Kaiser Permanente SF Facing Transplant Troubles?

By Anna Werner

Reporting

 (CBS 5) SAN FRANCISCO There are over 15,000 patients waiting for a kidney transplant in California and although the procedure has become almost routine, waiting for an organ is still difficult. But now, a CBS 5 investigation has uncovered serious questions about the kidney transplant program at Kaiser Permanente San Francisco, leaving some patients to wonder why it's taking so long?

Corra Mayo says she's learned by now, all she can do is sit, and wait. "One day at at a time, that's what you have to do," she says. Mayo needs a kidney transplant because of a genetic kidney disease so, she says in 1999, her HMO - Kaiser Permanente - referred her to UCSF Medical Center to be put on the waiting list. "I was a Kaiser patient and they didn't do transplants," she explains.

And in 2004, Mayo believed she was about to get one at UCSF. "I thought I was at the top of the list there."

But before that could happen, Kaiser announced they would take over doing those transplants themselves rather than paying UCSF to do them. And they sent her a letter, promising: "...you will not lose your place on the waiting list."

So what happened? "Never heard from 'em. Never heard from Kaiser," says Mayo. She says, never heard for a year. And when the family finally did get someone at Kaiser to respond? "They didn't recognize the case, and thought they must've misplaced my chart. They didn't know where it was." She says they didn't even seem to know who she was.

So now Mayo, who expected to wait four years for a new kidney, has been waiting seven. "It's sort of a fatalistic feeling, because I'm almost ready to give up."

Kaiser's kidney transplant program administrators say it's supposed to be a model for the rest of the country. But CBS 5 Investigates has uncovered troubling questions about the program, not just from patients but from insiders. For instance we found two of the center's three transplant nephrologists, doctors who look after kidney patients before and after surgery, although still technically on staff, are on personal leave - and not actually working in the program.

One of them, Dr. James Chon, in an apparent dispute with Kaiser over the status of his employment, wrote a 12-page letter to Kaiser's physician-in-chief in January, detailing problems he saw in the program, including 'numerous resignations' and other internal issues, which the doctor called "very serious and potentially explosive problems".

"I don't agree with the word explosive," says Mike Alexander, a Kaiser executive. "I think that is his opinion. I think we've had a great success rate, we've had the startup challenges any program has, I think there have been some communication issues." But he says when it comes to patients: "I don't believe we held up any transplant process because we were in a startup mode."

But not so, according to David Merlin. "The program as I saw it was disorganized, information was misplaced, lost, entire patients were lost for long periods of time. Merlin is the former administrator for Kaiser's transplant program.

Anna Werner: "You mean they lost track of patients?"

"Yes," says Merlin.

So what's the problem? Merlin claims Kaiser's transplant program was set up poorly, and still today is disorganized. "I had administrative staff and nursing staff bringing me phone messages and patient charts, here's another one, here's another one, here's another one that fell through the cracks and that was a term they used often."

And the effect on patients? Merlin says many were left waiting, he recounted one who he says asked him personally: "So David, does this mean that I have lost potentially two and a half years on the wait list. In my mind when he asked that question I knew, I was saying yes!"

And Merlin says: "Many, including myself, were concerned that some patients may have had a tremendous decline in their health status because of the neglect that had occurred. And the patients have a right to know."

"Mr. Merlin is misinformed, or providing misinformation." responds Dr. Sharon Inokuchi, who heads Kaiser's kidney transplant program. "Every single Kaiser patient was taken care of by Kaiser. We transitioned their care as smoothly as we could." Of any patients they lost track of, she says: "They did not suffer any disadvantage as a consequence."

But was that true of Corra Mayo? Both she and her daughter said they tried to make numerous contacts time and time again with Kaiser and no one would ever return their phone calls. "Right. It's unfortunate that patient perception or in fact their angst, may not actually be revealing events as they actually occurred." When we pointed out that her daughter's a nurse, "Yes, well, we're all professionals," says Inokuchi.

And even though Mayo says she was recently told she is now at the top of Kaiser's transplant list? Inokuchi says, "She's not at the top, there are a good deal of patients in the region who have much more waiting time than she does. So she must wait for an appropriate and compatible kidney donor. Because she is not without her medical risks. It is not entirely clear that this patient will be best served by a kidney transplant."

But just a few hours after we finished that interview, Kaiser officials called to bring Corra Mayo into the hospital for a transplant. And she's now in the hospital waiting for that kidney transplant.

And a note about David Merlin: he says after working for Kaiser for two months, he was fired and will be filing a lawsuit in the coming weeks. Kaiser administrators say he didn't work there long enough to understand their system.

And on another front, we took our questions to the state Department of Managed Care and have now learned that state investigators will be looking into possible delays for patients in the transplant program as well as other questions concerning the program.