"We Really Did Screw Up" - ' Technology, Finally'

In the year since Kaiser said it would close the kidney center, the company has worked to move patients back to the UC facilities and put in new technology and procedures to help. By June 30, 2006, Kaiser had transferred 360 patients. By Dec. 31, 2006, 2,163 patients had been moved. Last month, the last patient left Kaiser's rolls.

A virtual private network between Kaiser and the two UC hospitals allows them read-only access to Kaiser's internal CIPS electronic medical record application. The UC hospitals can print medical records from CIPS, to add to their files as they accept patients back. Kaiser has helped train at least 50 UC people on it and on HealthConnect, Schiffgens says.

UC and Kaiser also agreed on the format and content for data fields in patient records, and Kaiser created a "transfer tracking" spreadsheet to keep a running record of patient information transferred, with daily and weekly status reports generated. Kaiser put in a toll-free line for patient complaints and configured a database for collecting, responding to and analyzing them. Kaiser, the UCs and UNOS met weekly by conference call with DMHC to report progress. Kaiser also underwent monthly audits for compliance to UNOS wait-list policies, added another data coordinator to help de Belen and named a CEO for the center.

This work after the fact, to set up technology and define procedures, shows Kaiser's 2004 launch of the center "wasn't thought through properly," says patients' attorney Eisenberg. "They didn't do proper due diligence on what it would take to open a program of this nature."

For Ed Japitana, a nurse consultant at Medicare who investigated Kaiser, the problems came down to two things: not enough staff and not enough well-considered policies. From the beginning, when Kaiser sent initial paperwork to patients and gathered medical records from UC, more time should have been allowed, and more resources applied, to data management, Japitana says.

"The delay was in staffing and policies and procedures," he points out. "Kaiser should have taken this into account, but didn't."

As Merlin puts it: "They just opened the doors and turned on the phones."