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The Sad Tale of the USC Medical School Dean

It is unfortunate, that situation at USC Medical School, where the dean, Dr. Carmen A. Puliafito had been found in a Pasadena hotel room with a 21 year old woman in “provocative clothing” who overdosed on drugs. That happened in March 2016.

Allegations, pictures and even videos of Puliafito in the company of criminals and drug addicts had been popping up since 2015. There are many pictures of him enjoying recreational medicines. He was using methamphetamine and other drugs while serving as dean of the Keck School of Medicine. While there is nothing wrong with “partying”, the use of drugs and paying for prostitutes may be crossing the line.

It is sad, when a leader abuses his or her power and commits such errors in judgement. Why does this happen? Are they so high above the ordinary workers, do they make so much money that they feel infused with invincibility, are they beyond reproach, why do they suffer such ethical lapses?

Despite the vetting we mortal doctors go through to get privileges at a healthcare or teaching facility, why did USC not detect Puliafito’s ethical deficiencies? Too often, I hear that the institution reveres a candidate and after all, this one had a Wharton MBA. Institutions hate to insult candidates with pointed inquiries. Sometimes the little discovered nuggets of deficiency are considered just minor ethical oversights….we are all human.

So, this nonsense has been going on under USC’s nose for two years. I heard astonishingly, that USC is finally making plans to fire Puliafito. What? Another two year process?

If I was graduating from the USC Medical School, I am certain that Dean Puliafito will not be handing me my degree.

But he could be a hell of a party host that evening

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More Stupid Hospital Documentation Rules

Today I was notified by Medical Records at my hospital that one of my OR/surgery reports was incomplete. I had done hemorrhoid surgery on a patient 6 weeks ago. Someone in the medical records department flagged a deficiency in my OR note. I had left out the “drain” section – whether a drain was used or not. For my lay readers, you need to know that while drains can be used in abdominal surgery, I have never used one for hemorrhoid surgery in 27 years. In fact I can’t think of any colorectal surgeon ever using a drain for hemorrhoidectomy. In any case I was in violation as the hospital Medical Record Procedure Committee stated that Drain recording is a requirement and has to be addressed in the Operative report. I was directed to Rules and Regulations page 14. Was the documentation of drains a ‘requirement’ of the committee because of government regulatory agency rules or did the committee feel that drains should be used in hemorrhoidectomy? I doubt anyone sitting on this committee knows anything about anal surgery, so it’s likely a misinterpretation or misapplication of a badly written regulation. If this documentation of drains is required, then this should be mentioned in all surgery despite clinical relevance or common sense. Taking this to a ridiculous end in my hospital, drain use should be documented for anal fissure surgery, removal of rectal foreign body and colonoscopy performed in the OR in spite of logic that drains are never used in these procedures. It is thoughtless mindless enforcement of such ‘rules’ and regulations which lead to more and more doctors leaving medicine in frustration.

Patient Safety vs Just Culture

In a survey by the Agency for Healthcare Research and Quality’s (AHRQ) survey of hospital culture, some revelations came to light. It was disturbing that 26% of health care workers say whenever pressure builds up, managers want them to work faster, even if it means taking shortcuts. Fifty percent said they work in a “crisis mode”, trying to do too much too quickly and disturbingly, 36% report that safety is sacrificed to get more work done. Safety does not seem to be the priority when managers/administrators exhort workers to do more and overlook repetitive safety problems.

This is probably the tip of the iceberg. Each hospital is already under financial stress. They are placing higher unattainable financial targets in order to clear their overhead expense and try to break even what with the government cutbacks, increasing expense of business, etc.

It is hoped that with evolution in healthcare funding, there will be less emphasis on volume and more on good outcomes and results from the care delivered.

Complications can occur when a patient receives care. In fact, some patients develop a complication such as a wound infection after surgery. When that happens I don’t feel it is due to a mistake or error but many hospitals approach this in a punitive way. An email/letter is sent to the doctor but to get the point across it is also sent to the Department Head, Chairman of Surgery, and various administrators, so the complication is for all to view. All this does is make doctors reluctant to report errors.

Dr. Lucien Leape from Harvard in testimony to congress said, “the single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes.”

Only by developing a “Just Culture” and transparency like the airline industry where errors are reported without punishment will lead to improvement in healthcare safety. Continuing to push providers and punish the bad outcomes will leave healthcare mired in the last century.