CMS Report Finds Widespread Problems at Kaiser Kidney Program
Deficiencies at Kaiser Permanente's kidney transplant program in Northern California affected nearly every aspect of the program, but Kaiser officials did not intervene or seem aware that patients were at risk, according to a CMS report released Friday, the Los Angeles Times reports.
The report states that Kaiser did not assess the program's "ability to continue to meet the needs of the increasing number of patients and those others already in the program, to prevent or minimize service interruptions and facilitate efficient delivery and continuity of care."
Kaiser announced last month that it will close its kidney transplant center. Several news reports alleged program mismanagement that compromised patient care (Ornstein/Weber, Los Angeles Times, 6/24).
CMS inspectors said Kaiser remains out of compliance with federal hospital standards in management, patient rights, and responsibilities and oversight by its director.
The report also found:
- 24 patients were offered "zero-mismatch" kidneys last year, but Kaiser declined all of them;
- As of May -- 20 months after the program opened -- the status of 86 patients in the program was listed as "unknown";
- As of May, six patients were on an "inactive" list, meaning that they would not receive a kidney even if a perfect match was found and they were on the top of the waiting list (Vesely, Oakland Tribune, 6/24);
- Kaiser did not notify patients about longer wait times for a transplant at its San Francisco facility, a condition that results from the way organs are distributed nationally;
- Kaiser did not provide adequate information to Medicare beneficiaries who receive benefits through Kaiser about undergoing transplants at the University of California-San Francisco and UC-Davis if the beneficiaries were willing to pay a higher deductible (Russell, San Francisco Chronicle, 6/24);
- Three registered nurses in the program had "little or no knowledge of the assessment and care of pre-transplant patients";
- A data coordinator whose job was to ensure wait times were properly transferred had only one hour of phone training on how to use the United Network for Organ Sharing computer system. UNOS oversees the nation's transplant system; and
- Kaiser did not review and evaluate all aspects of the program "to ensure the delivery of quality care to patients" (Los Angeles Times, 6/24).
The report did not say whether any patients died as a result of the deficiencies.
Kaiser has submitted to federal authorities a plan of correction, which is still being reviewed. The proposal details plans for more intensive patient monitoring in collaboration with state health officials, documentation and planning of audits and better communication with patients.
CMS inspectors will return to the facility after a corrective plan is approved. If the facility fails that inspection, CMS has set a mid-August date for the HMO to lose federal funding for some kidney treatments (Oakland Tribune, 6/24). CMS would bar the San Francisco facility from receiving federal reimbursements for end stage renal disease treatments.
Although Kaiser has announced it will close the program, doctors will continue performing transplants until all patients are transferred to kidney programs at UCSF or UC-Davis (Los Angeles Times, 6/24).
On Thursday Kaiser Senior Vice President Michael Alexander, who oversaw the San Francisco hospital, announced his retirement. A spokesperson said it was a personal decision unrelated to the kidney program (San Francisco Chronicle, 6/24).
The Department of Managed Health Care also is investigating the HMO and could levy fines against Kaiser (Oakland Tribune, 6/24).