Hospital Halts Liver Transplant Program
UCI Medical Center said late Thursday that it would stop performing liver transplants, hours after the federal government stripped the program’s certification and said the hospital was imperiling patients’ prospects for survival.
The decision came the day The Times reported that 32 people had died awaiting liver transplants in the last two years while the UC Irvine hospital in Orange turned down scores of donated organs.
“However disappointing this is, our first commitment is to our patients,” Dr. Ralph Cygan, UCI Medical Center’s chief executive, said in a written statement. He also announced an investigation into the program.
Cygan said the 106 patients on UCI’s liver waiting list would be transferred to other hospitals for transplants and other care.
UCI’s is the second liver program in Southern California to announce its closure within a week. St. Vincent Medical Center in Los Angeles said Nov. 4 that it would shut its program, weeks after admitting its staff inappropriately gave a liver to a patient who was deep on the waiting list and then falsified records.
The region now has four adult liver transplant programs left, with lists ranging from 120 at Loma Linda University Medical Center to 674 at UCLA Medical Center.
“So now what’s going to happen?” asked Joanne Cabrera of Garden Grove, who has cirrhosis. Cabrera, 63, said she had been waiting for a transplant at UCI since 1997.
But she did not learn until Thursday, from a Times reporter, that UCI had a serious staffing problem: It has not had full-time liver surgeons for more than a year. The hospital has been relying on part-time coverage by surgeons based at UC San Diego, 90 miles away.
Cabrera said she had never even met a transplant surgeon at UCI and had infrequent contact with the program staff.
“When I’ve been in the hospital the last few times, they don’t even go see how I’m doing,” Cabrera said. “It’s like they don’t really care.”
Under federal rules, a liver transplant program must perform at least 12 procedures per year and its patients must have a one-year survival rate of at least 77% -- standards aimed at assuring surgical proficiency. On Thursday, in a letter to UCI Medical Center, the U.S. Centers for Medicare and Medicaid Services said the program had failed on both counts.
In each of the last three years, just eight patients received transplants. Of those who got them between Jan. 1, 2002, and June 30, 2004, fewer than 69% were still alive a year later.
Some of these problems were well-known to California regulators. In May 2004, the state Department of Health Services stopped covering liver transplants at UCI for Medi-Cal patients, saying the program did not meet minimum standards, according to documents obtained by The Times on Thursday. Medi-Cal is the state and federal insurance program for the poor.
UCI last requested authorization to perform a liver transplant on a Medi-Cal patient in late 2003, but that request was denied, a health department spokeswoman said.
The federal government largely relies on transplant centers to report their own transgressions. UCI didn’t do that. It could not be determined Thursday whether federal officials were aware of the state’s action.
Federal officials began looking into deficiencies only this year, after receiving a complaint from a former patient who had been on the UCI waiting list from 1998 to 2002. That patient, Elodie Irvine, transferred to another hospital, where she quickly received a liver transplant.
The decision to pull federal funding is effective immediately and not subject to appeal, although the hospital can apply anew for certification if it meets minimum standards. UCI, like other transplant centers, depends heavily on federal funding.
Herb Kuhn, director of the federal Center for Medicare Management, acknowledged that the current system of oversight was “not as aggressive or as assertive as we’d like it to be.” He said his agency was crafting new rules that would improve oversight of transplant centers to more quickly spot those that were out of line.
The data upon which federal regulators based their decision was easily accessible on the Internet. In addition, every offer and refusal of an organ is recorded by the local organ procurement agency.
OneLegacy, the agency that allocates organs in Southern California, provided data Thursday showing that for at least five years, UCI had consistently rejected more liver offers than any of the five other adult transplant centers in the region. Its acceptance rate hovered around 4%, compared with a regional average of 9% to 13%.
In many cases, a center may refuse the same organ for several patients. From January to September of this year, for instance, UCI received 129 offers from OneLegacy involving 66 livers. Just four were accepted.
Two-thirds of the livers that were refused were ultimately transplanted at other centers.
It is common for transplant centers to turn down offers. Organs can be the wrong size or of poor quality -- reasons most frequently cited by UCI. Federal regulators, though, suggested that UCI’s low number of transplants was linked to poor staffing.
The United Network for Organ Sharing, a nonprofit group under contract with the government to oversee donations and transplants nationally, also had the numbers showing problems at UCI -- on its own website.
That group had received a complaint from the same woman who alerted the federal government. Elodie Irvine, 51, reported that for months in 2002, the hospital failed to submit critical information on her condition, which caused her to drop to the bottom of the waiting list.
The organ sharing network referred the matter to one of its committees and conducted a review at UCI in June. The matter is still being studied, and is not scheduled to be discussed again by the committee until January, according to a source familiar with the case.
Annie Moore, a spokeswoman for the organ network, said her group did not second-guess hospitals that turn down organs. Nor is it bound to enforce federal standards.
“If we look at certain performance indicators and they seem not to be where they should be -- the expected numbers -- then we offer assistance to the program to bring them back to the accepted levels of performance,” Moore said.
“Some of these issues are based on medical judgments, and we don’t have the authority to make medical decisions,” she added.
The group has never publicly scolded a hospital.
With UCI’s and St. Vincent’s program now shut down, the remaining liver transplant programs in Southern California are preparing to absorb the displaced patients.
“These are very sick patients generally, and they tend to need to have things done,” said Dr. Okechukwu Ojogho, a transplant surgeon at Loma Linda. “Our center is clearly available to accept any patients.”
Loma Linda has four transplant surgeons and estimates it can perform up to 60 liver transplants per year, double what it is currently doing.
Patients on the waiting lists at the other centers should not be significantly affected. Patients throughout the Southern California region already were competing for livers based on their health and not the time they spent on the waiting list. “I’m in God’s hands,” said Cabrera, the patient who had been wait-listed eight years. “If it’s his will, it is.... Only he knows when he’s going to take me.”
