THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Tuesday, September 17, 1996 TAG: 9609170287
SECTION: LOCAL PAGE: B3 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: 71 lines
If you live in Hampton Roads and you need a liver transplant, the closest place in the state to get one is Richmond.
That two-hour trip is:
A. A bad thing, according to Sentara Norfolk General Hospital, because it separates you from your family and costs you extra money.
B. A good thing, according to the Medical College of Virginia in Richmond, because it means you'll get care from a center with lots of experience and a good success rate.
Sentara Norfolk General wants to start a liver transplant program, but its plan is opposed by the people running a similar program at MCV. Monday, both sides made their arguments at a public hearing of the Eastern Virginia Health Systems Agency, a regional health planning agency that reviews applications. The agency will advise the state on whether the program should be allowed.
Sentara doctors said the distance to MCV creates problems for patients in Hampton Roads. There is the time and expense of travel for patients and families. There is extra cost because MCV repeats some X-rays and blood tests done in Hampton Roads. There is the emotional trauma of separation from family and friends.
``We certainly can improve the service by being locally available,'' said Dr. Michael Ryan, a Hampton Roads liver specialist.
Sentara wants to recruit an experienced liver transplant doctor, said Sandra Miller, director of community relations for Sentara Health System.
Sentara plans to use operating rooms already set up for transplants, and procedures and departments already in place to support the health system's heart, lung, heart-lung and kidney programs. The hospital started its first program, for kidney transplants, in 1972.
Officials from Sentara pointed to the good success rates of the hospital's heart transplant program and said they expect similar things from a liver program. The five-year survival rate for patients in the heart transplant program is 76 percent, somewhat higher than the national average of 70 percent. Sentara plans to do about six liver transplants in the first year, and 12 the next. Doctors expect those numbers to grow as Hampton Roads' population does; they also point to rising cases of hepatitis, an infectious condition that can stop the liver from functioning. The program also would draw patients from the Eastern Shore and northeastern North Carolina.
MCV doctors said liver transplant programs need a higher volume of cases to keep costs down and to develop expertise. They predicted higher death rates in the early years.
``The costs will be increased not only in dollars but also in lives,'' said Dr. Robert A. Fisher, director of the MCV liver transplant program. ``Do we really want 12 livers performed annually?''
They pointed to MCV's survival rate, 70 percent at five years after the transplant, which exceeds the national average by about 10 percent. Across the United States, high-volume centers have the best rates, they said. MCV has replaced 52 livers so far this year, said Fisher.
``What I'm afraid we're going to end up with is two glasses that are half-empty,'' said Dr. Sheldon Retchin, head of MCV's physician practice group.
The dispute has created an awkward situation for several Hampton Roads liver transplant patients. One is Ken Geroe, a Virginia Beach resident who said he considers some of the local liver specialists personal friends. But Geroe, who got a new liver at MCV in 1992, echoed MCV's call for more regional cooperation.
Sentara officials ``don't need to make any more money on the backs of people's lives,'' he said. ``If we've got a community that can support a world-class transplant program, why do we want to break it in two?''
Paul M. Boynton, executive director of the Eastern Virginia Health Systems Agency, asked both sides to document the relationship between caseloads and survival rates.
In November, the agency board will vote on a recommendation. The state will make the final decision, although it's not clear how long that will take. by CNB