THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Tuesday, November 12, 1996 TAG: 9611120231
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: 82 lines
If Sentara Norfolk General Hospital is allowed to start a liver transplant program, Hampton Roads patients will pay even more for the expensive procedure, says a report from a local agency that regulates hospital expansion.
The Norfolk program also may have a lower survival rate in the first few years than other state programs, according to the report from the Eastern Virginia Health Systems Agency staff, which recommends denying Sentara permission to start the program.
The report also says the state's two public teaching hospitals, which get most of the liver transplant patients from Hampton Roads, would lose business; they may be forced to charge more and they may have a harder time subsidizing transplants for poor people.
The agency report said Hampton Roads residents who need liver transplants are well-served by programs in Richmond, Charlottesville and Northern Virginia.
Sentara disputes the conclusions. Hospital officials plan a rebuttal today, when the agency's board will decide on a recommendation to pass on to state officials.
The hospital wants to add a liver program to its roster of transplant operations. Sentara Norfolk General already performs heart, lung, heart-lung and kidney transplants.
But state policy says such high-tech programs must see a certain volume of patients to be cost-effective and safe.
In this case, the hospital won't see enough cases to justify the program, the staff report said.
Sentara expects to perform six liver transplants in the first year and 12 in the second year. The hospital hopes eventually to be doing 25 to 30 transplants per year. In contrast, Richmond's Medical College of Virginia expects to do 65 transplants by the end of this year. Because Norfolk's program would have a low volume, it would lose money over the first two years and may need to charge more to cover its overhead, the report said.
And the drop in business at MCV and the University of Virginia in Charlottesville could affect costs there, the report said, making it harder for these programs to subsidize transplants for people who don't have medical insurance.
As for safety concerns, the new program probably would meet minimum state standards for survival rates. But the rates at MCV, for example, are much higher than the expected rates at Sentara, the report said.
In the beginning, Sentara would probably have a survival rate of 50 to 60 percent at one year after transplant. The agency staff based its estimates on statistics from a national transplant clearinghouse. MCV's recent one-year survival rate was 85 percent.
Sandra J. Miller, director of community relations for Sentara Health System, said the new program would have very low overhead. Operating rooms and other facilities are already in place, and staff members already familiar with transplants will be involved with the new program. While the program may lose money in its start-up year, it will begin paying for itself the second year, she said.
The staff expertise would also help the transplant program's survival rate. She said that the state's estimates were based on statistics from programs that have no experience in other types of transplants. Sentara's liver patients would benefit from Sentara's experience in transplants , she said. Since Sentara's other transplant programs have very good survival rates, it's reasonable to expect the liver program would, too, she said.
``We have a very, very successful transplant program, with some of the lowest mortality rates in the country for cardiac and so forth,'' she said. ``We're not talking about a start-up program.''
The operations will be done by an experienced surgeon, who would be recruited from a program elsewhere, Miller said.
Miller disputed the argument that a Norfolk program would hurt other hospitals like MCV. MCV has urged the Health Systems Agency to turn down Sentara's request.
The demand for liver transplants is growing, because of drug and alcohol abuse and the spread of hepatitis, an infectious condition that can stop the liver from functioning. Although there is still a lack of donated organs, hospitals can expect their transplant programs to grow, she said. MEMO: The agency's board will meet to decide on a recommendation today
at 1:30 p.m. at Norfolk International Airport, conference room A. The
meeting is not a public hearing, but members of the public are welcome
to observe.
KEYWORDS: TRANSPLANT by CNB