Inadequate Care Found in UCI Kidney Program

The University of California-Irvine Medical Center's kidney transplant program did not adequately train staff, monitor the diets of transplant patients or regularly conduct required reviews of care, according to a CMS report released Wednesday, the Los Angeles Times reports (Ornstein, Los Angeles Times, 2/16). The report was based on a December 2005 inspection (AP/Contra Costa Times, 2/16).

According to the report, the kidney program "did not ensure that nursing and other direct care staff completed training for the care of transplant patients," and nurses on duty did not know the "basic dietary evaluation requirements for the post-transplant patient."

CMS said it found a "lack of evidence that the nurse manager had a minimum of one year experience caring for kidney transplant patients" (Bernhard, Orange County Register [1], 2/16).

The report also criticized UCIMC for failing to provide peer review for care provided to kidney transplant patients. One medical staff member told an inspector that "there was no member of the medical staff who either had the expertise or competency" to conduct the reviews.

UCI Chancellor Michael Drake said, "Whatever changes are necessary are going to be made, period."

In a response to the CMS report, UCI officials said they had improved training and oversight in the program and had established a system for reviewing patient care. Officials added that none of the problems cited in the report caused patient harm, and the program remained certified.

UCI also said it would provide a written explanation for each kidney turned down for patients on the hospital's waiting list (Los Angeles Times, 2/16).

UCI is expected to release the results of an internal review of the hospital and its liver-transplant program as soon as Thursday (Bernhard, Orange County Register [2], 2/16). The liver program closed in November 2005 after losing federal funding. An Aug. 5, 2005, report by CMS found that more than 30 patients at the UCIMC died awaiting liver transplants after the hospital turned down organ donations because of staffing shortages (California Healthline, 11/11/05).

The report is expected to discuss the causes of recent problems and ways to prevent similar problems from happening in the future (Orange County Register [2], 2/16). The report also will include recommendations to address deficiencies at the hospital (Los Angeles Times, 2/16).

Last week, officials for the United Network for Organ Sharing told UCI officials that UNOS is considering penalties after reports of problems in the hospital's liver and kidney transplant programs and the discovery that UCI officials misled the network about staffing issues and other problems.

Two people with knowledge about the issue said one sanction being considered could force the kidney transplant program to close, the Times reports.

However, another person familiar with the matter said that sanction might be unlikely because improvements have been made within the program and UNOS would be reluctant to close a program unless it was beyond recovery, according to the Times (Berthelsen/Mehta, Los Angeles Times, 2/11).