Programs on probation

A rare sanction by a national organ-Donation network cites deficient patient care and misrepresentations by officials at UC Irvine's beleaguered transplant centers

By Chris Knap and Blythe Beernard

The Orange County Register

March 24, 2006

"It's like a slap on the wrist. It's really an insult to us. I think out of respect for the families who lost their loved ones, they should have shut it down completely. They need to clean house in there." Elodie Irvine, 51, Waited for kidney and liver transplants at UCI for four years, and eventually received new organs at Cedars-Sinai Medical Center. Her lawsuit sparked the Medicare investigation that led to the shutdown of UCI's liver-transplant program File photo: Sang H. Park, The Orange County Register

By the numbers 191: People who got an organ transplant at UCI between 2000-2005 155: People on UCI's waiting list who died waiting for transplants during that time 118: People currently on UCI's waiting list for kidney or pancreas transplants

LONG BEACH -- The national organ-sharing network placed UC Irvine's transplant programs on probation Thursday for deficiencies in patient care and false representations about the availability of surgical staff.

The rare adverse action by the United Network for Organ Sharing is one step below its most serious sanction, designating a hospital as "not in good standing." Some organ-network officials had pushed for that sanction for UCI but the board of directors settled Thursday on probation.

The organ-network directors said UCI must produce a plan for corrective action, including improvements to ensure patient safety and the hiring of additional transplant surgeons for its kidney and pancreas programs. The medical center will still be eligible to receive organs from the national group, but will remain on probation until it has completed its improvement plan

Dr. Francis L. Delmonico, the Harvard professor who chairs the board, commended UCI officials for actions taken so far to resolve problems in their transplant program. But he said probation is necessary to make sure that the improvements are completed.

"This action underscores our commitment to maintain the highest standards for quality of care and safety... and to maintain public trust in the nation's transplant system," Delmonico said.

UCI officials did not attend the meeting, but said they are committed to improving the kidney-transplant program.

"We're working very hard to demonstrate that our program is first-rate," said Eugene Spiritus, chief medical officer.

The closure of UCI's liver-transplant program proved an embarrassment to the organ network, which is charged by the federal government with tracking patient care at its member hospitals.

The organ network was moving to shut down UCI's liver program in 2004 because of the low volume of transplants at UCI and lower-than-average patient survival.

But the network relented in July of that year after Ralph Cygan, then chief executive of the Medical Center, and Dean of Medicine Thomas Cesario, met face to face with the network's standards committee. Cygan assured the committee that a surgeon from UC San Diego, Marquis Hart, would be taking over transplantation at UCI.

In fact, Hart never left his job at UC San Diego, and instead split his time between the two hospitals. Eight or fewer liver transplants were performed at UCI in 2004 and '05, a period when more than 100 people were on the waiting list to get new livers.

Dozens died without getting new organs.

Federal auditors for Medicare eventually discovered, in July 2005, the lack of full-time surgical coverage at UCI.

The liver-transplant program was shut down in November after federal officials disqualified UCI from transplanting Medicare patients.

Although UCI is the only transplant hospital in the country on probation, it is not the only one that has been sanctioned this year. On March 3, the organ network designated St. Vincent Medical Center in Los Angeles as a member not in good standing for transplanting a liver into a Saudi national ahead of 50 sicker patients in 2003, then covering up the switch.

The organ-network board, meeting this week in Long Beach, spent much of its session working on stricter standards and procedures it hopes will prevent similar problems at other hospitals.

"We were heavily burned this past year," said Dr. Sue McDiarmid of UCLA, chairwoman of the organ group's Membership and Professional Standards Committee. "We learned a lot of things the hard way."

The changes include:

• Requiring hospitals to notify the organ bank of investigations by other regulatory agencies, such as the audit by Medicare that eventually closed UCI's liver program.
• Closer monitoring of hospitals that refuse a large number of organs, a warning sign that, at UCI, went unnoticed.
• Shorter timelines for allowing struggling hospitals to make improvements.
• Closer monitoring of transplant surgeons, including doctors running more than one program and surgeons who have previously worked for a sanctioned program.
• A confidential hotline for patients or whistle-blowers who want to report problems.

"The important thing to know is that the board takes this seriously," said Delmonico, the chairman

"We are going to change this system and make it better."

CONTACT US: (714) 796-2240 or cknap@ocregister.com

Copyright © 2005 The Orange County Register.

This article posted April 14, 2006.