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Kaiser
Told to Fix Problems With Kidney Patient Hotline
Some
seeking answers on the transition to UC transplant programs express
frustration over the poor quality of data. By
Charles Ornstein and Tracy Weber, Times Staff Writers May 18,
2006
State regulators Wednesday ordered Kaiser
Permanente to fix communication foul-ups stemming from the abrupt
suspension of its Northern California kidney transplant program after
learning that some patients were unable to get satisfactory answers to
their most basic questions.
Days
after Kaiser and regulators promised patients a smooth transition to
outside programs, The Times found that anxious callers had trouble
getting through to a 24-hour hotline or had been given baffling,
incorrect or useless information about their care. In response to the problems
identified by the newspaper, the state
Department of Managed Health Care told Kaiser to beef up its hotline
staff "by whatever means necessary," improve the quality of information
provided to patients and guarantee that a knowledgeable clinician is
available to respond to questions within 48 hours.
"This
has been all hands on deck," said Cindy Ehnes, director of the managed
care department, adding that she would be personally involved in
correcting the problems. "Everybody's scrambling."
Ehnes encouraged patients with unresolved complaints to call her
department's help line at (888) HMO-2219.
Kaiser announced the program's suspension Friday after a series of
reports in The Times found that patients were imperiled in mid-2004
when the HMO ordered about 1,500 of them to transfer to its new center
in San Francisco. They had been treated in established programs at UC
San Francisco and UC Davis, under contract with Kaiser.
In
announcing the suspension, Kaiser officials said they sought to ease
patients' worries about their care. They promised that a hotline would
be staffed "24/7" to answer any questions or concerns.
But Walter Jewell said that he called the hotline an hour after it
opened and that no one answered.
Archie
Graham said that when he phoned days later, complaining that Kaiser had
relied on the media to alert the 2,000 patients on its waiting list of
the shutdown, an operator said: "I totally agree."
And when a
staffer returned a call from Phillip Maxson and his wife, Marianne, the
couple said the woman was unable to answer their questions, because she
had been on the job just three days. Instead, they said, she offered
excuses for Kaiser's poor performance — citing, among other
things, a
dearth of cadaver organs caused by tough auto-safety standards.
"I almost dropped the phone," said Marianne Maxson. "She was some poor
chump they hired to read this script."
Kaiser
officials conceded Wednesday that there were problems with their
hotline — (800) 390-3508 — and said they were
working with the managed
care department to fix them.
"We're going to be very clear about
what our people tell people at the other end of the line," said Rick
Malaspina, a Kaiser spokesman.
Some patients said they felt whipsawed by Kaiser's rapidly changing
statements over the last two weeks.
As
of the middle of last week, the giant HMO was touting the quality of
its program and doctors were calling patients to assure them that they
had no reason to worry. A few days later, patients said, they learned
from the news media that the program was closing.
Patients aren't the only ones feeling confused.
Dr.
Stephen Tomlanovich, medical director of the renal transplant service
at UC San Francisco, said that during a meeting Monday, Kaiser
officials vowed to phone all of the HMO's transplant patients to inform
them of what was happening with their cases. (UC San Francisco stands
to receive the bulk of Kaiser's patients; the rest will go to UC Davis.)
"We
were led to believe that Kaiser was going to be actively calling
patients to explain to them what was going on with the transplant
program," he said.
Malaspina said Wednesday that the HMO had
no such plans — even for patients close to receiving a
transplant.
Instead, Kaiser will soon send out form letters explaining the transfer
process, he said.
Kaiser plans to continue performing transplants for willing patients
until the transition is complete.
The
transfer process is not simple, and if carried out improperly, can harm
patients' prospects for a kidney. Hospitals must fill out forms with
personal information on each patient they accept. Patients must also
give written consent to have credit for their waiting time —
a key
factor in obtaining a kidney — transferred to a new program.
When
Kaiser opened its program, it submitted many incomplete and inaccurate
forms, delaying the transfer for hundreds of patients. These patients
were essentially cut off from transplants for months.
And 25
patients who had been treated at UC San Francisco were denied the
chance to receive kidneys that were ideally matched to them because
Kaiser directed the university to reject the organs during the
transition between programs.
With the current confusion, Tomlanovich said he is worried that a
patient could lose a chance for a kidney.
"I
want to believe that the patient will not miss an opportunity," he
said. "I don't know that this is not going to be a possibility."
UC
Davis officials, who met Tuesday with Kaiser representatives, said they
are doing everything possible to make sure the transition goes well. "We want to do it right,"
spokeswoman Carole Gan said. "Nobody wants what they did. Nobody wants
another Kaiser."
That's
Erin Cronshagen's worry. "I just feel like I'm in limbo right now,"
said the 31-year-old medical assistant who has been waiting more than
four years. "We're not just pieces of paper."
Cronshagen, who
had her first kidney transplant at age 7, said she has faith in UC San
Francisco but not in Kaiser. "I just don't understand how all of that
is going to work. I don't think [Kaiser officials] know what's going on
either, which is really sad."
Ana Polanco could use some reassurance right now.
She
said thrice-weekly sessions of dialysis had sent her husband, Victor,
into a suicidal depression that was only eased by intensive
psychotherapy and constant reassurance from Kaiser that he was on the
verge of getting a kidney.
"They say, 'Victor, you're No. 1 on the list.' They've been telling him
that for about five months," she said.
But
since the San Francisco couple learned of the program's suspension,
they said, they've heard nothing — and Ana Polanco fears that
the delay
will affect her husband physically and mentally.
"We have not heard from Kaiser, 'I'm sorry, Mr. Polanco,' " she said.
"I hope [the transition] works, because I'm very worried."
Some patients say Kaiser has treated them well and they're confident
the switch to the UC programs will be successful.
Jessica
Collins, a 50-year-old teacher from Hayward, said that even though
she's been on the waiting list 10 years, she's in no hurry to get a
kidney.
"I just am doing fine on dialysis," she said, adding that her primary
concern is whether a new kidney will work if she gets one.
Collins
said that she has no problem moving back to UC San Francisco but that
she's been happy at the HMO. "I have no problems with Kaiser," she
said. "None."
A spokesman for the United Network for Organ
Sharing, a federal contractor that oversees the nation's transplant
system, said Wednesday that officials have had "very preliminary"
discussions with Kaiser about how to transfer patients to the UC
hospitals but that nothing has been put in writing. "A lot of those logistics need
to be worked out," Joel Newman said.
Among
the questions that regulators and doctors are still considering: Are
the UC hospitals willing to take the Kaiser patients they previously
treated without evaluating them first? Will the patients who have been
solely on Kaiser's list need to be seen by the UC programs before their
care can be transferred?
Physicians involved with the Kaiser
transplant center have declined to comment about the transition or
anything else. Head surgeon Arturo Martinez, who started up the
program, told a Times reporter, "You should be ashamed of what you've
done," before hanging up the phone.
Phillip Maxson is trying
not to get too frustrated. But as the days slip by, he is feeling
desperate. His wife's company has been sold, and she is losing her job
June 30. That means he will lose his health insurance. It is unclear
whether transitional coverage will pay for a transplant.
Since Friday, he said, he has spent hours on the phone trying
unsuccessfully to find out his fate from Kaiser.
"It's like trying to talk to a used car salesman after you bought the
car," he said.
Tracy Weber may be reached at tracy.weber@latimes.com; Charles Ornstein at charles.ornstein@latimes.com.
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