Monday, March 21, 2011

Kaiser Permanente’s Kidney Transplant Program: Kaiser Mismanagement and Patient Injuries

Kaiser transplant center medical director Sharon Inokuchi

See more Kaiser cases.

Was Kaiser transplant director Sharon Inokuchi clueless? Or was she doing what someone at Kaiser wanted? By failing to obtain kidneys, Kaiser avoided the huge costs of transplant operations and years of follow-up and medication.

Kaiser Permanente’s Kidney Transplant Program: Kaiser Mismanagement and Patient Injuries

Ruben Porras, a pressman in his 40s with the Sacramento Bee, had been waiting for a kidney at UC Davis for 3 years. In 2004 he expected to become eligible to receive a kidney very soon; that is, until Kaiser cancelled the program at UC Davis. Porras was put on inactive status in November 2004—so that he couldn’t receive a kidney—and was not transferred to Kaiser’s San Francisco program until September 2005. Because kidneys are given out by geographic regions, and it is more difficult to get a kidney in populous San Francisco than in Sacramento, Porras’ expected waiting period lengthened from the 3 years he had already waited to around 6 years. Porras wasn’t informed of the change in his situation.

In the meantime, several of Porras’ relatives had volunteered to donate a kidney for him and they were being assessed as possible donors at UC Davis. When Kaiser cancelled the contract with UC Davis, the assessments there were cancelled and no assessments were ever done at Kaiser. When relatives tried to call Kaiser to continue the assessments, no one at Kaiser returned their phone calls. Less than one month after his transfer to the long San Francisco waiting list was finally completed, Porras died from an infection connected to his continued dialysis treatment. He was 47...

Porras’ case is not unique. There have been many other reports of mismanagement at Kaiser’s new San Francisco kidney transplant program. In another case, 63-year-old James Klinkner quickly completed and sent in his forms when he was told that he was being transferred from the program at UC San Francisco to Kaiser’s San Francisco hospital. The form was apparently lost or not processed by Kaiser, and they sent Klinkner another one to fill out. He called the medical director of the program to find out what had happened, but his call wasn’t returned. Klinkner died from complications from dialysis just 3 days after he turned 64.

How did all this happen? And why? Up until mid-2004, Kaiser had contracts with UC Davis and UC San Francisco to handle Kaiser’s kidney transplant patients. Then Kaiser decided to open up its own kidney transplant program in San Francisco. Kaiser cancelled its contracts with UC Davis and UC San Francisco and its plan was to transfer all Kaiser transplant patients to the new Kaiser program. But the transfers did not go well, and some were delayed, leaving those patients without eligibility for a long period of time.

Reports now reveal that hundreds of patients were removed from transplant eligibility lists for months, and some were refused authorization for transplants at UC San Francisco when possible kidney matches became available. Complicating matters further, it is now difficult to find the patients who were affected because patients were never notified that Kaiser had cancelled its kidney transplant contracts with UC Davis and UC San Francisco. Kaiser is now under investigation by the California Department of Managed Health Care.

Where is Sharon Inoguchi now?
Still happily employed by Kaiser.
Kaiser doesn't appear to be upset with her.
Why not? Perhaps because she was doing
what they wanted when she kept patients
off lists to receive kidneys.

(from Kaiser website March 2011:)

Sharon Inokuchi, MD
South San Francisco Medical Center
Joined Kaiser Permanente: 2003

..."I joined Kaiser Permanente after more
than 10 years in private practice, to join
a team with a real focus on quality
patient care. Kidney disease is
increasing in the U.S. Slowly and quietly
the disease will progress, damage
tissues and if unchecked, the failing
kidney will change life dramatically.
Unless something changes, this will
happen to so many of us. I believe that
the solution to this problem is to try to
prevent kidney injury, discover problems
early, fix the things we can and then
protect the kidneys from damage. This
is the right time and place to make this

"Patients I see often come thinking all is
over and the kidney is dead. For most,
there is hope. Changes in medicines,
diet and behaviors can often slow the
process and protect the kidneys. Doing
this will also improve health and help
control blood pressure and sugars. I
will work with every patient to try to make
this happen. And I expect my patients to
learn and try. We will work together. Our
goal is to make every life worth living.

"This is my life’s work. I love to teach and
working with patients has been a joy.

"In my leisure time, I enjoy reading,
needlework and spending time with
friends and family. Taking walks and
using the treadmill lets me eat an
occasional donut and helps to keep me

My Credentials

Medical school-- Harvard
Residency-- UC San Francisco Medical Center
Fellowship-- UC San Francisco Medical Center
Fellowship-- Veterans Affairs Medical Center, San Francisco, CA
Board certification-- Internal Medicine, American Board of Internal Medicine

Wednesday, March 9, 2011

Influential research misses financial conflicts

Influential research misses financial conflicts
By Frederik Joelving
Mar 9, 2011

Scientists who review large sets of drug trials for medical journals often ignore financial conflicts that might warp the evidence, according to a study out Tuesday.

That's more than just an academic problem, experts say, because the reviews are considered just about the strongest evidence that medical science can muster.

"It influences how physicians make decisions and how guideline panels come up with their guidelines," said Brett D. Thombs, of McGill University and the Jewish General Hospital in Montreal, whose findings are published in the Journal of the American Medical Association (JAMA).

Thombs' team found that of 29 reviews, or "meta-analyses," of earlier drug trials -- culled from top journals like JAMA and The Lancet -- only two reported who had funded the original trials included in the review.

And none of the reviews mentioned whether the authors reporting on those trials had been paid by drugmakers.

Such financial ties have been linked to research inflating the benefits of new drugs and downplaying the risks, said Thombs.

For instance, according to a 2008 report, only half the trials on antidepressants sent to the U.S. Food and Drug Administration, which approves new drugs, got a positive review by the agency.

By contrast, from the medical literature it appeared that more than 90 percent of the trials favored the drugs, because the majority of those that were unfavorable simply never got published...