdrawn after 32 people died awaiting livers in 2004-05. Their doctors turned down organs that were successfully transplanted elsewhere.

They came under fire when the director of the University's Willed Body Program sold parts of cadavers and did unauthorized autopsies.

In 1995 the fertility doctors were accused of stealing patient's eggs and embryos and implanting them in other patients without permission. That program was also shut down.

One of the leaders in the Cardiology Department was found to have no California license and no cardiology credentials. He resigned.

Usually, repeated high-profile scandals such as these indicate serious problems with ethical culture and it starts at the top. There seem to be endemic management problems and too many examples of poor ethical decision making. I am certain there are hundreds of dedicated, well intentioned clinicians at UCI who provide excellent patient care. But I would challenge the Board and Medical Executive Committee to do a thorough house-cleaning and shine the light on management to start a culture change of ethical and open behavior.


Anonymous said...

You summarized an eye-opening problem at an academic institution. You are so correct, Dr. Brayer, about the need to clean house and bring ethics back to UCI

Anonymous said...

So... you're an internist, right? Tell me, have you never, even once, had a resident or intern fill out discharge paperwork in advance, so that they wouldn't get paged out of rounds for incomplete paperwork when the patient actually goes home at 10 am? That's exactly the same thing, isn't it? I don't work at UCI, but I bet that a lot of the motivation for doing the paperwork in advance is quick turnover - having the normal stuff boilerplated in makes it easy if the case goes well, and then you only have to document by exception. If the case doesn't go well, you pull out new forms and start fresh. (For internists, if the patient doesn't get discharged, you tear up the pre-filled discharge sheet, but if all the discharge patients have to wait for the intern to get out of rounds, then no one's going home until midnight, so the intern 'fraudulently' fills out the discharge forms in advance.) Let's keep some perspective on why people do this, and then we can solve the problems.

I think that the big error comes not with filling stuff out in advance, but signing it ahead. Having normal paperwork ready to go for a case that goes as expected is just efficient, and serves patients better because you can focus on the stuff that is individual for them, not on charting the stuff that is the same in every routine case.

Anonymous said...

why am I not surprised??

ERMurse said...

There is a big difference between a resonable practice of filling out Discharge Orders in anticipation of an AM Discharge and describing events in a surgery that havent happened yet. A simple Discharge in AM if patient meets criteria x.y.and z followed by the orders covers pre-written discharge orders but how do you describe a procedure and say you did x and y ahead of time. In ED Nursing some Nurses write their discharge note and patient condition at discharge prior (some even fudge in vital signs) to performing it. An equally troubling practice.

Anonymous said...

i was injured in the ER from being a pain injection then told to go and get a urine sample. i fell fromd dizziness hurt left side the doctor came hollowing after they had put me in the bed saying i was going home now without a exam i could not walk he jerked me out of the bed off that hard board i could not move my legs so he had others in the room put me back. i as for a super she came fix me in bed right left came back and side i was being admitted. never seen the doctor again. getting around in a wheel chair heving therphy then move to a nursing home for therphy to walk again. they bill medicare for the bill not saying anything about my fall where this came from. the records had all kinds of lies reported. what can be done about this to stop this waste of tax payers money. i know this is not the first time they have done this. went again to the ER they refuse to treat me. i was sent home in pain. i had been going to that hospital bfore and never was denied treatment until know. can this be done to a person.

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