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Hospital Receives Sanction

Federal oversight group places San Diego's Sharp Memorial Hospital on probation for problems with its pancreas transplant program.

September 21, 2006|Charles Ornstein and Tracy Weber | Times Staff Writers

RICHMOND, Va. — A San Diego hospital on Wednesday became the third transplant center ever -- and the third in California -- to be publicly sanctioned by the federal contractor that oversees the nation's transplant programs.

Sharp Memorial Hospital was placed on probation for deficiencies in its pancreas transplant program by the United Network for Organ Sharing. The group found that Sharp had not performed a pancreas transplant for more than a year, even as it added patients to its waiting list.

"There were patients on the waiting list who had not been informed" that the hospital's program was essentially inactive in much of 2005 and 2006, said Dr. Sue V. McDiarmid, UNOS president and a pediatric liver transplant specialist at UCLA Medical Center.

UNOS statistics show that two patients awaiting a pancreas at the hospital died in 2005 and 2006 -- although it could not be determined whether their waits contributed to their deaths.

UNOS suggested to Sharp that it voluntarily inactivate its pancreas program until it sorted out its problems, but the hospital refused, McDiarmid said. Probation "really did seem to be the only way to move forward so that patients could be protected," she said.

Dan Gross, executive vice president of hospital operations for Sharp HealthCare, confirmed that the program had been inactive because its pancreas surgeon had been called up for active military duty.

"Our error was that we didn't call [UNOS] and tell them" that we hadn't performed a transplant in six months, Gross said.

But Gross said that when it became clear that the surgeon was not going to be back any time soon, Sharp recruited a new surgeon, who performed a kidney-pancreas transplant in July.

Gross said the program did not inform patients in the meantime because another surgeon on Sharp's surgical staff could have done the transplants. But Gross acknowledged that on two occasions, the hospital was forced to turn down a donated pancreas because a surgeon was not available.

Wednesday's action, which came during a UNOS board meeting in Richmond, Va., follows two sanctions within the past year against Southern California transplant programs. No other program had been publicly sanctioned before then.

In March, the group declared St. Vincent Medical Center a "member not in good standing" -- its harshest sanction -- after the Los Angeles hospital conceded that its doctors had improperly arranged for a liver transplant for a Saudi national, bypassing 50 people on a regional waiting list whose conditions were more dire. Hospital staff then falsified records to hide the arrangement, St. Vincent officials acknowledged. The program closed last fall.

Also in March, UNOS placed UCI Medical Center's transplant programs on probation after a scandal that closed its liver program last November.

UCI shut the program after The Times reported that 32 patients had died awaiting operations in 2004 and 2005, when the hospital turned down scores of organs that might have saved them, sometimes because no surgeon was available.

At least one other California transplant program is likely to be sanctioned soon, UNOS documents show.

Kaiser Permanente's now-closed kidney transplant program in San Francisco already has agreed to pay a record $2-million fine to the California Department of Managed Health Care following reports in The Times that the program had endangered hundreds of patients during its ill-conceived and disorganized start-up. UNOS' disciplinary committee has recommended that Kaiser be branded a "member not in good standing," documents show, but the action has not been formally approved.

Wednesday's sanction against Sharp is not the first black eye for the hospital and its transplant center. In 2003, Sharp and the San Diego Hospital Assn. paid the federal government $6.2 million to settle allegations that the hospital had submitted millions of dollars in false claims to Medicare.

Sharp allegedly billed the federal agency for employee salaries, medical director fees, laboratory costs and hospital space that were not used for the acquisition of organs, according to federal officials.

All of the hospital's transplant programs -- including those for heart and kidney patients -- will remain on probation until it can show that the pancreas program's problems have been corrected, UNOS president McDiarmid said.

UNOS began its review of Sharp in January because the group requires that pancreas transplant programs perform at least one surgery every six months to remain active. The rule is designed to ensure that patients have a legitimate chance for a transplant.

Sharp last performed a kidney-pancreas transplant in April 2005, but did not do another such surgery until July of this year, UNOS statistics show. The program currently has 11 people on its pancreas waiting list and seven awaiting kidney-pancreas transplants.

McDiarmid said Sharp was never able to provide an acceptable explanation for why the hospital wasn't performing any transplants. "It was always, 'We're going to do one tomorrow.' Then tomorrow never happened," she said.

Practically speaking, probation is mostly a blow to the hospital's image. Sharp may still perform pancreas transplants, but UNOS will notify all transplant centers and organ procurement organizations of the sanction. In addition, Sharp must notify its pancreas transplant candidates that the program is served by only one surgeon.

Charles Ornstein reported from Richmond, Va. and Tracy Weber from Los Angeles.

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