California HMO regulators said this week that it will take months longer than expected to transfer about 2,000 patients out of Kaiser Permanente's troubled kidney transplant center in San Francisco, prolonging patients' dependence on a program that has been plagued by scandal.
When the Kaiser program announced in May that it would shut down, the California Department of Managed Health Care predicted that all of the HMO's Northern California patients would be moved to new centers within six weeks. But preparing patients and their records for transfer has taken more time than anticipated, officials say, pushing the target to the end of the year.
"That's our new goal," said Lynne Randolph, a spokeswoman for the department, who added that some patients needed updated tests and that records had to be standardized.
Her agency also plans to announce as early as next week that it will levy a record-breaking fine against Kaiser for problems in the transplant program, according to a person familiar with the matter. The largest fine previously collected by the agency was $1 million in 2002, also against Kaiser, for lapses in the treatment of a patient who died.
So far, only 231 Kaiser kidney patients have been officially transferred to transplant programs at University of California hospitals in San Francisco and Davis, Randolph said.
Some Kaiser patients received word of the most recent delays with dismay.
Walter Jewell, 32, said he doesn't even know whether he has been transferred yet. He was perplexed this week to get a letter asking his preference between the UC hospitals, because he had already told Kaiser he wanted UC San Francisco.
"Right now if I got a call for my kidney transplant, I don't know who is going to be calling me," said Jewell, who has been waiting since June 2004. "I know they're in the process of doing something, but I don't know what . I'm still really concerned."
Kaiser, the nation's largest HMO, announced the closure of its kidney transplant program in May after reports in The Times detailed problems arising from the center's start-up in the fall of 2004. Northern California transplant patients, who had been treated at UC San Francisco and UC Davis medical centers under contract with Kaiser, were forced to transfer to the new program.
The center compiled a dismal record: Last year at Kaiser's program in San Francisco, twice as many people died on the waiting list as got kidneys, the newspaper found. The statewide pattern for transplant centers was the reverse: Twice as many patients received kidneys as died.
Hundreds of patients were not properly transferred from their old programs to Kaiser's, leaving them in limbo with little hope of receiving new kidneys.
Federal regulators later concluded that practically every aspect of the Kaiser program was flawed and threatened to cut off Medicare funding for treating all end-stage renal disease at the HMO's San Francisco hospital. But the U.S. Centers for Medicare and Medicaid Services late last month accepted Kaiser's plan for fixing its problems, even though the program is closing.
Some Kaiser patients who have been transferred said their cases have been quickly and professionally handled by UC programs — getting them kidneys within days or weeks. Even though organs are distributed regionally, not by individual hospitals, they said Kaiser seemed slow to act on their behalf or found reasons not to perform their surgeries.
Karen Goodlow, 44, said she heard next to nothing from Kaiser after being forced into its transplant program in fall 2004. She never met the transplant team, she said, even though she had been awaiting an organ since June 2000 and should have been near the top of the list.
But last month, weeks after transferring to UC San Francisco's transplant program, she got her new kidney.
"It was like night and day the care I got at UCSF compared to Kaiser," Goodlow said. "Everybody explained everything to me. Everybody was able to answer my questions. It just all went like clockwork."
Goodlow, an administrative assistant from Vacaville, said she noticed increased energy within a day of her July 12 transplant.
"It was just that instant," she said. "For the most part, I find that I don't have to schedule my life anymore. For the last six or seven years, I was scheduling my life around dialysis."
Darlis Beale, 57, had been waiting for a kidney for more than eight years. She too endured grueling sessions of dialysis, a process that removes impurities from the blood.
Beale was officially transferred to UC San Francisco last month. Less than two weeks later, while driving to choir practice, she got the call that a kidney had been found for her.
It didn't go exactly as planned. Once in surgery, doctors were forced to use the donor's second kidney because the first one didn't function properly. But the new kidney began working right away, Beale said.
Another Kaiser patient awaiting the second kidney was forced to wait for another.
"I just can't imagine how awful that would be," Beale said.
So far, however, Goodlow and Beale are among the lucky few.
Since May 12, when the closure was announced, 20 of the HMO's patients have gotten new kidneys: 12 at Kaiser, five at UC San Francisco and three at UC Davis.
Kaiser spokesman Matthew Schiffgens said the closure of the transplant program should not hurt any patient's prospects for a kidney. Until everyone has been transferred, Kaiser will continue performing surgeries as kidneys become available.
Northern California Kaiser kidney program by the numbers: 2,080 Patients on Kaiser Permanente's kidney transplant waiting list when the program announced May 12 that it would close 1,256 Patients who have been contacted and given a choice of moving to established programs at UC San Francisco or UC Davis medical centers, as of Thursday 971 Medical records transferred to the UC hospitals 231 Number of patients officially reassigned to the UC hospitals through the national organ network 20 Number of transplants performed on Kaiser patients since May 12*
Source: California Department of Managed Health Care