School for Scandal

How does UCIs medical-school dean stay healthy?

In Doing Battle, acclaimed author and World War II veteran Paul Fussell noted that a basic infantry principle is to "never . . . silhouette oneself on a hilltop." Fussell was referring to actual life-or-death combat. The maxim could, however, easily apply to less dangerous forms of battle—like public relations.

On Sept. 30, Thomas C. Cesario, dean of UC Irvine's medical school, demonstrated an acute if tacit appreciation of Fussell's advice. In the wake of allegations that a university employee had illegally sold cadaver parts, Cesario did what he's done during each of the numerous ethics scandals that have plagued his school: appear sufficiently alarmed, promise corrective action, and neatly place blame elsewhere.

Miraculously, the dean has—at least so far—kept himself safely out of the line of fire.

According to Cesario and his boss, self-described "angry" Chancellor Ralph J. Cisterone, all will be well at the medical school after UCI implements new bureaucratic measures including the creation of an outside review panel, the appointment of a new associate dean for administration, and the launching of periodic unannounced program inspections. In a memorandum likely intended for public consumption, Cesario also promised to hold department heads responsible for improving administrative oversight to nix potential future scandals. "Management ability will be a key factor in the evaluation of their performance and in consideration of re-appointment," he wrote.

It is unknown how comfortable Cesario was issuing threats to his staff about management and oversight. (He didn't return calls seeking comment.) He came into office in February 1994 amid cheers for his alleged "excellent administrative skills." But the string of medical-school scandals since then—in fertility research, billing, cancer research, embezzlement, accreditation and the current cadaver nightmare—suggests that the dean's oversight skills are lacking.

Examples are plentiful. After the federal government ordered a 1996 audit to resolve suspected fraudulent medical-reimbursement claims filed by the university, Cesario said weakly, "I don't know what they're going to find." Two years later, he maintained that problems at the school's embattled neurosurgery training program—which suffered through seven chairpersons in seven years—were "easily soluble." Just five months before mismanagement shut down the same program, Cesario told reporters, "I really have a lot of confidence in the place. It's going in the right direction." He allowed an investigation into the highly questionable ethical practices of one professor, Dr. John Hiserodt, to be conducted by Hiserodt's business partners. He once callously referred to the stolen-embryos affair—one of the worst ethics scandals ever to taint an American university—as "just a fly in the ointment." In 1996, the dean supplied the target of a criminal probe with the secret identity of the whistle blower in the case; Cesario claimed he was unaware that the university had agreed to protect the source, but a state senator described Cesario's action as unconscionable.

Memories are apparently short, and the dean is nothing if not a local media darling. He is also a favorite of Orange County's corporate elite, who routinely tap into tens of millions of dollars in annual federal research grants that go to UCI's medical school. The school's latest moves gained a round of desperately needed positive PR and prompted the Times Orange County to publish the following front-page headline: "UCI Tightens Loose Reins on Medical School." (In the story, Cesario was portrayed as an aggressive reformer committed to, in the dean's own words, "the public trust.")

But what to make of university officials who have spent years blaming everything from "bad luck" to lawsuit-happy patients to rogue professors and are only now—six years into a spate of internationally renowned ethics scandals—beginning to acknowledge deep institutional problems? How much responsibility should Cesario, as the man running the beleaguered medical school on a day-to-day basis, shoulder?

Gene Ioli, a former UCI cancer researcher and corruption whistle blower who is suing the university for alleged retaliation, is among those who say they believe Cesario has fostered an environment in which ethical concerns have been secondary to the university's medical center and school profits.

"I find it odd and sad that those leaders who have held and who still hold high positions in the medical school do not show how important basic ethical values are," said Ioli. "This is why the trouble continues to this day, and it has given Irvine a bad name, a tainted name. . . . Ultimately, Cesario is responsible for this. I wouldn't be surprised if he goes down in the next couple of months. How much more can the School of Medicine take?"

Cesario does have vocal supporters, but a longtime medical-school doctor and professor who spoke on condition of anonymity (fear of on-the-job retaliation is a real concern on campus) agreed with Ioli. The doctor praised the dean as "charming" but said, "There are feelings here that he should step down. He hasn't lived up to expectations."

Cesario publicly announced his own expectations when he became dean five years ago. "What we're talking about is enhancing our position among American medical schools," he said. "I think we can grow academically and in prestige." Wide-eyed university officials gave the dean his marching orders: dramatically raise UCI's research reputation. Research, of course, attracts tens of millions of dollars annually in federal grant money and allows the school to form lucrative, profit-based partnerships with venture capitalists. At the time, then-executive vice chancellor Sidney Golub said of Cesario, "There is no way that he couldn't succeed." It's safe to say something terrible went wrong from the beginning.

"The prevailing attitude has been, 'How much can we get away with?' not, 'How can we do ethical research?'" said Ioli. "It's not really about the research or patient safety anymore. It's about the money. They're looking more for profits at the school. I believe they think they can get away with this."

Although he has presided over the worst public showing of any medical school in the country during the 1990s, Cesario poses as dumbfounded. The man who authoritatively gave a 1993 speech at the Disneyland Hotel titled "The Crisis in Clinical Academic Medicine" now says he wants an oversight panel to tell him if there are any "impediments" at UCI's medical school.

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