Hospital Is Rebuked in Organ Case

The national organization that regulates organ transplantation handed its harshest rebuke Thursday to St. Vincent Medical Center in Los Angeles -- the first time it has publicly sanctioned one of its members.

The action by the United Network for Organ Sharing results from St. Vincent’s admission in September that its doctors had improperly arranged for a liver transplant to a Saudi national using an organ intended for a higher-priority St. Vincent patient.

The unauthorized action bypassed 50 people on a regional waiting list whose conditions were considered more dire.

The transplant took place in 2003 but wasn’t discovered until a routine audit two years later. St. Vincent immediately ceased doing liver transplants after the discovery and shortly afterward shut down its liver program, which handled 21 operations in 2005.

The sanction is a notable departure for the oversight group, a government contractor that historically has disciplined troubled transplant centers in private, if at all. It comes after U.S. Sen. Charles E. Grassley (R-Iowa), publicly questioned the group’s willingness to police the nation’s 255 transplant programs.

Grassley, an influential legislator who heads the Senate Finance Committee, first raised concerns after the revelations about St. Vincent became public last fall.

The network’s executive director, Walter Graham, said Thursday that the decision “sends a strong message to the entire transplant community about the importance of institutional responsibility for organ transplantation. It sends a message about the overall importance of patient safety and regard for the public health.”

In a statement, St. Vincent said its lawyers would challenge the sanction in court, arguing that the oversight group overstepped its bounds because the hospital, which continues to operate heart, kidney and pancreas programs, now is in compliance with transplant rules.

“We have been proactive in developing and implementing a comprehensive corrective action plan to ensure that the problems that occurred in the liver program cannot occur in the hospital’s other transplant programs,” the statement said.

A network spokesman said the punishment, which officially designates the hospital as a “member not in good standing,” was justified.

“Certainly the board of directors looked at the legal issues and the application of the bylaws and felt that it was acting within its authority,” said spokesman Joel Newman.

Thursday’s rebuke carries symbolic significance and is a blow to St. Vincent’s reputation but has limited practical effects.

The sanction does not prevent St. Vincent from performing other organ transplants, adding patients to its waiting lists or providing follow-up care.

Instead, St. Vincent must send letters describing the discipline to the approximately 4,000 patients who either await transplants at the hospital, near downtown Los Angeles, or remain under the center’s care.

The hospital, which has one of the oldest and largest kidney transplant programs in the country, also forfeits power within the transplant community. Transplant surgeon Robert Mendez, who for years led St. Vincent’s kidney transplant program, is a past president of the organ network. Now the hospital’s officials are barred from serving on the network’s board or its committees and cannot take part in votes within the organization.

St. Vincent will remain a member not in good standing until officials can demonstrate that new safeguards will prevent such incidents from recurring.

Graham said the decision is unlikely to force the closure of other transplant programs at St. Vincent or cause federal health officials to withdraw Medicare funding, which covers the bulk of its transplants.

Most private insurers already had removed St. Vincent from their lists of preferred providers or had stopped referring patients there.

Graham said the network could have taken a more drastic step against the hospital, recommending that U.S. Health and Human Services Secretary Mike Leavitt suspend its programs, which would have prevented it from adding patients to waiting lists, or close them. The board, he said, did not find that patients were in “imminent danger.... Had we found that sort of thing, we would have taken more serious actions.”

Federal health officials could not be reached for comment late Thursday.

St. Vincent has acknowledged that there were numerous breakdowns in its liver program and that several staff members knew about them but participated in the coverup.

Federal inspectors, who separately investigated the breaches, also found that the hospital’s top liver transplant surgeon, Richard R. Lopez Jr., misled the patient for whom the donated liver was originally intended, Saad Al-Harthi.

After the September 2003 transplant, the hospital removed Al-Harthi from the waiting list but led him to believe that he was still a candidate for an organ. He died in 2004, his son said.

Al-Harthi and the patient who received the liver, Abdullah Al-Bugami, were both Saudi nationals whose care was paid for by the Royal Embassy of Saudi Arabia, a common service offered to Saudi citizens abroad.

Lopez, who was removed from his position at the hospital, has denied wrongdoing.

After troubles also arose in UC Irvine Medical Center’s liver transplant program, forcing its closure, transplant network officials ordered a reevaluation of their policies with an emphasis on more public disclosure and a need to be a more visible watchdog.

Dr. Andrew S. Klein, director of Cedars-Sinai Medical Center’s transplant center and a network board member, said that because of his geographic proximity to St. Vincent, he was excluded from discussing the sanction. But he said generally that network officials are taking a more active role in monitoring transplant centers, and such rebukes are “indeed something that they should do.”

Though Thursday’s action was based solely on violations in St. Vincent’s liver program, The Times has detailed problems in the hospital’s kidney program as well.

Kidney transplant patients at St. Vincent have died at a higher-than-expected rate over the last several years, according to a separate agency that analyzes data from all transplant centers on behalf of the federal government.