"We Really Did Screw Up" - ' First Missteps' (
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FIRST MISSTEPS
Kaiser stopped outsourcing kidney transplants in Northern California and brought them in-house in 2004. Because Kaiser already provided both pre- and post-transplant care for its insurance patients, doing the surgeries in between would "provide greater integration of care and convenience for transplant patients," says Schiffgens, the Kaiser spokesman.
If it could perform the 100 transplants per year it projected, Kaiser, nearly overnight, would preside over one of the largest kidney programs in the country.
After the state and federal investigations last May, regulators determined that Kaiser executives "failed to oversee" the transplant program, DMHC wrote. Nor were they "apparently even aware of the significant planning and other activities that would be required to transfer 1,500-plus members from the transplant lists of external providers, into the new Kaiser renal transplant program."
"The cumulative effect," Medicare concluded, "resulted in failure of the center to deliver statutorily mandated services and comply with federal requirements."
At that point, Kaiser gave up on the center. Faced with either fixing it or losing Medicare funding, the company avoided both scenarios: Within days of the inspectors leaving Kaiser's offices, Kaiser said it would transfer all of its patients 2,313 by then back to UC, then shut the center down.
Kaiser has paid a $2 million fine to DMHC for the deficiencies the agency cited after its investigation, the largest fine ever dealt by the state to an HMO. Kaiser also volunteered $3 million in contributions to a transplant education group.
But other investigations may be in the works. Arthur Weatherford, assistant chief of investigations at California's Bureau of Medi-Cal Fraud and Elder Abuse, which investigates medical harm of the elderly, exchanged e-mail about Kaiser with Merlin, a former administrative director of the Kaiser center and, later, the whistle-blower who exposed Kaiser's problems to regulators and the media. Weatherford didn't return Baseline's calls. A source inside the bureau confirmed that it is looking into the matter but wouldn't say on what grounds.
DMHC, meanwhile, continues to investigate how Kaiser handles patient complaints. Burks and at least 50 patients and families of people who died waiting for kidneys at Kaiser are suing the company in separate cases for, among other charges, medical negligence or wrongful death. Kaiser declined to discuss the lawsuits.
"Something went awry here and nobody may ever know what," says Jim Morell, president of Morell & Associates, a health-care consultancy in Northbrook, Ill., that has no direct knowledge of the transplant center, but has been following public accounts of what happened. "Kaiser made a decision going forward that it's not worth what it had to do to clean it up."
Core questions remain, including why it wasn't until Kaiser decided to close the center that it put in information technology, such as custom spreadsheets and a virtual private network between it and UC, to help manage patient data. Why, despite Kaiser's pioneering work in electronic medical records since the early 1990s, the new transplant center apparently managed most incoming patient data on paper. Why it didn't use one of the specialized transplant databases available from health-care technology vendors. Why it wasn't until the end that Kaiser developed basic policies and procedures, such as weekly meetings and monthly reports, to ensure data didn't go missing and appropriate parties stayed apprised of Kaiser's progress with patient records.
The lawsuits may eventually produce answers, through testimony and documents. However, court filings show Kaiser lawyers are working to get the suits out of open court and into arbitration, where the company usually settles legal disputes with patients.
As the story continues to unfold, so do warning lessons, health-care consultant Morell says. In trying, as many companies do, to get information across boundaries, between organizations, and from paper to electronic form, he says, "you have the opportunity for everything to go wrong which it obviously did."
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