Reports Find Deficiencies at St. Vincent, UCI Liver Transplant Programs
St. Vincent Medical Center is not in compliance with eight conditions that must be met to receive federal funding for its liver transplant program, according to an October 2005 report by CMS, the Los Angeles Times reports (Ornstein, Los Angeles Times, 12/28/05). Hospital officials suspended the program in September 2005 upon discovering the case in which a patient who was 52nd on a regional transplant waiting list received an organ ahead of others (California Healthline, 11/4/05).
According to the report, in several instances staff members were asked to falsify documents to cover up the improper transplant. Staff members who knew about the ethical breach said a working environment of "'fear and retribution'" prevented them from voicing complaints or grievances and making recommendations, the report states.
The report also found that the lead transplant surgeon at the hospital misled the patient for whom the liver originally was intended into believing he was still a candidate for a liver, although the patient's name had been removed from the waiting list.
CMS found other problems at the hospital unrelated to that transplant, including a lack of hospital records showing patients received physical examinations, appropriate screening tests or psychosocial examinations before being added to the waiting list. In addition, the report found no records that a selection committee reviewed transplant candidates before they were added to the waiting list.
The hospital could lose federal funding if the problems are not addressed adequately, according to the Times.
Hospital officials acknowledged that "a number" of staff members knew about the improper transplant and participated in the alleged cover up, the Times reports.
The hospital said it has created a new transplant committee that reports directly to the hospital's governing board and has provided additional training to transplant staff members. The hospital also has developed new ethics materials and set up a hotline for employees to report concerns about quality at the hospital. In addition, the hospital said it is improving its documentation methods.
Lawyers for administrators of the transplant program denied any wrongdoing in the case (Los Angeles Times, 12/28/05).
A three-member team appointed by the United Network for Organ Sharing that reviewed the liver transplant program at the University of California-Irvine Medical Center in July 2003 found seven "deficiencies and concerns" related to the program, the Orange County Register reports. The review, conducted by two doctors and a transplant administrator, found a critical shortage of transplant surgeons, financial disincentives to perform transplants and deficiencies in tracking and treating patients.
UNOS in May 2004 recommended closing the program, citing a lack of "forward progress," but UCIMC persuaded the organization to allow the program to continue (Knap/Edds, Orange County Register, 12/23/05).
In related news, nine families of patients who died while awaiting liver transplants at UCIMC have filed wrongful death lawsuits against the hospital, staff doctors, the former head of the transplant program and the UC Board of Regents, the Register reports.
The lawsuit alleges that the hospital conspired to keep patients on the waiting list as long as possible because of a "strong economic interest" in higher-paying operations. The lawsuit also alleges that patients and their families were misled about a patient's chance of receiving a liver at the hospital (Edds, Orange County Register, 12/24/05).
UCI Chancellor Michael Drake should "offer a more forthright public assessment" of UCIMC's liver transplant program because "[p]eople need to be informed about realities so they can make their own decisions about their lives and the lives of their loved ones," a Register editorial states (Orange County Register, 12/28/05).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.