If Kaiser Permanente's Fresno hospital had acted on complaints and kept a closer watch over its medical staff, two babies might still be alive, federal health inspectors concluded in a report released this week.
The U.S. Centers for Medicare and Medicaid Services began investigating the hospital in October, two days after the Los Angeles Times reported that doctors and nurses had complained repeatedly to higher-ups about perinatologist Hamid Safari's medical and interpersonal skills.
Rather than address their concerns, hospital leaders allowed Safari to continue treating high-risk pregnant women without restriction, staffers told the newspaper.
Safari allegedly botched at least two deliveries after staff members had raised concerns. One baby died in the delivery room; another died months after her birth.
In its report, the Medicare agency criticized the way Kaiser Fresno responded to those deliveries, both of which were detailed in The Times story. At least one staffer told inspectors that Kaiser had received complaints about Safari as far back as 1998.
In a written response to the report, Kaiser Fresno administrator Susan Ryan defended the hospital's quality oversight program and said officials took appropriate action after Safari's alleged mistakes.
In a statement to The Times on Friday, Ryan said, "These are difficult and emotional situations, and we empathize with all involved. When these events occurred, they were thoroughly investigated and corrective actions were taken. This has led to significant improvements in our perinatal safety program."
In one of the two cases cited by inspectors, Safari waited more than three hours before he performed a caesarean section on a patient in 2004 -- even though there was clear evidence that her baby was in distress, the report said. The baby was severely deprived of oxygen and died months later.
One Kaiser nurse told inspectors that she fruitlessly voiced concerns about the baby's condition to Safari, and that after the delivery, the perinatologist "was hounding nurses" and telling them how to describe the incident in the medical records.
Another staffer told inspectors there was a "violation of common sense and standard of practice" during that delivery.
In the other case, in April 2005, Safari allegedly severed the spinal cord of a baby after repeatedly and vigorously attempting to draw him out with a vacuum extractor. When the baby finally emerged, he was "white as a sheet" and unresponsive, staffers told inspectors. He died.
A clinical summary documented that the baby "had a good fetal heart rate up to the time of delivery," the Medicare report said.
One nurse told inspectors that after the baby was pronounced dead, Safari was "angry and yelled at everyone else saying it was their fault." Safari then "harassed" staff members and told them what to write in the medical records, the nurse said.
In July 2005, three months after the second baby's death, Kaiser imposed restrictions on Safari, barring him from performing vaginal deliveries and requiring him to be monitored by another physician or advanced-practice nurse. The restrictions became permanent in April, hospital officials said.
Since September, Safari has not performed any surgeries or C-sections and has served only as a consultant at the hospital, Ryan wrote Friday.
The federal report refers to additional guidelines that had been put in place for Safari, including a rule that he make his rounds with a high-risk nurse specialist. But nurses told inspectors that Safari did not follow those rules, and the hospital did nothing about it.
One perinatal nurse said Safari's failure to comply "was a serious and significant problem with potential negative impact" on his patients. The federal report concluded that Kaiser's failure to hold Safari accountable "placed patients at risk."
In her statement to The Times, Ryan wrote that the hospital "will take further steps to ensure Dr. Safari is accompanied during rounds."
The federal report is the latest in a series of critical assessments of Safari, Kaiser Fresno and the giant HMO itself, the nation's largest, with 6.5 million members in California.
In September, the state medical board accused Safari of gross negligence, seeking to revoke or suspend his license. And Kaiser's handling of the matter is the subject of a civil lawsuit filed by two doctors who claim they were punished for raising concerns about the April 2005 incident in which the baby died. Kaiser denies the allegations.
Safari's lawyer, Stephen D. Schear, said he believes his client will be exonerated. He also speculated that the federal report was based on "bad information" from the same sources who talked to the medical board and perhaps The Times.
"This is all just a tragic smearing of a very excellent doctor by people who had motivation and the means to ruin his reputation without basis," Schear said.