Medical Center Rocked by Scandal

UC Irvine Health Sciences, which oversees the UCI Medical Center and the School of Medicine, is campaigning to raise over $50 million in private funds toward the construction of a new hospital since recovering from the fertility and willed-body program scandals that drew international attention and tarnished its image in the late 1990s. Last week, however, UCI Health Sciences suffered yet another devastating blow to its reputation.

The UCI Medical Center in Orange voluntarily shut down its Liver Transplant Program indefinitely after the U.S. Centers for Medicare and Medicaid Services rescinded its certification and decided to stop funding liver transplants at UCI. This action stemmed from an investigation which revealed that the hospital failed to meet many federal standards established for transplant centers.

The most significant finding was that the UCIMC turned down over 100 offers for livers since last summer that could have saved the lives of those on the transplant waiting list. Unfortunately many of those patients waiting for a liver transplant at UCI were waiting in vain. Since 2003, 40 people have died at the UCIMC, and 15 people have died this year alone while waiting for liver transplants, according to data from The Organ Procurement and Transplantation Network.

While UCI officials rejected the livers offered to them by saying they were of poor quality, even though many of those rejected were subsequently accepted by other transplant centers, the CMS pointed to the fact that UCI was understaffed as the reason for rejecting so many livers.

‘We … question how Dr. Ajai Khanna and Dr. Marcus Hart, the medical director of UCI’s transplant team, can be members of UCI’s liver transplant team at the same time that they are part of [UCSD’s] liver and/or kidney transplant teams,’ said Laurence Wilson, director of the Chronic Care Policy Group for the CMS in a letter to the UCIMC. ‘In fact, it appears that UCI has not had its own resident liver transplant surgeon since June 2003 but has been contracting with surgeons from other transplant programs for coverage since that time.’

UCIMC Chief Executive Office Ralph Cygan was upset with the CMS’s decision and defended the quality of the program.

‘We are profoundly disappointed by this action,’ Cygan said in a statement released on Nov. 10. ‘For the last several years the university invested a great deal of time and resources into revitalizing our program. … In fact, as recently as February 2005, the Medical Center had received the support from [the United Network for Organ Sharing] for the continuation of our liver transplant program based on the program’s actual patient and graft survival rates.’

The approximately 100 patients who were still on the UCI transplant waitlist have been transferred to waitlists at other hospitals in the Southern California region.

Thomas Mone, chief executive officer of OneLegacy, a nonprofit organization that serves as a bridge between donors and transplant recipients, told The Associated Press that those on the UCI waitlist who have transferred out would not have their waitlist position changed dramatically, which should actually be beneficial for them.

‘This shouldn’t make a significant difference in their wait time and for many patients at UCI it will probably speed them up,’ Mone said.

The CMS also noted that UCI failed to meet annual minimum transplant standards.

Liver transplant centers are required to perform at least 12 transplants a year and have a one-year survival rate of 77 percent and a two-year survival rate of 60 percent in order to maintain federal funding. However, from 2002 to 2004, UCI performed an average of only 7.33 transplants a year and has only performed five this year. From 2002 through the middle of 2004 the one-year survival rate was only 68 percent.

When compared with liver transplant centers nationwide, UCI’s program is strikingly substandard.

According to data from the Scientific Registry of Transplant Recipients, the percentage of people removed from the UCI waitlist for a transplant was 7.3 percent, while the national average was 33.7. The percentage of people removed at UCI because of death was 15.6 percent, compared with a 10.4 percent average nationwide. One year after being placed on the waitlist, 11.1 percent of patients had received a transplant while the national average was 31.1 percent.

Wilson also said in the letter that ‘UCI failed to effectively manage the patient list, which had adverse effects on at least two patients … [and] there was a lack of evidence to establish that UCI took corrective action to address its substandard volume and survival rates.’

Following the closure of the Liver Transplant Program, Cygan said that the UCIMC would create a committee of internal and external experts to evaluate the program.

The CMS began an investigation into UCI’s program following a lawsuit by Elodie Irvine, a 51-year-old resident of Irvine, who was on the UCI waitlist for a liver transplant for over four years from 1998 to 2002. She transferred to another waitlist, where she received a liver after waiting only two months. It was revealed during the lawsuit that during Irvine’s years on the UCI waitlist, UCI turned down 38 livers offered for her.