Scrutiny of St. Vincent Intensifies

The group charged with administering the national organ transplant system is considering decertification of the liver program at St. Vincent Medical Center and plans an audit of all transplants performed there in the last five years, the hospital’s top administrator told a confidential meeting of the medical staff.

St. Vincent President and Chief Executive Gus Valdespino told the doctors that the national group, the United Network for Organ Sharing, had found major lapses in oversight of the hospital’s liver program, according to two people who attended the Oct. 5 meeting. The sources spoke on the condition of anonymity for fear of reprisal by the hospital.

The Los Angeles hospital suspended liver transplants late last month after discovering that staff members, including doctors, had improperly arranged for a September 2003 transplant to a Saudi national who was 52nd on the regional waiting list, bypassing dozens of people whose conditions were considered more dire.

If the liver program loses its national certification, it could be shut down.

Separately, U.S. Sen. Charles E. Grassley (R-Iowa), chairman of the Senate Finance Committee, called Wednesday for an investigation into St. Vincent’s program and the national system for overseeing organ distribution.

“I am glad that the problems at St. Vincent have been brought to light, but it should not have taken two years to discover that there was a problem,” he wrote to Elizabeth Duke, administrator of the federal Health Resources and Services Administration.

“The integrity of the organ distribution system has got to be maintained,” Grassley said in an interview. “Something is obviously wrong here.”

In another development, a St. Vincent spokesman acknowledged to The Times last week that an employee had tried to report wrongdoing in the liver transplant program at the time of the improper transplant but was rebuffed.

“We had one employee who told investigators that he had mentioned concerns to his immediate supervisor in an informal way, and his impression was that the supervisor didn’t want to hear about it,” hospital spokesman Paul Silva said. “He filed no formal report on this and did not call our [ethics hotline], as far as we can tell, nor did the supervisor take any action, as far as we can tell.”

Silva would not identify the supervisor or the employee. The supervisor no longer works at the Los Angeles hospital, but the employee does, he said.

The organ misallocation is drawing the attention of state and federal officials not only because it violates the basic tenets of organ transplantation but also because of an alleged coverup by hospital staff. St. Vincent officials admit that their staff falsified documents several times, pretending that the transplant was for another Saudi patient who was near the top of the regional waiting list. That patient never received a new liver and later died in his home country.

At the Oct. 5 doctors’ meeting, Valdespino said the organ network considered the improper transplant one of the most egregious actions it had ever seen, according to the people who attended the meeting.

St. Vincent officials declined to comment on their communications with the organ oversight group or on confidential medical staff meetings. Valdespino was out of town Wednesday and unavailable for comment.

The United Network for Organ Sharing also declined to comment, saying the results of any inquiry would not become public unless the hospital was deemed to be “not in good standing.” If that happens, the group’s board has a range of sanctions at its disposal. The most extreme would be decertifying the liver program and conceivably barring the hospital from performing any transplants. St. Vincent is one of the largest transplant centers in the state, specializing in kidney, heart and pancreas transplantation, as well as liver.

Grassley said he is asking the Justice Department and the inspector general of the Department of Health and Human Services to look into alleged violations of transplant rules and whether anyone broke federal laws prohibiting the purchase or sale of human organs.

Grassley’s finance committee oversees the Medicare and Medicaid programs, which pay for some organ transplants.

Walter Graham, executive director of the United Network for Organ Sharing, said in a statement that his group intends to cooperate fully with the inquiry.

In his letter, Grassley said transplant regulators should have questioned St. Vincent earlier because the hospital has allocated about 8% of its donated livers to foreign nationals since 1995, higher than the 5% guideline set by the national organ oversight agency.

“I wonder how many Saudi nationals received liver transplants at St. Vincent while Americans awaiting a liver died,” he wrote. “Let me be clear: I am not against foreign nationals receiving organ transplants in this country, but I want to be sure they do not receive priority over United States citizens and permanent residents.”