Problems Found in Another Kidney Unit

State health regulators have found that systemic problems in the kidney transplant program at Western Medical Center-Santa Ana resulted in its “inability to ensure the provision of quality healthcare in a safe environment.”

Western’s kidney program, one of the smallest in the state, performed just 13 transplants last year -- two short of the number required to remain proficient, the state Department of Health Services found.

The hospital also did not keep adequate records and failed to perform regular checkups on patients over several years, according to the report from inspectors who reviewed the program in March. In one case, the medical center didn’t ensure that a suicidal transplant patient received needed psychiatric help, the report said.

The hospital also could not provide proof that two key staff members had received required remedial training after faring poorly on a competency assessment, according to the report, which was provided to The Times this week.

The findings, which triggered immediate changes at the hospital, come as three California transplant programs have closed in recent months amid lapses in performance or management. The report also renews concerns about the ability of small transplant centers to meet patients’ needs.

The state survey portrays Western’s 18-year-old program as having a variety of internal problems, but it does not point to any patients who died as a result.

The hospital’s corrective plan was approved last month by the state health department and a reinspection found no problems, said Anne Marie Watkins, the hospital’s chief nursing officer. A state health department spokeswoman confirmed that the hospital was now in compliance with state rules.

Western officials defended the program, pointing to its good survival rate. Among patients who received a kidney transplant from July 2002 to December 2004, 95% lived past the one-year mark, statistics show, similar to the national average and about the rate expected for the hospital.

Watkins said that problems cited by inspectors related to the way the hospital kept its documents, not the quality of care provided. For example, she said, patients received regular physical exams but the documents weren’t available for inspectors. Similarly, the employees cited as needing improvement received training, but records to prove it couldn’t be found during the inspection.

“The way I look at this report, there wasn’t anything related to a bad patient outcome or [suggesting] we were providing poor quality,” Watkins said.

The hospital has told the state that it plans to perform at least 15 transplants, the required minimum, this year. Western has 91 patients on its waiting list.

Not mentioned in the report is the fact that Western has turned down an inordinate number of kidneys offered on behalf of its patients. Between July 2004 and June 2005, Western accepted just 8.8% of the kidneys it was offered, compared with a national median of 25.9%, according to data compiled by the national organ network and analyzed by The Times.

A higher turndown rate does not necessarily mean that more patients will die, because kidney transplant candidates can continue to receive dialysis. But the procedure, which removes impurities from the blood, is grueling and can, over time, reduce the chances of a successful transplant.

Watkins said the program always turned down organs for legitimate reasons -- for example, questions about the donors’ age or health.

The disclosure of problems at Western comes after scandals within other transplant programs in California.

St. Vincent Medical Center in Los Angeles halted its liver program in September after officials conceded that its doctors had improperly arranged for a transplant to a foreign national using an organ intended for a patient who was higher on the waiting list. Staff members then falsified records to cover up the situation, officials have said.

UCI Medical Center in Orange shut down its liver program in November after The Times reported that 32 patients awaiting transplants died in 2004 and 2005 while the hospital turned down viable organs that might have saved some of them. For more than a year, the hospital had no full-time liver transplant surgeon.

And last month, Kaiser Permanente said it would close its kidney transplant program in Northern California after The Times detailed problems that arose after the giant HMO forced as many as 1,500 patients to move to its start-up program in 2004 from established transplant centers at other hospitals.

The state has about 25 kidney transplant programs, more than half of which are in Southern California. In addition to Western, programs that performed fewer than 15 transplants last year are St. Mary Medical Center in Long Beach, Arrowhead Regional Medical Center in Colton and Children’s Hospital and Health Center in San Diego.

Another small program, at St. Bernardine Medical Center in San Bernardino, closed last year after deciding that it did not have the volume of transplants to remain viable, officials said at the time.

Dr. Goran B. Klintmalm, chief of the Baylor Regional Transplant Institute in Dallas, said centers should be required to perform 40 to 50 kidney transplants annually to maintain the skills necessary for the best outcomes.

Smaller centers with less experience tend to select the least sick patients and the healthiest organs, wary of marring their success rate, he said. In general, that makes some patients wait longer for transplants.

“They take only the lowest-risk recipients and the lowest-risk donors, and then they say they have fabulous results,” Klintmalm said. “The argument doesn’t fly.”

Dr. Steve Q. Bui, an Orange County kidney specialist who refers patients to Western’s program, praised the hospital’s main transplant surgeon and its nursing care: “They do a very good job. I have never had a problem with any of the patients.”

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Tracy Weber can be reached at tracy.weber@latimes.com and Charles Ornstein at charles.ornstein@latimes.com.