State Notifies Deficient Transplant Programs

The state Medi-Cal program has notified four organ-transplant programs that they could lose their state funding because they have excessive patient deaths or perform too few surgeries.

In letters made public Wednesday, the California Department of Health Services demanded plans of correction from the liver transplant units at USC University Hospital in Los Angeles and UC Davis Medical Center in Sacramento, as well as the heart programs at California Pacific Medical Center in San Francisco and Sutter Memorial Hospital in Sacramento.

All four appear to be out of compliance with at least one of the state’s minimum standards, the Aug. 23 letters said.

Explanations and plans for corrective action are due by Sept. 29.

A UC Davis spokeswoman said Wednesday night that its liver program does meet the state’s volume and survival standards.

The letters expose weaknesses in California’s transplant system, which has already been shaken by the closure of three programs amid scandal in the last year. Medi-Cal is the state’s health insurance program for the poor.

Dr. Fulton Lipscomb, head of the health department’s medical policy section, said his staff reviewed each program’s data after The Times inquired last month about subpar numbers at USC.

Asked what action ultimately might be taken against the four programs, Lipscomb said, “It depends on what kind of explanations they give us.”

A one-time blip in the data would be viewed differently than a progressive decline in patient survival, he said. Serious problems could result in a loss of funding.

USC and California Pacific were identified because their one-year survival rates after transplants were lower than the Medi-Cal standard of 80%.

UC Davis had 1 1/2 times as many deaths as expected in its liver unit, and Sutter did not perform enough operations to maintain competency, Lipscomb said.

The post-transplant survival rate in USC’s liver program is among the lowest in the nation, according to data released last month. For patients receiving new livers from January 2003 to June 2005, 75.8% lived for at least a year after their transplants -- far below the U.S. average of 86.6%.

Government-funded researchers have determined that USC’s survival rate is statistically lower than expected, even after adjusting for such factors as patient age and condition as well as organ quality.

USC officials said they had not seen the state’s letter. Previously they had retained a team of external reviewers to make confidential recommendations on the liver program but have said little else publicly about their plans.

At California Pacific, the heart transplant one-year survival rate was 77.3% among patients who had surgery between July 2002 and December 2004. (The hospital suspended its program in May 2003 while it searched for a new chief surgeon. It reopened the program several months later.)

Jeffrey Miller, the transplant program’s administrative director, said the latest one-year survival rate was an anomaly given the program’s long-term success.

“We take steps here on a daily basis to improve care where it can be improved,” Miller said.

The Sutter liver program was decertified by Medi-Cal last year because it performed too few heart transplants.

The state agreed this month to recertify Sutter as a Center of Excellence, on a provisional basis, after the hospital’s lawyers challenged the legality of the state’s actions, Lipscomb said.

The latest letter, he said, simply reaffirms the state’s interest in keeping watch over the hospital’s performance.

Sutter spokeswoman Nancy Turner said the hospital was ready to provide Medi-Cal any information it needed.