Swift Switch for Key Kaiser Patients

The 141 people closest to getting kidneys will go to two UC centers from the HMO's suspended program as soon as next week, regulators say.

By Charles Ornstein and Tracy Weber
Times Staff Writers

May 26, 2006

State regulators announced Thursday that 141 Kaiser Permanente patients closest to receiving kidney transplants in Northern California would be shifted as early as next week from Kaiser's own troubled center to other transplant programs.

The transfers would be the first since Kaiser announced May 12 that it would indefinitely suspend its fledgling San Francisco transplant program after reports that patients were endangered because of delays, poor planning and a lack of oversight.

Kaiser said 94 of the patients being moved to the transplant programs at UC San Francisco and UC Davis medical centers had completed all required testing and had accumulated enough seniority on a master waiting list to receive a transplant in the near future. Their organs are to come from deceased donors, so it is impossible to say exactly when their surgeries will occur.

The remaining 47 patients have relatives or friends willing to donate a compatible kidney and could receive their transplants at any time.

This initial group represents a small fraction of the 2,000 patients on Kaiser's waiting list, however. The rest will be moved to the two UC hospitals in groups, based on how long they have been waiting for kidneys and other factors.

The HMO will make sure "that we address the needs of those patients who are most ready for transplant first," said Mary Ann Thode, president of Kaiser Foundation Health Plan and Hospitals in Northern California.

Some patients, however, said they were worried that they would not receive proper priority because they had heard little, if anything, from Kaiser's transplant staff in the 21 months the program was in operation.

Kaiser patient Joyce Figg, 56, has been waiting more than seven years for a new kidney. Just before she was shifted to Kaiser's new center in the fall of 2004, her UC San Francisco coordinator told her that she was nearing the top of the list and needed additional pre-transplant testing. But Kaiser never performed the tests, she said.

"If I had stayed with UCSF, I probably would have had" the transplant, she said. "UCSF had a better handle on everything, and I think they were keeping up with people a lot better."

Melvin Randolph, 68, has been waiting nearly nine years. He too was told by UC San Francisco in mid-2004 that he was coming close to a transplant but that he might need bladder surgery before it could occur, said his wife, Rita. Once Kaiser took over, however, Melvin was not evaluated further, she said.

Now the couple don't know whether he is well enough to have a transplant or even the bladder surgery, Rita Randolph said. "We would have to wait and play it by ear," she said.

The California Department of Managed Health Care, which regulates the state's HMOs, said it was relying on Kaiser to determine who was ready for a transplant. But spokeswoman Lynne Randolph said the agency was interested in hearing from patients with complaints about the HMO's program. The department's toll-free hotline is (888) HMO-2219.

Regulators hope to transfer all 2,000 patients within weeks, but Kaiser officials said they could not predict how long that process would take. "I don't think we can honestly give you an answer on that because of all the complexity and paperwork involved," Thode said.

Kaiser announced the closure of its center after The Times reported that 1,500 patients were forced into the HMO's start-up program from established centers at UC San Francisco and UC Davis, which had been under contract with Kaiser.

At Kaiser's new center last year, twice as many people on the waiting list died as received kidneys. The statewide pattern for transplant centers was the reverse: Twice as many patients received kidneys as died.

Hundreds of patients were not properly transferred from their old programs to Kaiser's because the HMO submitted incomplete and inaccurate forms. Those patients were essentially cut off from transplants for months.

And 25 patients who had been treated at UC San Francisco were denied the chance to receive kidneys that were nearly perfectly matched to them because Kaiser directed the university to reject the organs during the transition between programs.

A spokesman for United Network for Organ Sharing, the federal contractor responsible for overseeing the national transplant system, said it is working with Kaiser, the UC hospitals and state regulators to ease their transition. The programs will work together to minimize the potential for errors or paperwork snafus.

On Thursday, the managed care department announced the appointment of a patient advocate to oversee the transition. She is Allison Kregness, a certified nephrology nurse.

Meanwhile, Kaiser officials said they had been working to fix communication problems with patients. This week, the HMO said, it sent letters to all of the patients on its waiting list, reassuring them that they would be transferred "as quickly and smoothly as we can."

Kaiser also said it had been fixing problems with its own toll-free hotline for kidney patients: (800) 390-3508.

Last week, the managed care agency ordered Kaiser to improve staffing and provide patients with better information after complaints arose about unanswered calls and unhelpful operators. Kaiser has since pledged to respond to callers within 48 hours.

Kidney patient Bonnie Fadavi said she called Thursday and was told that her call would not be returned for at least a week.

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