Tougher Transplant Oversight Urged

California lawmakers called for better oversight of organ transplant programs at a hearing Tuesday, citing scandals that have forced the closure of three transplant centers in the state within the last year.

Members of the Assembly Health Committee said the state may need to consider tougher laws -- providing, for instance, for fines against hospitals -- to protect transplant patients from programs with poor survival rates or inadequate staffing.

They also questioned why regulators had not even heard about serious problems with programs before the media, particularly The Times, had reported on them.

“It is disturbing to me that no one really is monitoring these programs to ensure that policies and procedures are being followed,” said Assemblywoman Patty Berg (D-Eureka). She called the hearing “a call to action at all levels to make improvements to the system and to restore faith in the organ procurement and transplantation system.”

Because the legislative session is drawing to a close, it is unlikely reforms will be enacted this year, but some lawmakers said the issue should be a priority when lawmakers return.

Committee staff members, in a background report, cited a patchwork of regulatory agencies -- state and federal -- that oversee transplants but do not necessarily communicate with one another. According to that report, “It has become apparent that there is no central agency responsible for receiving and monitoring complaints from patients in this state.”

Committee Chairwoman Wilma Chan (D-Alameda) agreed, suggesting that regulators should have a better handle on patients’ problems.

“I’m not trying to pick on you,” Chan told a panel of regulators, including representatives from the U.S. Centers for Medicare and Medicaid Services and state agencies that oversee hospitals and HMOs. “I’m just saying: How can we make this better, or are you happy with the way it is now? I certainly don’t think people here are very happy with the way it is now.”

Panelists said patients should feel comfortable contacting their agencies directly, but they are glad to hear about problems any way they can, even if it’s through the media.

The committee focused on transplant problems at St. Vincent Medical Center in Los Angeles, UCI Medical Center in Orange, Kaiser Permanente in San Francisco and USC University Hospital in Los Angeles.

St. Vincent halted its liver transplant program in September after acknowledging that its doctors had violated national transplant standards in 2003. Surgeons transplanted a donated liver into a patient who ranked 52nd on the regional waiting list, bypassing dozens of people whose conditions were considered more dire, the hospital said. Staff members subsequently falsified documents to cover up the action.

UCI closed its liver program in November -- the day The Times reported that 32 people had died awaiting transplants in 2004 and 2005 while the UC Irvine hospital turned down scores of donated organs. Unbeknownst to patients, UCI had not had a full-time liver transplant surgeon for more than a year when it closed the program.

Kaiser ended its kidney transplant program in May, days after The Times detailed the problems that arose after the giant HMO forced up to 1,500 patients to move to its start-up program in fall 2004. Hundreds of patients were not properly transferred from their old programs to Kaiser’s, leaving them with little hope of receiving new kidneys.

And The Times reported last month that the liver transplant program at USC University Hospital has one of the highest death rates in the nation, with twice as many patients as expected dying after their surgeries.

Legislators asked whether California had inferior transplant centers compared to the rest of the nation, but speakers said they doubted it.

“I’m sure that the kinds of problems that existed here exist elsewhere,” said David Magnus, director of the Center for Biomedical Ethics at Stanford University. “Probably the reason why it’s gotten more attention here has to do more with rigorous actions of the media than it has to do with anything fundamental to do with transplant programs in California versus elsewhere.”

William Lawrence, director of patient affairs at the United Network for Organ Sharing, the federal contractor responsible for safety and equity in the nation’s transplant system, sought to reassure lawmakers.

“If your concern is that this is rampant behavior, I assure you it’s not,” he said. “Once is too much. If I were a patient on the waiting list of a program that had these kind of problems, I’d be distraught.”