UCSD’s docs present for your entire surgery?

UCSD’s simultaneous skin time

Are UCSD doctors violating university policy by conducting simultaneous operations in the institution’s array of surgical suites? “The Policy defines Overlapping Surgery as an ‘operation or procedure in which the actual operating time overlaps with the actual operating time of another operation or procedure performed by the same surgeon,’” says a newly-posted November 6, 2023 report by the university’s department of Audit & Management Advisory Services. “However, the key and critical components [of the operation] do not overlap.” If they do, it’s called concurrent surgery, a big-no, the document says. “Overlapping surgeries that are reasonably expected to be concurrent (where critical elements of the two cases will be occurring simultaneously) are expressly not allowed except in [emergency] situations.”

Says the report, “Based on our review, we noted instances where documentation of the requirements for transparency, identification of backup surgeon, or presence for key and critical portions [of a given operation] was not always present in the files reviewed, or did not always conform to the Policy.” A chart included in the audit report defines “Skin Time” as the period between the first incision and the complete closure of the surgical wound. 

The period of time in the operating room before Skin Time is called “Patient Prep Time” and, afterwards, “Clean Up Time,” per the report. Of 29 surgeries that were “judgmentally selected” by auditors from UCSD operating room records over the period from September 2022 through February 2023, “21 [or seventy-two percent] of these cases were actual overlapping cases based on Skin Time. We noted gaps in documentation for the required elements for overlapping cases.”

The auditors went on to say, “We evaluated our sample of 29 cases based on surgeon in and out of room times to verify when the primary attending surgeon left the OR to perform another surgery and whether the surgeon engaged in another billable event. We noted that, in some cases, the surgeon left the OR prior to the completion of incision closure, otherwise known as the procedure stop time. 

Perioperative Services explained that it is not unusual for surgeons to leave the OR when an incision closure begins as residents complete the incision closure process; however, it is expected that the primary surgeon remains in the vicinity to be immediately available, or that a backup surgeon has been designated to oversee the non-critical portion of the procedure.”

The report goes on to say that “perioperative Services is still in its early stage of monitoring compliance and has not included consideration of billing in their monitoring process.” In addition, “we also noted some areas where policy interpretation was inconsistent, including whether Skin Time is considered key and critical, which can impact the determination of whether a case is concurrent.”

Christopher Holden: from Sempra score to settling.

Sempra’s political charity

California Assembly Democrat Christopher Holden has agreed to pay an $18,000 penalty to the state’s Fair Political Practices Commission to settle a case involving “approximately 94 charitable payments (of $5000 or more) — totaling approximately $1,576,500 — made to the California Legislative Black Caucus Policy Institute,” per a stipulation agreement approved by commissioners on March 21. 

The list of big corporate donors to Holden’s cause included Sempra Energy and its subsidiary SoCal Gas, which each kicked in $7500 in November, 2017. Notes the document, “Payments made at the behest of elected officials — including charitable donations — are a means by which donors may seek to gain favor with elected officials.” Sempra is currently battling a citizens initiative drive to put the proposed public takeover of its San Diego Gas & Electric subsidiary on the ballot for voter approval.

In August, 2018, per a company news release, SDG&E hosted Holden and California state senator Pat Bates in its “state-of-the-art” Weather Center in Kearny Mesa. “Holden and Bates are both keen to learn about partnerships we’ve built with academia, fire agencies and others to create predictive computer programs that allow us to forecast the spread of fires and pre-stage resources accordingly,” the release said. 

The non-profit Black Caucus policy institute, ultimate beneficiary of Sempra’s contribution, “raises money to provide scholarships for high school students who need financial assistance to attend college,” per the document. “At the time, Holden served as Chair of the Legislative Black Caucus and as Chair of the Institute,” says the FPCC document. 

“The payments were made in 2017 and 2018 by more than six dozen donors to the Institute at Holden’s behest, in his capacity as Chair of the Institute. This case was opened after Holden filed the late reports on his own initiative, and after the late-filed Form 803 behested payment reports were provided to the Fair Political Practices Commission by the Assembly Rules Committee.”

Pat Bates: learning how Sempra plans to help fight fires.

Big money grudge

State Coastal Commissioner Dayna Bochco of Los Angeles came up with a $10,000 contribution to the gubernatorial campaign of state Senator Toni Atkins on March 29, a freshly filed disclosure report says. The wife of wealthy TV producer Steve Bochco once pulled aside Los Angeles Times writer Steve Lopez to lodge a complaint. “She was irked by a column of mine, and she told me so,” wrote Lopez in August 2016. “I’d written about a political fundraiser for the incoming state Assembly speaker, Anthony Rendon. 

It was hosted by, among others, Bochco and a hired gun who represents developers seeking commission approval for their projects. Other lobbyists/consultants were there, too, as were reps from companies with projects in play. Some of them wrote checks to the incoming speaker, who would have the authority to appoint new coastal commissioners. It was all way too cozy and an example of why we should all fear the clout and political connections of those who want to build on what’s left of the undeveloped coast.”

Not to worry, Bochco told Lopez, who wrote, “Bochco often commutes to commission meetings in her husband’s private jet, along with other LA-based commissioners. Some commissioners hold or aspire to public office, and the unpaid job is a great way to build connections with potential donors, deal-makers and others. 

"But Bochco isn’t running for anything, so far as I know, and I wondered why she took on a job that eats up a lot of time and brings no shortage of second-guessing.” Lopez reported that Bochco told him, “’I can’t defend any given behavior that may have crossed a line.’ But she stuck up for her colleagues. She conceded that some are more political than others, but added: ‘I don’t think any of us is in the sway of anybody.’”

— Matt Potter

(@sdmattpotter)

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