St. Vincent Medical Center, one of the largest organ transplantation centers in the state, has suspended its liver program after discovering that its doctors improperly arranged for a transplant to a Saudi national using an organ that should have gone to a much higher priority patient at another hospital, officials said.
Hospital staff members then falsified documents several times to cover up the alleged maneuver, pretending that the transplant was for a patient who was near the top of the regional waiting list, hospital President and Chief Executive Gus Valdespino confirmed Monday.
The transplant took place in September 2003 and was paid for by the Royal Embassy of Saudi Arabia. But Valdespino said the problem was discovered only this month when officials were responding to routine questions from auditors at the United Network for Organ Sharing, the nonprofit group that administers the national transplant system.
The patient who received the successful transplant was actually 52nd on the list, which covers much of Southern California and takes into account such factors as who is sickest and who has been waiting longest.
A patient at UCLA Medical Center was entitled to receive the organ and St. Vincent should have declined it, Valdespino said.
Transplant directors and ethicists from across the country say what is alleged to have happened at St. Vincent is a sin in organ transplantation, which is heavily regulated by a procurement network, as well as state and federal officials, to maintain integrity and fairness in the process.
The idea of moving one patient above another for other than medical reasons is "totally unconscionable," said Dr. Douglas Hanto, chief of the transplant division at Beth Israel Deaconess Medical Center in Boston. "It's wrong unequivocally."
The hospital, west of downtown Los Angeles, notified the state Department of Health Services about the line-jumping problem Monday, and agency spokeswoman Lea Brooks said inspectors would immediately investigate.
St. Vincent officials said that Dr. Richard R. Lopez Jr., director of the liver transplant program, and Dr. Hector C. Ramos, the assistant director, no longer were affiliated with the program. They declined to say whether the doctors had been terminated from those positions.
An attorney for Ramos said her client had done nothing wrong. A lawyer for Lopez said he did not have enough information to comment.
Suspending the program means that 75 patients on the waiting list for livers may have to seek care at other hospitals, possibly delaying their chances for a life-saving transplant. Patients who need livers typically suffer from end-stage liver failure, cirrhosis and other liver and metabolic diseases. The liver filters medications and toxins in the body and metabolizes carbohydrates, fats and proteins.
The Royal Embassy of Saudi Arabia paid the $339,000 cost for the transplant and hospital stay, which is 25% to 30% higher than what the hospital would typically be paid for the procedure by insurance companies and government programs, Valdespino said. A lawyer for Ramos, who was paid separately for his services, said he believed that the patient was an impoverished Bedouin and that the doctor didn't know if he would be compensated.
Patients without insurance, such as those from foreign countries, pay a higher rate than those whose health plans have negotiated steep discounts with the hospital.
The St. Vincent liver transplant program, which was created in 1995, has performed 184 transplants, according to data from the national organ network, including 22 last year. The hospital is in the process of contacting the 75 patients on its waiting list about the program's suspension.
The organ transplantation system in the United States strives to ensure that organs get to those who can benefit most from them.
Before placing a patient on a transplant waiting list, a hospital runs tests and assesses the patient's physical and mental health. The patient is not ranked at first, but instead is placed in a pool of potential recipients.
When an organ becomes available, after a donor dies, the patients are then ranked. A regional transplant coordinator tries to find someone who matches the donor's blood type, and also factors in medical urgency, waiting time and the geographical distance between the donor and the recipient.
The selected patient must be healthy enough to undergo major surgery and be willing to receive the transplant immediately.
The national organ network has said that no more than 5% of organs should go to foreign nationals, and indeed the actual percentage is much lower. However, data show that the liver transplant program at St. Vincent provided about 8% of its organs to foreign nationals. Overall, less than 5% of the hospital's organs go to citizens of other countries.
The scenario described by St. Vincent officials violated national standards in several respects. According to Valdespino, this is what happened: