Originally Posted At:
http://www.latimes.com/news/printedition/front/la-me-kaiser13may13,1,5276524.story?
THE STATE
Kaiser Halts Kidney Venture
The HMO abruptly announces that it will transfer about 2,000 transplant
patients back to UC hospitals. The details are unresolved.
By Tracy Weber and Charles Ornstein, Times Staff Writers
May 13, 2006
Kaiser Permanente announced Friday that it was indefinitely suspending
its kidney transplant program in Northern California after revelations
that it had endangered hundreds of patients.
"I think, quite frankly, they searched their souls and they decided
that it just was going to be very difficult to ensure that all the
patients' needs were met," said Cindy Ehnes, director of the California
Department of Managed Health Care. "They were trying to essentially fix
the airplane while they were flying it."
The decision, which Kaiser described as voluntary, followed reports in
The Times last week detailing the problems that arose after the giant
HMO forced up to 1,500 patients to move to its start-up program in the
fall of 2004.
The patients had been treated in established centers at UC San Francisco and UC Davis, under contract with Kaiser.
At Kaiser's new center in San Francisco, twice as many people died on
the waiting list as received kidneys last year. 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, leaving them in limbo with little hope of
receiving new kidneys.
Friday's decision to suspend the program appears to have been made in
some haste, with reporters given about 10 minutes' notice of the
telephone briefing.
As recently as Wednesday, Kaiser officials had touted the program's
quality at a news conference, while apologizing for administrative
blunders.
Now, Kaiser will send all of its patients back to the UC hospitals.
"We really felt that in order to ensure that our patients were
absolutely getting the best care possible, at this point in time we
really needed to suspend operations," Mary Ann Thode, president of
Kaiser Foundation Health Plan and Hospitals in Northern California,
said in Friday's call.
"We think we're making the right decision and doing what we should be doing in this situation," she added.
The move solves some problems but creates another: how to safely transfer a caseload now totaling more than 2,000 patients.
Before Kaiser launched its program in 2004, the HMO worked more than a
year on a plan to move its patients from UC San Francisco and UC Davis.
Even so, the transition was fraught with problems. More than 200 Kaiser
patients were never properly shifted to the Kaiser program.
The reverse migration will essentially happen on the fly.
Neither Kaiser officials nor regulators could provide details Friday
about the transition. Meetings are scheduled in the coming week to hash
them out.
"There's no plans in place," said Dr. Stephen Tomlanovich, medical
director of UC San Francisco's renal transplant service. "Nor did they
contact us to have an emergency meeting before this press conference."
Dr. Richard Perez, chief of UC Davis' transplant center, said he did
not know the extent of Kaiser's plans until being told by The Times.
"I think in the long run, it's best for the patients," he said. "They
were being taken care of appropriately before [Kaiser took over their
care], and it sounds like it's going to go back to that."
Kaiser's Thode said the transplant program would continue to perform
surgeries on willing patients until the shift was complete. She could
not say when that would be.
During the transition, the HMO will also continue evaluating people who are willing to donate a kidney to a relative, she said.
One key issue is ensuring that patients do not lose their seniority on
a waiting list, which determines the order in which they are to receive
their transplants. In San Francisco, the typical wait for a new kidney
is about six years.
Patient Darlis Beale, who has been waiting seven years, was initially surprised to hear of the HMO's decision.
"Oh my," she said. "Let me catch my breath."
Later she wrote in an e-mail: "That transplant unit fell about as fast
as Ferdinand Marcos and the Berlin Wall. It just caved in on the weight
of lies and maltreatment that it gave to its patients."
Beale, who sued Kaiser on Thursday, is on dialysis, a grueling process that removes impurities from the blood.
Karen Sorensen, whose 74-year-old mother, Corra Mayo, is on Kaiser's
list, was also pleased. Mayo had been at the top of the list at UC San
Francisco in early 2004 but still has not received a transplant under
Kaiser's program.
"They were probably going to get shut down anyway, so this is just them
voluntarily doing it themselves," Sorensen said. "You can't have this
kind of a screw-up with this many peoples' lives" and stay open.
The failure of the San Francisco transplant program is a setback for
Kaiser, which had said that bringing transplants in-house would provide
patients with coordinated care among physicians, labs, pharmacies and
hospitals.
Instead, many patients experienced disarray — and deteriorating
health. They complained that relatives willing to be living donors were
put off or inexplicably rejected. They said their calls were not
returned and they sometimes received conflicting advice from their
Kaiser doctors.
The Times reported Friday, for instance, that one Kaiser patient said
his doctor handed him a telephone number, recommending that he seek a
kidney in the Philippines rather than waiting to get one in the Kaiser
program.
Kaiser members are part of a unique healthcare entity that runs both a
health plan and a hospital system. Except in rare circumstances,
members get their care from Kaiser hospitals and affiliated Permanente
medical group doctors only.
Friday's decision does not affect patients in Southern California,
where members needing transplants are sent to outside hospitals with
which Kaiser has contracts.
Though somewhat taken aback at the giant HMO's move, officials at both
UC hospitals said that they would make whatever accommodations are
necessary for the returning Kaiser patients.
UC San Francisco already has discussed adding evaluation clinics to
handle the influx and putting transfer forms on its website for
patients to download and send in.
Tomlanovich said he is confident that his program can safely handle the
Kaiser patients — hundreds of whom were awaiting kidneys at UC
San Francisco before 2004. The program, which already has 2,741
patients on its kidney waiting list, has eight kidney surgeons and four
nephrologists — kidney specialists — compared with Kaiser's
two surgeons and one active nephrologist.
But, he added, the patients need to understand that "we can't do it in 24 hours."
Officials at the United Network for Organ Sharing, which oversees the
national transplantation system, said they will be actively involved in
the process. The network said previously that Kaiser did not provide
adequate notice that it planned to transfer so many patients to its
program in 2004 — creating problems that delayed the transition.
Network spokesman Joel Newman said officials hope to learn from that experience.
"We'll do everything that we can to ensure that the transfer is as quick and as efficient as possible," he said.
Kaiser's announcement makes it the third transplant program in California to close in recent months.
St. Vincent Medical Center in Los Angeles halted its liver program in
September after officials admitted that in 2003, its doctors improperly
arranged for a transplant to a Saudi Arabian national using an organ
intended for a higher-priority St. Vincent patient. Staff members then
falsified records to cover the situation up, officials have said.
UCI Medical Center in Orange shut down its liver program in November
after The Times reported that 32 liver transplant patients died in 2004
and 2005 while the hospital turned down viable organs that could have
saved some of them. For more than a year, the hospital had no full-time
liver transplant surgeon to perform the operations.
But Kaiser's program is many times larger than those.
"I have made a personal commitment that no patient will slip through
the cracks," said Ehnes of the managed care department, which plans to
appoint a monitor to track the transition process. "Our paramount
concern is for patient safety." She is also insisting that Kaiser staff
a 24-hour helpline for patients: (800) 390-3508.
The suspension of Kaiser's program does not halt investigations by the
state and federal governments, or Ehnes' own agency, into its failures.
The probes could bring severe financial penalties.
Asked whether the program could reopen, Thode said, "We don't know at this point."
Charles Ornstein may be reached at charles.ornstein @latimes.com and Tracy Weber at tracy.weber@latimes.com.
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