Kaiser put kidney patients at risk

From the L.A. Times:

By opening its own transplant center in the Bay Area, the HMO harmed recipients’ odds of obtaining organs, a Times probe finds.

By Charles Ornstein and Tracy Weber, Times Staff Writers
May 3, 2006

In mid-2004, more than 1,500 Kaiser Permanente patients awaiting kidney transplants in Northern California got form letters that forced them to change the course of their treatment.

Kaiser would no longer pay for transplants at outside hospitals, even established programs with thousands of successes. Instead, adult patients would be transferred to a new transplant center run by Kaiser itself ? the first ever opened by the nation’s largest HMO.

Within months after Kaiser’s kidney program in San Francisco started up, its waiting list ranked among the longest in the country. No other center had ever put together such a list so fast.

The patients didn’t know it, but their odds of getting a kidney had plummeted.

Kaiser’s massive rollout in Northern California endangered patients, forcing them into a fledgling program unprepared to handle the caseload, according to a Times investigation based on statistical analyses, confidential documents and dozens of interviews.

Hundreds of patients were stuck in transplant limbo for months because Kaiser failed to properly handle paperwork. Meanwhile, doctors attempting to build a record of success shied away from riskier organs and patients, slowing the rate of transplants performed.

National transplant regulators apparently did not notice the program’s failures, though some were obvious in the statistics the regulators themselves posted on the Internet.

In 2005, the program’s first full year, Kaiser performed only 56 transplants, while twice that many people on the waiting list died, according to a Times analysis of national transplant statistics.

At transplant centers statewide, the pattern was the reverse: More than twice as many people received kidneys than died.

Kaiser also suffered by comparison to the two outside hospitals that previously had tended to its Northern California patients. In each of the two years before Kaiser opened its program, UC San Francisco and UC Davis medical centers together performed at least 168 transplants on Kaiser patients, three times as many as Kaiser managed in its first full year.

“If they couldn’t handle as many as they were doing before, they should have just transferred some” patients, said Neva Smith, whose daughter, Alison Bertino, was moved to Kaiser from UC San Francisco.

Bertino, 30, died last June while waiting for a kidney.

It is difficult to say whether she or any other Kaiser patients died as a direct result of the program’s faltering start. What is clear is that many fewer patients received transplants than before, forcing them to remain on grueling sessions of dialysis to remove impurities from their blood. Prolonged dialysis can lead to deadly complications and decrease the chances of a successful transplant later.

The problems at Kaiser went beyond mere growing pains, current and former employees said: Surgeons and kidney specialists battled over who should receive transplants. Desperate patients complained of inexplicable delays. Since the program opened, 10 permanent employees have quit or been fired out of a staff of 22.

“On the outside, the program seems to have settled into a reasonably functioning unit,” kidney specialist Dr. W. James Chon wrote to the hospital’s physician-in-chief Jan. 23, not long before he was placed on administrative leave.

“However, a closer look at the program will show that it is suffering from very serious and potentially explosive problems,” he said.

In interviews with The Times, Kaiser officials initially denied that there were problems. “Everything has been going on track,” head transplant surgeon Arturo Martinez said last week.

Since then, other officials have acknowledged that the program had provided The Times with incomplete or misleading information. The chief physician at Kaiser’s main San Francisco hospital conceded that the issues were “very serious.”

Read the full story here.

More:

May 4, 2006, from the L.A. Times: Kaiser Denied Transplants of Ideally Matched Kidneys

May 4, 2006, from the San Francisco Chronicle: State to investigate Kaiser organ program — HMO responds to inquiry into kidney transplants

May 5, 2006, from the L.A. Times: Kaiser slow to transfer patients

Previously:

Feb. 16, 2006, from San Francisco Business Times: Kaiser transplant exec exits after only two months