YOUR REGULATORS WILL PROTECT YOU (1)

20% of U.S. Transplant Centers Are Found to Be Substandard

About a fifth of federally funded transplant programs fail to meet the government's minimum standards for patient survival or perform too few operations to ensure competency, a Los Angeles Times investigation has found. The U.S. Centers for Medicare and Medicaid Services has allowed 48 heart, liver and lung transplant centers to continue operating despite sometimes glaring and repeated lapses, the newspaper's review found. There are 236 approved centers nationwide.

Although many of the substandard programs treat small numbers of patients, their collective failings carry a significant toll. Consider the latest available statistics, for transplants performed between 2002 and 2004. Nine lung programs failed to meet the minimum Medicare standards for survival, number of surgeries or both. These hospitals accounted for 21 more deaths than would be expected, based on a government-funded analysis of how all patients fare nationwide within a year of surgery. It is adjusted for the condition of the patients and the organs. Three dozen heart transplant programs didn't meet federal standards for survival or volume. They accounted for 43 more deaths than expected. Altogether, the programs examined by The Times had 71 more patients die than expected within a year of transplant.

"The bottom line message is that there are too many programs in the United States that need to be shut down," said Dr. Mark L. Barr, a cardiothoracic transplant surgeon at USC and president of the International Society for Heart and Lung Transplantation.

The disclosure of Medicare's failings follows a series of reports in The Times detailing dangerous lapses in oversight of the national transplant system. Three transplant centers in California have closed since September after their problems came to light. Medicare, which funds most of the nation's transplant centers, requires programs to perform a minimum number of transplants and to achieve a specific survival rate to be certified for funding. The benchmarks vary by organ, and there are none for kidney transplants. Should the programs later fall short, Medicare rules mandate no sanction, only that the programs turn themselves in.

The agency has the authority to pull certification - and therefore funding - from any center that does not meet its standards. But it rarely does. It has cut off funding to 11 centers since 2000. In nearly all of those cases, it moved only after the programs had voluntarily ceased operations, according to federal documents reviewed by The Times. In one case, its decertification came eight months after the program shut down.

Only recently, after The Times began asking detailed questions, did the agency step up its scrutiny. In March, it sent letters to all its approved programs, asking for information about their staffing and performance. It already has found about 25 programs that are "seriously out of compliance" with Medicare standards, said one agency official who spoke on condition of anonymity because the findings are preliminary. Some programs have problems so severe that the agency is considering immediate decertification, the official said. That could force closure.

Some transplant surgeons say Medicare has been too permissive, continuing to support poor-performing programs abandoned by private insurers. "This is a continued artificial bolstering of the programs that shouldn't exist," Barr said. To decertify such programs, he said, "would have been the natural Darwinian process to occur. The weakest in the herd get weeded out." The records of these centers are no secret. The Times identified the 48 programs by examining the total number of transplants performed in 2005 by each Medicare-approved center, as well as the latest survival statistics made public in January by government-funded transplant researchers. All of the information is available on the websites of the United Network for Organ Sharing and the Scientific Registry of Transplant Recipients.

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YOUR REGULATORS WILL PROTECT YOU (2)

Rapist doctor back to work in Australia

The Medical Board of Queensland is set to renew the practising rights of a doctor convicted and jailed four years ago for violent criminal offences, including rape. James Samuel Manwaring's probable reprieve under strict conditions imposed by the registration body has appalled his former employer, original complainant Dr Bruce Flegg, and stunned his victim.

Dr Manwaring, who graduated as a medical student from the University of Queensland in 1985, had a history of drug addiction which compromised the care he provided in jobs in Australia, the US and the United Kingdom. He committed his most serious offences in 2000 against a woman, who suffered serious physical injuries and mental trauma. After pleading guilty in late 2002 to rape, attempted rape, deprivation of liberty and assault, Dr Manwaring was told by District Court Judge Brian Hoath that nothing could "excuse your involvement in these offences". "During the course of your sexual assault on the complainant, she suffered multiple bruises and the aggravation of pre-existing degenerative changes in her jaw," Judge Hoath said.

Medical board head Jim O'Dempsey declined to be interviewed late yesterday, but confirmed in a written statement that Dr Manwaring "has met the stipulation of the Health Practitioners Tribunal to be eligible to apply for re-registration". Dr Manwaring could not be contacted late yesterday. The board's statement said that 24 conditions, including the testing of his hair for traces of drugs, would be closely monitored. "It should be noted Dr Manwaring cannot start practice as there are a number of the conditions imposed by the tribunal where he requires board approval prior to commencement of practice," the statement said.

Sources close to the medical board said it had not used its power and discretion to reject Dr Manwaring "despite the inescapable grounds that the man is a convicted and violent criminal with a shocking history as a practitioner".

Dr Flegg, who owned a medical practice before becoming a Liberal Party state MP, yesterday slammed the board's decision as reckless and irresponsible. "Serious violent criminal offences are not compatible with professional standards. I believe the board has been weak and feeble in not wanting to be legally challenged," Dr Flegg said yesterday. "Manwaring is a violent convicted criminal and a serious professional offender. "The board is supposed to be the guardian of standards and public confidence."

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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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