The University of Kansas Medical Center's now-suspended heart transplant program violated ethical norms and betrayed the public's trust, a nationally known medical ethicist says.
"This is another in what has been a recent series of failures in quality control in hospitals," said Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. "The Joint Commission should pay a visit yesterday."
The Kansas City Star revealed earlier this month that the medical center's heart transplant program had admitted patients but performed no transplants for almost a year. Surgeons turned away available hearts because the hospital lacked sufficient staffing to carry out the procedures, they said (May 15, p. 18).
"If the allegations in the story are correct," Caplan said, "(doctors and administrators) betrayed patient trust by letting people linger when they could not provide them hearts because they didn't have the staff or resources."
Medical center administrators wrote in a May 11 letter to the Star that the surgeon in charge of transplants, Jon Moran, M.D., made all medical decisions, not administrators.
"(Moran) began to refuse almost all hearts that were offered to him for transplantation but did not notify administration of this fact until November 1994," wrote Daniel Hollander, M.D., executive dean of the University of Kansas School of Medicine, and Glenn Potter, vice chancellor for hospital administration. They also said a committee reviewed staffing in the heart transplant program and found it to be in order.
Caplan responded, "It is simply not acceptable, if (administrators) concede that transplants were not being done and people were being wait-listed, to argue that the only person with authority is the surgeon in charge of transplants. Administrators, other heart specialists, cardiologists, department chairpersons, utilization-review personnel, people in the billing office-all of those people should have noticed something was going wrong."
Caplan said the national oversight group, United Network for Organ Sharing, should have been more vigilant.
"Do we have a tough enough national network if this can be allowed to go on? I wonder if UNOS shouldn't be taking a long look here to see whether their own standards are adequate."
Joel Newman, a UNOS spokesman, said that once a hospital meets requirements to establish a heart transplant program, "We do not have authority to suspend membership or remove somebody as a UNOS member. That authority is held at HHS."
University medical center officials are withholding further comment until a formal internal review is conducted. The Kansas Legislature has initiated its own investigation.
The Joint Commission on Accreditation of Healthcare Organizations is aware of the situation and is reviewing it, spokeswoman Alice Brown said.