Transplant Network Weighing UCI Sanctions

UCI Medical Center is facing sanctions from the organization that manages the nation’s organ transplant system, including one that could force the hospital to close its kidney transplant unit, according to people familiar with the matter.

Medical center executives flew to Chicago last week to meet with a subcommittee of the United Network for Organ Sharing. The panel, which handles issues involving professional standards, is considering penalties following discoveries of substandard care in UCI’s liver and kidney transplant programs and misleading statements UCI officials made to the network about improving the liver transplant program.

The potential penalties were revealed Tuesday to UCI staff members in a meeting at the medical center in Orange. Hospital administrators told kidney transplant staff members that one sanction under consideration could force the program’s closure, according to two people with knowledge of the meeting.

One person close to the matter said that sanction might be unlikely, because the kidney transplant program had been improving and the network would be reluctant to shut down a program unless it was beyond recovery.

The network has never imposed a penalty that harsh. But people familiar with panel members’ thinking said they were angered and embarrassed at being deceived by UCI and wanted to impose a sanction that the hospital would take seriously.

The network’s deliberations are confidential. Sources who agreed to discuss the matter spoke on the grounds that they would not be identified.

Meanwhile, in a speech Friday before Orange County business and civic leaders, UC Irvine Chancellor Michael V. Drake said problems with the medical center would create a “great opportunity” to rebuild and better the hospital.

Drake said he expected to receive a report next week from an outside committee that would provide “a broad blueprint of what we can do to adjust things so this kind of news does not get made by us in the future. What we really want to make sure is that this never happens again.”

And in an e-mail sent Friday to medical center staff, interim Chief Executive Officer Maureen Zehntner said the hospital had received a surprise visit from the Joint Commission on Accreditation of Healthcare Organizations, and was advised that UCI’s programs would remain accredited. The commission is the main oversight body that accredits healthcare programs nationwide.

UCI closed its liver transplant program in November, after The Times reported that 32 patients died in 2004 and 2005 even as the hospital turned down scores of viable organs, at times because it had no surgeon available to perform the operations.

The medical center’s kidney transplant unit has had similar problems. It turned down more than 90% of the kidneys it was offered between July 2000 and June 2005 -- one of the lowest acceptance rates among adult transplant centers in the nation. During that period, 35 patients died while awaiting kidney transplants, though that death rate is not out of line based on the condition of the patients.

Like the liver program, the kidney program operated without a full-time transplant surgeon for more than a year. It was not clear if patients were told.

A host of other problems at UCI recently have come to light, including an underperforming bone marrow transplant program, division leaders who lack credentials and questions about nepotism and favoritism toward the son of a financial donor to the hospital. A decade ago, revelations surfaced that fertility doctors stole eggs and embryos from unsuspecting patients and implanted them in other women.

Fallout continued Friday, when UCI acknowledged that the associate chief of its cardiology unit resigned from his leadership position last month. Dr. Mani Vannan, who has been criticized for not having a California medical license or board certification, will continue practicing at UCI, but will not supervise other doctors.

Vannan’s boss, Jagat Narula, chairman of the cardiology department, continues in his post despite being criticized for being in similar circumstances.

The medical center’s former chief executive, Ralph Cygan, was among a group of UCI executives who told network officials in 2004 that the medical center had hired a full-time liver transplant surgeon. In fact, the surgeon, Dr. Marquis Hart, was based at UC San Diego and served at UCI only part time.

Cygan resigned last week, and UC San Diego demoted Hart for his role in the matter from his position as director of abdominal transplantation. Hart’s attorney said that his client had done nothing wrong.

UCI’s kidney division has been performing more transplants in recent months: The hospital has hired a new doctor to perform transplants, retained another to be on call and has struck an agreement with UCLA to care for its patients if no other options are available.

Among the sanctions the network is considering is a declaration that UCI’s membership in the organization is “not in good standing,” which would open the door for the federal government to withdraw funding of treatment for Medicare patients. It would also allow private insurers and health plans to cancel contracts. Such an action would be publicly disclosed.

Other penalties range from a letter of reprimand, to probation, in which the hospital would be given time to comply with a set of imposed conditions. Most severely, the network could terminate a hospital’s membership in the organization, which would prohibit it from doing any transplant business.

The network’s Management and Professional Standards Committee could write a letter of reprimand on its own, but the full board would have to approve the more severe punishments.

Zehntner led the UCI delegation that met last week with the network’s committee. She did not return a telephone call seeking comment.

Neither did the two UCI officials who informed the kidney staff of the possible sanctions: Clarence Foster, a kidney transplant surgeon, and Gail McGory, the manager of kidney acquisition. A spokeswoman for the medical center, Simi Singer, said hospital officials had no comment.

Joel Newman, a spokesman for the Richmond, Va.-based network, said in an e-mail that he could not discuss the meeting.

A decision could come in March, sources say.