DOZENS DIE BECAUSE OF CALIFORNIA PUBLIC HOSPITAL INADEQUACIES

More than 30 people died waiting for liver transplants at the University of California, Irvine Medical Center while the hospital turned down scores of organs, according to a report in Thursday's Los Angeles Times. The hospital received 122 liver offers between August 2004 and July 2005 but transplanted just 12, according to the story, which was based on an Aug. 5 federal report that the paper obtained through the Freedom of Information Act.

The number of transplants and the patients' survival rate fell short of federal requirements between 2002 and 2004, according to the report by the U.S. Centers for Medicare and Medicaid Services. The problems were linked to a staffing shortage [The old, old story in public medicine]. The hospital medical center has not had a full-time liver transplant surgeon since July 2004, although federal standards require that a surgeon be constantly available. More than 100 UCI patients are awaiting transplants, 28 of whom joined the roster this year.

Dr. David Imagawa, who oversees UCI's liver transplant program, said a full-time transplant surgeon will join the hospital in early 2006. "We agree that there were some problems, and we're moving forward to change them," said Imagawa, who founded UCI's liver transplant program in 1994 and left in 2002 before returning last summer.

The federal review was prompted by a complaint from former UCI patient Elodie Irvine, who suffered from a disease that caused large cysts to form on her liver and kidneys. Irvine languished on the transplant list from 1998 to 2002 as UCI turned down 38 livers and 57 kidneys offered for her. Organ offers stopped in February 2002 because the hospital did not submit required information on Irvine's condition to the national group that oversees organ transplants. As a result, she dropped from the top of the transplant list to the bottom. Doctors "kept saying, 'You're on top. You're on top.' They led me to believe that there were no offers," said Irvine, 51. "They left me to die." Irvine ultimately received a transplant at Cedars-Sinai Medical Center. She settled a lawsuit against UCI Medical Center earlier this year.

Imagawa acknowledged the hospital made mistakes in Irvine's case but said the organs offered for her were "not suitable for someone without life-threatening emergency." According to the federal report, UCI performed only eight transplants a year between 2002 and 2004 — less than the federal requirement of 12 annually. Just under 69 percent of the liver transplant patients survived at least a year — below the 77 percent survival rate required for federal certification, the report said. Despite the problems, the hospital maintained its accreditation from the United Network for Organ Sharing.

UCI Medical Center was rocked by two other major scandals in recent years. In the mid-1990s, fertility doctors stole patients' eggs and implanted them in infertile women who in some instances gave birth. The university paid nearly $20 million to settle legal claims. In 1999, the facility fired the director of its donated cadaver program amid suspicion that he had improperly sold spines to an Arizona research program.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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