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UCI Lags in Bone Marrow Transplants

January 12, 2006|Kimi Yoshino and Christian Berthelsen | Times Staff Writers

UCI Medical Center's bone marrow transplant program failed to perform enough transplants in all but one of the last 11 years to meet state standards and withdrew from a state program for the poor after repeated criticism, records show.

California health regulators told UCI in 2002 that its program was "persistently inadequate" and rebuffed the hospital's plan to correct deficiencies. The program also failed to obtain accreditation from the agency that inspects marrow transplant programs and does not qualify to participate in a national registry of marrow donors.

To meet those standards, medical centers are required to perform at least 20 transplants per year -- 10 with a patient's own marrow and 10 with donated marrow. UCI met that requirement only one year, 1997, since the program's inception in 1995.

Nevertheless, the Orange hospital's website touts UCI's "top-notch" marrow transplant team and a cancer center "renowned for its bone marrow transplant program."

A spokeswoman for the medical center said last month in an interview that the marrow transplant program was fully functional. Asked if there were any problems with it, the spokeswoman, Susan Mancia, said, "No, not that we're aware of. We have a really robust and viable program."

Mancia acknowledged Wednesday that her answer was misleading but said that was what doctors and university officials -- whose names she couldn't remember -- told her. She later said two doctors, Randall Holcombe, the chief of hematology/oncology, and Leonard Sender, the program's interim director, were among those she talked to. Neither returned calls seeking comment.

UCI officials refused to respond to detailed questions about the program Wednesday, saying they would not provide further information without a written request for documents.

They issued a statement saying, "UCI is justifiably proud of its ability to provide comprehensive care to individuals suffering from blood and other cancers whose successful treatment requires the most up-to-date therapies and treatment modalities, including where appropriate, bone marrow transplantation."

Details about the marrow transplant program come as serious shortcomings in UCI's liver transplant program have emerged. The Times reported in November that 32 people died awaiting livers in 2004 and 2005, even as doctors turned down organs that were successfully transplanted elsewhere.

A report detailing UCI's investigation of the program is expected to be released next month.

The U.S. Centers for Medicare and Medicaid Services withdrew certification and funding, and UCI shut down that program, which also failed to perform the minimum number of transplants. The hospital also did not have a full-time liver transplant surgeon on staff.

Problems with the marrow transplant program were first reported Wednesday by the Orange County Register. Bone marrow transplants are an integral part of treating cancers such as lymphoma, myeloma and leukemia, as well as other blood, immune system and genetic disorders. They are used to replace diseased blood cells with healthy ones, often after chemotherapy or radiation treatment.

Since 2001, UCI doctors have performed 45 bone marrow transplants; 36 of the patients are living, according to the hospital's statistics.

The marrow transplant program also has suffered from staff and management turnover.

In 2002, the shortcomings came to the attention of the state Department of Health Services, which threatened to suspend Medi-Cal coverage for poor patients seeking bone marrow transplants at UCI.

According to letters the state provided Wednesday, UCI outlined plans for improvement, but state regulators found them lacking.

In a Dec. 17, 2002, letter to UCI, Fulton Lipscomb, chief of the department's medical policy section, said, "Given these persistently inadequate numbers, the correction action steps outlined in your letter to address your low numbers are vague and frankly, insufficient to ensure with any confidence that you can effectively turn UCI's adult [bone marrow transplant] program around in a one-year time frame."

UCI asked for a "one-year grace period" and said people at "the highest level," including medical school dean Thomas C. Cesario and hospital director Dr. Ralph Cygan, were fixing the problem. Part of their plan included joining forces with the City of Hope in Duarte, though that fell through.

Yet even as UCI officials promised to improve the program, the hospital's performance deteriorated. In 2002, doctors there performed just five transplants and only two the following year. Hospital officials promised the problems would be fixed by June 2004.

The medical center's low number of operations made it ineligible to participate in the national donor registry of marrow transplants, called the National Marrow Donor Program.

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