Soon after we started Health Care Renewal, we ran a series of posts about the University of California-Irvine (UCI) medical school and medical center, featuring stories of mismanagement of major programs, especially those involving organ transplantation (liver, kidney, and bone marrow) while the top executives who presided over the mess received generous compensation, sometimes in strikingly irregular ways, and while at least one whistle-blower alleged he lost his job for complaining about safety issues. Some of the stories went back another 10 years, to 1995. One particularly striking story involved the UCI infertility program. Three physicians were accused of stealing ova from some women to implant in others. One physician was convicted, and two fled the country (see post here).
One of those physicians just turned up. As reported by ABC News at the end of 2010:
The case had major repercussions for how fertility clinics operate:
Note that the disconnect between problematic quality of care at UCI and the generous compensation afforded its top leaders continued through 2010, as this post discussed.
Aside from its colorfulness, there are other reasons to recall the story of the stolen ova and the subsequent troubles at UCI. First, the list of problems over 15 years discussed in our series of posts suggests an institution whose leadership culture is seriously disturbed. I cannot view the institution from a distance and figure out what the fundamental problems are with its leadership and governance, but there must be some. (Note that per a 2006 post, an internal report did fault lack of accountability, leadership by people with no medical background, absence of clear reporting lines, and the overlooking of whistleblowers, but these are just descriptions of bad management and governance, not explanations of them. Furthermore, it is not clear whether there have been any fundamental changes in leadership or governance since then. If there readers know there is more to this, please let me know in the comments section below.)
Second, this case illustrates how the anechoic effect has decreased recognition that the problems at UCI may be part of more systemic problems. Despite the number of problems that occurred, their vividness, and their coverage in local media, the troubles at UCI have not gotten national media attention, nor as far as I can tell, have they ever been discussed in the medical, health care, health services research, or health policy literature. (I have tried multiple Google scholar searches using the institution's name, and keywords including "scandal," and the names of some of the physicians most prominently named in our series of posts, and have found nothing relevant.) The 15 year history has produced almost no echoes, and hence now has become as striking a black hole in the annals of bad health care leadership and governance as was the case of the fall of the Allegheny Health Education and Research Foundation (AHERF).
Certain issues that we discuss on Health Care Renewal have become less anechoic, in particular, conflicts of interest caused by academic physicians financial ties to the drug, biotechnology and device industries. However, the larger issues of mismanagement by lavishly compensated, and hence perversely incentivized executives remains relatively anechoic. I am not sure how big a scandal it will take to remove the taboo from discussing it.
One of those physicians just turned up. As reported by ABC News at the end of 2010:
U.S. authorities are working to extradite one of the doctors accused of being behind of the biggest fertility scandals in history. Mexican authorities arrested Dr. Ricardo Asch last month.
Back in the 1990s, Asch and another fertility doctor, Jose Balmaceda, were charged with stealing embryos and eggs belonging to dozens of women who sought treatment at the University of California-Irvine Center for Reproductive Health and implanting them into other women.
They are also accused of not reporting more than $1 million in earnings, and fleeing the country to avoid prosecution.
Marla McCutcheon is one of the women who says she was victimized by Asch. She was one of his patients until she decided to switch physicians because she said she found him 'uncaring.'
McCutcheon, from Irvine, Calif., says she found out years later that after she'd left Asch's care that there were leftover eggs she didn't know about. To this day, she doesn't know what happened to those eggs.
'I would have done anything for those eggs at that time. It's still hard for me to grasp that there might be something to my eggs. Someone may have been able to get pregnant from them,' McCutcheon said.
At the time of the scandal, ABC News saw documents showing that more than 60 other women who were patients at the fertility center had eggs taken from them without their consent. Asch, however, said he knew nothing about it. During the time the incidents occurred, it was not illegal to transfer human tissue without consent.
The case had major repercussions for how fertility clinics operate:
The scandal allegedly involving Asch, Balmaceda and another doctor, Sergio Stone, rocked the field of reproductive medicine, and doctors say they still feel its effects.
'Reproductive medicine is very new. It's come a long way and we've made tremendous progress, but because of scientific advances, it's very high-profile,' said Dr. Jani Jensen, a Mayo Clinic reproductive endocrinologist in Rochester, Minn. 'Whenever there are publicized incidents like this that involve ethical issues, it's sometimes difficult to engender the public's trust.'
Dr. Howard Zacur, director of the Division of Reproductive Endocrinology and Infertility at the Johns Hopkins Fertility Center in Baltimore, Md., said patients still want reassurance their eggs and embryos will be protected from these types of incidents.
It is now against the law in California to take eggs from a woman without her consent.
Note that the disconnect between problematic quality of care at UCI and the generous compensation afforded its top leaders continued through 2010, as this post discussed.
Aside from its colorfulness, there are other reasons to recall the story of the stolen ova and the subsequent troubles at UCI. First, the list of problems over 15 years discussed in our series of posts suggests an institution whose leadership culture is seriously disturbed. I cannot view the institution from a distance and figure out what the fundamental problems are with its leadership and governance, but there must be some. (Note that per a 2006 post, an internal report did fault lack of accountability, leadership by people with no medical background, absence of clear reporting lines, and the overlooking of whistleblowers, but these are just descriptions of bad management and governance, not explanations of them. Furthermore, it is not clear whether there have been any fundamental changes in leadership or governance since then. If there readers know there is more to this, please let me know in the comments section below.)
Second, this case illustrates how the anechoic effect has decreased recognition that the problems at UCI may be part of more systemic problems. Despite the number of problems that occurred, their vividness, and their coverage in local media, the troubles at UCI have not gotten national media attention, nor as far as I can tell, have they ever been discussed in the medical, health care, health services research, or health policy literature. (I have tried multiple Google scholar searches using the institution's name, and keywords including "scandal," and the names of some of the physicians most prominently named in our series of posts, and have found nothing relevant.) The 15 year history has produced almost no echoes, and hence now has become as striking a black hole in the annals of bad health care leadership and governance as was the case of the fall of the Allegheny Health Education and Research Foundation (AHERF).
Certain issues that we discuss on Health Care Renewal have become less anechoic, in particular, conflicts of interest caused by academic physicians financial ties to the drug, biotechnology and device industries. However, the larger issues of mismanagement by lavishly compensated, and hence perversely incentivized executives remains relatively anechoic. I am not sure how big a scandal it will take to remove the taboo from discussing it.
