Kaiser Permanente’s Kidney Transplant Program: Kaiser Mismanagement Under Investigation

News reports have revealed that the California Department of Managed Health Care began an investigation of Kaiser Permanente’s kidney transplant program for Northern California in late March 2006, after receiving information from a confidential source. Kaiser was said to have turned over documents to the regulatory agency on May 2, 2006.

Kaiser Permanente is a not-for-profit organization that administers both managed care and hospitals. The California Department of Managed Health Care has jurisdiction over managed care services under The Knox-Keene Health Care Service Plan Act of 1975 and regulations. Though the Department does not have jurisdiction over hospitals, it can regulate patient access to services and oversight and referral procedures. If it is found in violation of California laws and regulations, Kaiser could lose its license for managed care in California or face a large fine.

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Up until mid-2004 Kaiser contracted with UC San Francisco and UC Davis to provide kidney transplants for Kaiser members. When it decided to handle kidney transplants itself, Kaiser cancelled care contracts with UC San Francisco and UC Davis and notified approximately 1,500 members by letter that they were to be transferred to the new Kaiser program in San Francisco. Several problems arose with this change.

Kaiser did not immediately transfer patients to the new program, so many patients were left without eligibility for a transplant for a long period of time. Transfer of a patient involves registration with the federal contractor that is responsible for overseeing kidney distribution, UNOS (United Network for Organ Sharing). Without a proper registration, a patient is not eligible to receive a kidney. Eligibility depends on the length of time the patient has been waiting, so a proper transfer must include a transfer of waiting-time credit. Many delays and errors were reported in Kaiser’s attempts to make these transfers, and one year into the program 330 out of the original 1,500 patients had not been transferred. At the time the investigation was begun—almost 2 years after Kaiser notified members that it was canceling care contracts with Northern California University hospitals—a reported 220 had not had their waiting time transferred properly and 6 had not been transferred at all. The first of the former UC Davis patients were not transferred until 4 months after the contract with UC Davis was cancelled.

Because of the delays in transfers, some patients missed opportunities to receive kidneys. UC San Francisco doctors revealed that they had 25 cases of kidneys with antigen matches for Kaiser patients. Kaiser refused to authorize UC San Francisco to do the transplants, so the organs had to be refused. No one informed the patients that they were missing a possible opportunity to receive a new kidney.

Kaiser appears to have taken on the transfer of 1,500 patients to the new program without the ability to provide them all with transplant services. In the first year of the new program at Kaiser’s San Francisco hospital, only 56 kidney transplants were performed, even though 168 or more had been performed at UC San Francisco and UC Davis in each of the 2 preceding years. Kaiser performed transplants for only 3% of the members on the waiting list, while other hospitals in California performed transplants for 12% of the patients on their waiting lists. At Kaiser, almost twice as many patients on the waiting list died as received transplants, while statewide over twice as many patients received transplants as died on the waiting list.

Kaiser’s kidney transplant program has been plagued with management and staffing problems. The first administrator of the program left a few months into the program and a second was terminated after a year. Another kidney specialist walked out, and Dr. James Chon was placed on administrative leave after a dispute with the newest administrator and after writing a 12-page letter to a Kaiser official outlining the problems in the program. The newest administrator, Dr. Sharon Inokuchi, was relieved of her administrative duties to attend to patient care according to a May 7, 2006 article. She was the only doctor left at the hospital to manage patient care for transplant patients at that point. Inokuchi had claimed on May 3, 2006 that she had not refused UC San Francisco permission to perform transplants, a statement Kaiser had to retract because Chon indicated that he had contacted her directly.

For information on the dangers to patients from kidney transplant delays See Kaiser Permanente’s Kidney Transplant Program: Kaiser Mismanagement and Patient Injuries.

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