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Kaiser Slow to
the HMO opened its kidney transplant center, it failed to alert
regulators to the glut of crucial paperwork coming, officials say.
Permanente launched its
transplant program in 2004 without holding basic discussions with
regulators about how to safely transfer up to 1,500 of its patients
from other programs to its San Francisco center, according to a Times
from the United Network for Organ Sharing, a federal
contractor responsible for overseeing the nation's transplant system,
said this week that they were not notified of the need to move hundreds
of patients to the giant HMO's new program until September 2004, after
it had already opened.
previously paid two
UC San Francisco and UC Davis, to care for its kidney transplant
patients in Northern California.
"This is an
unprecedented situation," United Network spokesman Joel
Newman said in an interview. "Normally when … transfers are
we handle them in onesies and twosies, as they come up."
transition was further complicated by Kaiser's own paperwork, which
was full of "errors or inconsistencies," Newman said in an e-mail to
The Times. Some of the patients Kaiser tried to transfer into its
program weren't even listed in a national database of people waiting
for a kidney, he added.
requires detailed patient information from a medical
center, as well as a patient's written consent, before it will process
Kaiser patients were never told that their transfers had
not been processed, in effect placing a new kidney out of reach,
according to interviews and documents. But many patients and relatives
were suspicious, they say, because the cases seemed stalled and their
telephone calls to Kaiser were not returned.
learning in recent days about what happened, some expressed
the large amount of patients that have Kaiser as their
HMO, they should have realized the impact and have been better
prepared," said Elizabeth Porras, whose husband, Ruben, had been on the
verge of a transplant at UC Davis.
Kaiser not to see its transplant
patients any more, UC Davis placed Ruben Porras and 66 other Kaiser
patients on inactive status in November 2004, rendering them ineligible
for a transplant. But Porras' transfer didn't come through until
Less than a
month later, he died.
my opinion Kaiser gave my
husband … a death sentence," Porras wrote in an e-mail
Thursday to The Times.
under no obligation to notify the United Network that it
would be submitting a mountain of paperwork related to patient
transfers. Nor were there any rules specifying how quickly the HMO's
transplant center could grow or how much information it must give
result, the United Network
was virtually blindsided by
Kaiser's rapid roll-out. The organization was forced to quickly cobble
together a new computer program just to handle the Kaiser caseload,
September 2005, a year after the Kaiser center opened, about 330
Kaiser patients had still not been properly transferred because the HMO
submitted flawed or incomplete paperwork, the network said. Even so,
the agency never stepped in to stop the transition, nor did it
investigate whether patients were being harmed by the move.
bogged down, many patients didn't get
prompt credit for the time they had been waiting for a kidney. In San
Francisco, kidneys are primarily allocated based on how long a patient
time is not transferred through the United Network from
one program to another, it appears that a patient is a new addition to
the list. The patient is then placed at the bottom, pushing a
transplant years into the future.
Klinkner was determined not to lose his place in line.
When he got
word of Kaiser's new program, he quickly sent in a form to
the HMO so he could receive credit for three years of waiting at UC San
Francisco. But the form apparently was not processed, said his son, J.
sent it to him again," the son said of Kaiser.
James Klinkner called the program's medical director to find
out if his transfer went through, but she never got back to him, his
Klinkner died Dec. 13, three days after his 64th birthday, after
suffering complications from dialysis. Kaiser declined to discuss his
patients had little choice but to go through the transfer
process. Because Kaiser runs both an HMO and a hospital system, its
members must receive their care at Kaiser facilities unless otherwise
directed. (In Southern California, Kaiser continues to contract with
outside hospitals for transplants.)
reported earlier this week that Kaiser's takeover of its
members' kidney transplants in Northern California endangered patients.
The number of transplants dropped sharply, leaving many patients on
prolonged dialysis, which can lead to complications and dim prospects
for a successful transplant later.
newspaper has also reported that 25 Kaiser patients 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.
persist. More than 220 Kaiser patients remain on UC San
Francisco's list, their wait time still not transferred to the Kaiser
center, university officials said.
university said this week that it had repeatedly alerted Kaiser
that these patients lingered on its list. But Dr. Sharon Inokuchi, the
medical director of Kaiser's kidney program, said in an interview that
the program had never been notified.
officials now acknowledge that the program had, in fact,
received the list of patients.
HMO's problems have come to light this week, UC San Francisco
has received anxious calls from Kaiser patients asking to come back on
their own dime.
paying out of pocket, kidney transplants can cost $100,000
At UC Davis,
many patients remained on the inactive list for months.
more than four months to move the first UC Davis patient to
its new San Francisco program, according to university spokeswoman
October, a UC Davis employee sent a fax to Kaiser telling the HMO
that the wait time for 11 patients had still not been transferred.
candidates are still waiting to be moved.
thing that could have happened would be for their wait time
to be transferred immediately, and then they would have assumed their
proper place on the list," said Dr. Richard Perez, chief of the UC
Davis transplant program. "Because the wait time transfer was delayed,
I think that hurt their chances for getting a transplant essentially."
Malaspina, a Kaiser spokesman, said Thursday that the HMO had
launched a "high-level, full-scale internal investigation" into its
transplant program and was withholding additional comments until it had
high level of
concern about the accuracy" of
information that Kaiser management has received from officials at its
kidney center, he said.
administrators have provided misleading or
inaccurate information to The Times several times in the last week.
acknowledged that it had erred when it said
that none of its transplant recipients had died since its transplant
center opened. In fact, one did die, officials now say.