Discipline meted out to Kaiser

Times Staff Writers

Seven months after Kaiser Permanente announced that it was closing its problem-plagued kidney transplant program in San Francisco, the group that oversees the nation's transplant system sanctioned the program Wednesday by removing its "good standing."

Dr. Sue V. McDiarmid, president of the United Network for Organ Sharing, said in a written statement that Kaiser had "effectively denied patient access to kidney transplantation and threatened safety for patients on its waiting list" during the tumultuous start-up of its kidney program in 2004 and 2005.

Wednesday's action marks the fourth time this year that the United Network for Organ Sharing, a federal contractor, has publicly disciplined a transplant program in California.

In all but one case, however, UNOS acted months after the programs had voluntarily closed amid scandal.

Several former patients in Kaiser's program expressed frustration at the long-delayed penalty, which now has little practical effect.

"Too little, too late," said Bernard Burks, 56, who had complained repeatedly to Kaiser about delays in his care.

"The damage has already been done," said Jason Mitchell, 33. "In my mind, they should have done this six months ago back when it came to light that Kaiser was committing such travesties against all of its patients."

UNOS began looking into problems at Kaiser in May after The Times reported that more than 1,500 Kaiser patients had been endangered during the start-up of the kidney program. The patients were forced by the massive health maintenance organization to leave established programs at two outside hospitals and join Kaiser's fledgling unit. In the process, Kaiser lost track of hundreds of patients and delayed critical surgeries.

Kaiser announced May 12 that it was closing the troubled program and would return the patients on its waiting list, which had grown to 2,000, to outside transplant programs. That process is nearly complete but will not meet a previously set deadline of Dec. 31.

At the time, a top official of the HMO publicly apologized for the problems. But during the closed-door hearing Wednesday, Kaiser representatives struck a different tone, said McDiarmid, a pediatric liver specialist at UCLA.

"I wouldn't characterize their position to us as acknowledging major errors," McDiarmid said. At times, she said, Kaiser officials actually denied that there had been serious lapses.

Mary Ann Thode, who made the public apology as president of Kaiser Foundation Health Plan and Hospitals in Northern California, declined Wednesday to discuss whether the HMO denied problems during the hearing.

"I can't make any statements at all about anything at all that went on with the proceedings," Thode said.

The regulatory group's action, which is mostly a public-relations blow to the giant HMO, comes months after state and federal health officials completed their investigations with nearly identical conclusions.

In June, the U.S. Centers for Medicare and Medicaid Services found that Kaiser's program was poorly planned, poorly staffed, poorly run and poorly qualified. The Medicare agency threatened to cut off some federal money to Kaiser's San Francisco hospital but relented after Kaiser promised to make reforms -- at least until patients could be transferred to other programs.

In August, Kaiser agreed to pay a $2-million fine to the California Department of Managed Health Care, as well as make a $3-million contribution to organ donation efforts.

McDiarmid said UNOS acted "very quickly" to investigate Kaiser, explaining that the process takes time because her organization must give programs ample opportunities to contest any findings.

Still, the sanction sends an important message, she said.

"Transplant candidates are an especially vulnerable population and must be assured that transplant institutions will fulfill their responsibilities," she said in the written statement. "A violation of this public trust must be censured by the transplant community."

The sanction against Kaiser was taken during a two-day meeting that marked the end of a turbulent period for UNOS -- more than a year in which gaps in its oversight were exposed and it was forced to examine its willingness to police member programs.

A Times investigation in October found that the little-known group has been slow to investigate lapses at transplant centers, even when patients were unexpectedly dying. It also has kept many of its findings secret, leaving patients and their families unaware of programs' shortcomings.

UNOS officials have acknowledged that they need to be more aggressive.

Mitchell, the former Kaiser patient, said the stakes are too high for UNOS to give programs like Kaiser a belated "slap on the wrist." On disability, the former legislative director spends hours each week tethered to a dialysis machine that cleans his blood.

"I don't think people really understand how completely that [Kaiser] devastated lives, mine in particular," he said.





Transplant woes

The United Network for Organ Sharing, the nation's primary regulator of organ transplantation, holds its last 2006 meeting in Tucson, after 16 months of scandals and oversight lapses involving California programs. A summary:

* September 2005: St. Vincent Medical Center in Los Angeles stops performing liver transplants after admitting that its doctors had improperly given a liver to a Saudi national using an organ intended for a higher-priority patient on St. Vincent's waiting list. Hospital staff members knew about the ethical breach but covered it up.

* November 2005: UCI Medical Center in Orange closes its liver transplant program the day The Times reported that it had been turning down a disproportionately high number of organs as patients died on its waiting list.

* May 2006: Kaiser Permanente closes its kidney transplant program in San Francisco after a series of stories in The Times found that it had endangered hundreds of patients, in some cases delaying critical surgeries or losing track of patients altogether. In August, Kaiser agreed to pay a $2-million fine to the California Department of Managed Health Care and contribute $3 million to promote organ donation in the state.

* June 2006: The Times reports that the federal government had taken no action against 48 federally funded transplant programs although they had failed to meet the government's minimum standards for patient survival or had performed too few operations to ensure competency. The agency promises reforms.

* July 2006: The Times reports that USC University Hospital's liver transplant program had one of the highest death rates in the nation, with twice as many patients as expected dying after their surgeries.

* October 2006: A Times investigation finds that UNOS, a federal contractor, often failed to detect or decisively fix problems at derelict hospitals -- even when patients were dying at excessive rates. When it did act, the group routinely kept its findings secret, leaving patients and their families unaware of potential risks.

Source: Times reporting

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