The UCSF-Kessler Saga and the Press

By  |  December 18, 2007 | 

I’ve not been posting regularly on this story (as you might imagine, it’s a bit tricky for me to do so), but for those following it from near and far (I’ve received emails from friends in Europe and Asia) there have been a number of interesting articles, including pieces in the LA Times, Washington Post, and SF Chronicle [some may require subscriptions]. The latter generated about 70 comments, from every corner of the ideological map.

What is striking to this observer – who still lacks any inside information about what really happened (damn!) – is the asymmetrical warfare being waged in the media. Former Dean Kessler, who is an attorney as well as a physician, knows everybody in the press from his FDA years, loves taking on big institutions (ask Big Tobacco if you doubt this), and has a – how do I say this charitably – rather unusual personal style, is able to speak freely to the media, creating a patina of glowing coverage that makes him look like a cross between Don Quixote and Ralph Nader. For example, the LA Times piece leads with a flattering picture of Kessler, looking appropriately troubled; the caption reads: “I couldn’t resign quietly,” Kessler said in an interview with The Times. “I wasn’t going to do that.” And the Washington Post piece includes this Kessler quote:

“I tried to solve the problems, because this money was not being used for the medical center, for program development, recruitment, medical education,” he said. “There are costs in life when you try to do the right thing.”

Meanwhile, Chancellor Mike Bishop, by all accounts (and my experience) a solid man of integrity, and the University are prevented by the rules of the legal game from saying much of anything. (The University released this statement yesterday; it isn’t exactly a spirited defense of the Mother Land.)

I don’t want to prejudge and it certainly wouldn’t shock me if the University had promised resources that dematerialized when Kessler arrived from Yale (this happens in recruits everywhere – to the point that it is a running joke in academic circles). But what’s playing out in the papers seems a bit unfair: the press coverage would lead one to believe that there is only one side to this story – heroic gadfly takes on deceptive, secretive bureaucracy – and I’m reasonably certain that there are two… or perhaps even only one that we’re not hearing.


  1. elliott gorelick December 18, 2007 at 6:50 pm - Reply

    All of the below is speculation with no inside knowledge and no connection to reality.

    Isn’t the most likely case that the University lied/misrepresented the discretionary funds available to the Dean’s office when Kessler was recruited. Kessler has been “using” those funds that he believed were promised. Because UCSF lacks rudimentary accounting controls and allows accounts to build up deficits as long as the right approvals for expenditures are given, the Dean’s account ended up in greater and greater deficit. While the first audit prompted by the anonymous accusations against Kessler showed nothing wrong, it probably showed some waste and probably some ill-advised lavishness when austerity was more appropriate IF funds were tight. Prior to June, the chancellor wanted to work out a resolution that addresses the Dean’s office deficit of tens of millions of dollars. This resolution involves austerity measures and controls that chafed Kessler. He balks and the chancellor asks for his resignation. This decision is easy because the top staff in the medical school does not work well with Kessler and Kessler has been openly critical of what he perceives as incompetence and corruption in the UC system in general and at UCSF in particular. The iron fist inside the velvet glove of asking for the resignation is Kessler’s “financial mismanagement” which has left the particular account in huge deficit (although not the medical school as a whole). Kessler, sees such statements as libel/slander and Bishop as a toady of a corrupt and incompetent UC’s President office along with a complacent medical school senior staff; he will not go quietly. Thus we have this dust up. No vigorous defense of UCSF is likely possible because it involves the underlying misrepresentation, the not quite accurate charge of “financial mismanagement” (which if publicized would probably cause a libel/slander suit), and the undeniable fact of corruption and incompetence within the UC system.

    All of the above is total speculation with no inside knowledge and no connection to reality.

  2. Bob Wachter February 7, 2008 at 5:55 pm - Reply

    For those of you following this story, a couple of recent articles of interest — one from the SF Chronicle and the other from the LA Times — regarding the results of an outside audit of the UCSF Dean’s office finances. Still a bit too arcane for me to sort out what really happened, though it may be that “mistakes were made.” Whatever the truth, Dr. K continues to dominate the press coverage.

    The plot thickens…

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About the Author:

Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google. His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.


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