Inspectors found large differences among hospitals in how often questionable cases were being referred for peer review. In Northern California, one hospital might refer as much as 20 times as many cases as another.

Even when peer review was performed appropriately, it did not always result in sufficient efforts to improve care, the report says. In a quarter of the 57 cases examined by the state in which peer review committees found a quality problem, follow-up was incomplete.

In one case, a peer review panel examining pediatric care determined that a doctor provided an "unacceptable standard of care," but it doesn't appear anyone alerted the hospital's top doctors to the findings so they could act.

Regulators also found several instances in which doctors were in charge of investigating cases in which the treatment they provided was called into question.

Marcy Gallagher, the chief state surveyor on the Kaiser inquiry, said inspectors identified at least three occasions on which committees at Kaiser hospitals inexplicably stopped their review of troubling cases before they were complete. Kaiser was asked to finish those reviews, she said.

Overall, the report found that the HMO "lacked the ability to verify consistent handling of complaints throughout its medical centers or to determine whether serious or chronic problems were being addressed."

Managed Health Care director Cindy Ehnes said, she will forgive $1 million of the record penalty if Kaiser made necessary improvements in its monitoring system.

This is the second time in a year that Kaiser has been publicly rebuked and fined for glaring breakdowns in oversight.

The state's latest inquiry grew out of its investigation into problems that forced the closure last year of Kaiser's kidney transplant program in San Francisco. Hundreds of patients were endangered when Kaiser forced them to transfer to its own fledgling program from established transplant centers at outside hospitals.

Kaiser closed its Northern California kidney transplant program in May 2006 after The Times exposed how hundreds of patients were stuck in limbo for months — with little hope of receiving new kidneys — because the HMO had failed to properly handle paperwork transferring them to its new program in 2004.

In Kaiser's program, twice as many patients died on the waiting list in 2005 as received kidneys, The Times found. The statewide pattern was the reverse: Twice as many patients received kidneys as died.

All the while, the Kaiser patients had to undergo prolonged dialysis, which removes impurities from the blood but can lead to fatal complications and reduce prospects for a successful transplant.

Source-Medindia
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