Kaiser Permanente’s Kidney Transplant Program: Kaiser Mismanagement and Patient Injuries

Ruben Porras, a pressman in his 40s with the Sacramento Bee, had been waiting for a kidney at UC Davis for 3 years. In 2004 he expected to become eligible to receive a kidney very soon; that is, until Kaiser cancelled the program at UC Davis. Porras was put on inactive status in November 2004—so that he couldn’t receive a kidney—and was not transferred to Kaiser’s San Francisco program until September 2005. Because kidneys are given out by geographic regions, and it is more difficult to get a kidney in populous San Francisco than in Sacramento, Porras’ expected waiting period lengthened from the 3 years he had already waited to around 6 years. Porras wasn’t informed of the change in his situation.

In the meantime, several of Porras’ relatives had volunteered to donate a kidney for him and they were being assessed as possible donors at UC Davis. When Kaiser cancelled the contract with UC Davis, the assessments there were cancelled and no assessments were ever done at Kaiser. When relatives tried to call Kaiser to continue the assessments, no one at Kaiser returned their phone calls. Less than one month after his transfer to the long San Francisco waiting list was finally completed, Porras died from an infection connected to his continued dialysis treatment. He was 47.

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Porras’ case is not unique. There have been many other reports of mismanagement at Kaiser’s new San Francisco kidney transplant program. In another case, 63-year-old James Klinkner quickly completed and sent in his forms when he was told that he was being transferred from the program at UC San Francisco to Kaiser’s San Francisco hospital. The form was apparently lost or not processed by Kaiser, and they sent Klinkner another one to fill out. He called the medical director of the program to find out what had happened, but his call wasn’t returned. Klinkner died from complications from dialysis just 3 days after he turned 64.

How did all this happen? And why? Up until mid-2004, Kaiser had contracts with UC Davis and UC San Francisco to handle Kaiser’s kidney transplant patients. Then Kaiser decided to open up its own kidney transplant program in San Francisco. Kaiser cancelled its contracts with UC Davis and UC San Francisco and its plan was to transfer all Kaiser transplant patients to the new Kaiser program. But the transfers did not go well, and some were delayed, leaving those patients without eligibility for a long period of time.

Reports now reveal that hundreds of patients were removed from transplant eligibility lists for months, and some were refused authorization for transplants at UC San Francisco when possible kidney matches became available. Complicating matters further, it is now difficult to find the patients who were affected because patients were never notified that Kaiser had cancelled its kidney transplant contracts with UC Davis and UC San Francisco. Kaiser is now under investigation by the California Department of Managed Health Care.

For more information about the Kaiser investigation, see Kaiser Permanente’s Kidney Transplant Program: Kaiser Mismanagement Under Investigation.

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