Four months after becoming the state’s only kidney transplant program, University Medical Center has been stripped of that privilege, leaving in doubt where more than 200 Nevadans awaiting kidney transplants might go for their procedures.
UMC was notified in a Thursday letter by Centers for Medicare and Medicaid Services, or CMS, that its certification for the transplant center will be revoked effective Dec. 3.
That means the hospital will not receive any payments for transplant services on or after that date, effectively closing the program.
The letter goes on to say the program was revoked because it did not meet required patient survival outcomes based on surveys CMS conducted in March and August.
"More people are dying than necessary at UMC,” Jack Cheevers, a spokesman for CMS’ Region IX, said about the federal health agency’s decision. "The hospital’s actual death rate for kidney transplant recipients is more than 50 percent higher than its expected death rate. And, the hospital hasn’t done what it needs to do to address its quality of care problems.”
However, hospital officials and others say the program is being unfairly penalized. One of the deaths used to justify the CMS findings was a suicide, they said. Were it not for that death, UMC Chief Executive Officer Kathy Silver said, the program would be in compliance.
But according to a 52-page report summarizing the March 12 survey at UMC, roughly 45 deficiencies in the hospital’s transplant program were documented.
Among the findings:
• The program failed to document that donor blood type and other vital data were compatible with the intended recipient prior to transplantation.
• The program "failed to keep their waiting lists up to date on an ongoing basis."
• The program failed to timely notify the Organ Procurement and Transplantation Network that patients had a successful transplant and should be taken off the network’s list.
UMC was asked to provide a plan of correction for those deficiencies, which it did. During a follow-up Aug. 7 survey, UMC was found to still be not in compliance for three deficiencies.
As in the March survey, one of those deficiencies was inadequate patient survival outcomes.
The hospital now has two options: allow CMS to decertify the program on Dec. 3, or voluntarily withdraw its certification. Silver said the latter course will be taken, but UMC still plans to challenge the decision.
Silver said Friday she was disappointed in CMS’ action.
"We’re trying to point out to them that the implications of closing this program would mean people having to travel several hours or more to get a kidney transplant. Some people can’t afford that,” Silver said. "This affects the whole region. These people will now be on the waiting lists of other transplant centers. This will impact those other facilities, even though the patients retain their status on the waiting lists.”
Patients in need of kidney transplants may now have to travel to out-of-state facilities such as the Mayo Clinic in Scottsdale, Ariz., or UCLA, officials say.
The CMS letter to the hospital says UMC must assist waiting list patients transferring to another transplant facility "without loss of time accrued on the waiting list."
Silver said the hospital has already sought help from the state’s congressional delegation, which is now pleading with CMS to reconsider.
"We have reached out to both the House and the Senate side of this delegation,” Silver said. "We feel very frustrated by this whole process and we are hopeful that between some of the administration remedies, and pressure applied through our congressional leaders, we can get CMS to reconsider.”
On Friday, Reps. Shelley Berkley, Jon Porter and Dean Heller sent a letter to CMS’ acting administrator, Kerry Weems, expressing their "strong disagreement" with the agency’s decision.
In their letter, they reference what they believe is the remaining unresolved deficiency — the patient survival outcomes. The May 2005 suicide caused UMC to not meet compliance standards for two overlapping reporting periods — July 1, 2004 to Dec. 31, 2007 and Jan. 1 2005 to June 30, 2007.
"This suicide of an otherwise successful transplant patient is lamentable, but beyond the control of UMC," the letter states.
"Our argument to CMS is that death should not be counted for purposes of a statistical calculation,” Silver said.
Berkley spokeswoman David Cherry said the congresswoman felt she needed to act considering the importance of a kidney transplant program in Nevada.
As of Friday, according to the United Network for Organ Sharing, 208 people were awaiting kidney transplants in Nevada. Ken Richardson, executive director of the Nevada Donor Network, said about 200 other patients are awaiting heart, liver and other transplants.
Richardson said he was shocked at CMS’ decision.
"This is important to our community,” he said. "This puts our community at a disadvantage. It is not a very good situation when a government agency recklessly disregards the needs of the people.”
In July, Sunrise Hospital and Medical Center’s kidney transplant program was folded into UMC’s to improve the county hospital’s performance. The goal was to turn UMC’s kidney transplant program into a "center of excellence" so it could eventually offer heart and liver transplants.
Richardson said UMC has been aggressively recruiting for surgeons and nephrologists to staff the kidney transplant program.
Sunrise had offered kidney transplants for nearly two decades before merging its program with UMC.
Because of the small number of kidney transplants performed in Southern Nevada — 26 at Sunrise last year and 40 at UMC — Sunrise officials said it made sense to consolidate the programs.
Contact reporter Annette Wells at firstname.lastname@example.org or 702-383-0283.