Transplant Errors May Cost Kaiser

Kaiser Permanente’s kidney transplant program in Northern California, which is in the process of shutting down amid scandal, received notice this week that it may face financial sanctions from the federal government because of serious deficiencies.

The U.S. Centers for Medicare and Medicaid Services inspected the program last month after The Times reported how Kaiser imperiled hundreds of patients in 2004 when it directed them to transfer from outside transplant centers to its fledgling program in San Francisco.

The Medicare agency found problems with the oversight of the transplant program, its protection of patients’ rights and the director of the center, placing Kaiser out of compliance with federal requirements, says a letter from the agency to the health maintenance organization.

If the deficiencies are not corrected to inspectors’ satisfaction, Kaiser could lose federal funding not just for transplant patients but for all Medicare patients with end-stage renal disease treated at the HMO’s San Francisco hospital.

Kaiser announced May 12 that it would close its kidney transplant program, but it continues to treat the 2,000 patients on the waiting list as it shifts their care to UC San Francisco and UC Davis in a process that could take months. The UC hospitals had treated many of the patients, under contract with Kaiser, before the HMO began its own program.

The government will not release specifics of its findings until Kaiser presents a plan of correction. The HMO has until June 15 to do so, though it can seek an extension. The government will then reinspect the program.

“It’s a serious situation,” said Jeff Flick, the Medicare agency’s regional administrator. “There’s a serious amount of work to be done.”

Even though the kidney transplant program is ending, Kaiser must still address the issues identified by regulators. The U.S. inquiry is one of several looking into what went wrong once Kaiser decided to perform its own transplants. The state Department of Managed Health Care is also investigating, as is the United Network for Organ Sharing, the federal contractor that oversees the nation’s organ transplantation system. In addition, Kaiser has launched an internal inquiry and asked a team of outside experts to weigh in.

A Kaiser spokesman said the HMO had begun work on the issues cited by the federal regulators. The findings were shared orally with Kaiser officials at the end of the inspection, on the same day Kaiser announced it was closing the program.

“We take very seriously the points they’ve outlined in the letter,” said Matthew Schiffgens, a Kaiser spokesman.

He said he did not know if any transplant staff had been disciplined as a result of lapses at the center. Right now, he said, Kaiser officials are focused on ensuring that patients are safely transferred to the UC hospitals.

“The postmortem on who did what, where, will be reserved for a later date,” he said.

The start-up of Kaiser’s program was fraught with problems, a Times inquiry found. Twice as many people died on Kaiser’s waiting list as received kidneys last year. The statewide pattern for transplant centers was the reverse: Twice as many patients received kidneys as died.

That left Kaiser patients on prolonged dialysis treatments, which can cause deadly complications and harm chances for a successful transplant later.

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. And 25 Kaiser patients who had been treated at UC San Francisco were denied the chance to receive kidneys that were nearly perfectly matched to them because Kaiser directed the university to reject the organs in the transition between programs.