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Discipline meted out to Kaiser

Transplant oversight group drops `good standing' rating seven months after the HMO closes kidney program in San Francisco.

December 14, 2006|Charles Ornstein and Tracy Weber | Times Staff Writers

TUCSON — 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.

charles.ornstein@latimes.com

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