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Kaiser Permanente San Francisco Medical Center declared member not in good standing

Published on: Wednesday, December 13, 2006

Tucson, Ariz., December 13, 2006 --After a hearing held today, the OPTN/UNOS Board of Directors declared Kaiser Permanente-San Francisco Medical Center (KPSFMC) to be a "Member Not in Good Standing."  This decision was based on the discovery and review of actions at KPSFMC that inhibited its patient's access to transplantation that resulted in threats to patient health and safety.

KPSFMC announced in May 2006 that it will voluntarily close its kidney transplant program after transferring all candidates previously listed to other active transplant programs.  Although more than 250 candidates remain on the center's wait list, KPSFMC has assured the OPTN/UNOS Board that all kidney transplant candidate transfers to other active programs will be completed as soon as possible.  Until the transfers are completed, and under the designation of Member Not in Good Standing, the center will continue to be able to receive organ offers, perform transplants and provide other transplant-related services.  The OPTN will closely monitor the center's activity during this transitional period to ensure patient safety.

  "The executive leadership of Kaiser Permanente-San Francisco Medical Center has expressed its commitment to providing continuity of care for its transplant candidates during this period of transition," said Sue V. McDiarmid, M.D., President of UNOS and the OPTN and chair of the OPTN/UNOS Board of Directors. "We are actively assisting in the transfer process along with the centers involved and the California Department of Managed Health Care.  We also acknowledge that Kaiser Permanente-San Francisco Medical Center has fulfilled the requests of the OPTN and UNOS to expedite this process.  At the same time, we believe the designation of Member Not in Good Standing is warranted to note the institution's lapses that effectively denied patient access to kidney transplantation and threatened safety for patients on its waiting list.  Transplant candidates are an especially vulnerable population and must be assured that transplant institutions will fulfill their responsibilities.  A violation of this public trust must be censured by the transplant community."

Summary of Events
KPSFMC received OPTN/UNOS approval in 2003 to establish a kidney transplant program and began performing kidney transplantation in 2004.  Prior to that time, subscribers to the Kaiser Permanente care network who lived in Northern California were authorized to receive kidney transplant services at other centers in the region.  The Northern California Kaiser network notified these subscribers that payment for transplant-related care would be authorized for care solely at this program as of September 1, 2004.

KPSFMC summarily transferred approximately 1,500 kidney transplant candidates over a period of a few months.  Pursuant to the transfer, significantly fewer Kaiser Permanente network subscribers in Northern California received kidney transplants than in the period prior to the transfer. 

Summary of Investigation and Due Process
Information and data collected by UNOS staff were conveyed to the OPTN/UNOS Membership and Professional Standards Committee (MPSC) for confidential peer review.  An onsite OPTN/UNOS staff review was conducted at KPSFMC in May 2006 to assess whether there were imminent threats to the safety or well-being of candidates, and a separate peer review visit was conducted in July 2006.

The MPSC undertook a systematic due process review of events, including the following steps:
  an interview with representatives of KPSFMC, conducted July 18, 2006
  a hearing before the full MPSC, with representatives of KPSFMC, on October 10, 2006

KPSFMC exercised its right under the By-Laws to an appellate review by the OPTN/UNOS Board of Directors. As part of its regularly scheduled meeting, the Board convened a special session for the sole purpose of conducting the appellate review and took the actions described above.

Member Not In Good Standing Designation
As established in the OPTN By-Laws, the Member Not in Good Standing designation is intended to provide public notice of an OPTN/UNOS member that has committed a serious violation of OPTN policies or by-laws or has demonstrated a serious lapse in patient safety or quality of care.

The Organ Procurement and Transplantation Network (OPTN) is operated under contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation by the United Network for Organ Sharing (UNOS). The OPTN brings together medical professionals, transplant recipients and donor families to develop organ transplantation policy.