State inmate gets new heart

State inmate gets new heart

By Steve Wiegand -- Bee Staff Writer
Published 5:30 a.m. PST Friday, Jan. 25, 2002
A California inmate has become the first person to receive an organ
transplant while in state prison, adding fuel to the debate over the costs of
providing medical care to an expanding, and aging, prison population.
In an operation performed without fanfare at the Stanford Medical Center
three weeks ago, a 31-year-old two-time felon was given a new heart.
The taxpayer-financed operation and subsequent aftercare, which prison
officials estimate could carry a total price tag of $1 million, is certain to
raise questions as to whether there are limits to the kinds of treatment ailing
inmates must be given.
"We don't have a policy per se," said Russ Heimerich, a spokesman for the
California Department of Corrections. "We have a requirement, based in law and
in losing many, many lawsuits, to provide medically necessary care to
inmates.
"The courts have told us that inmates have a constitutional right to health
care. You and I don't, but inmates do. ... We have to do whatever is medically
necessary to save an inmate's life."
The inmate, whose name is being withheld by the department for reasons of
medical confidentiality, is serving a 14-year sentence for a 1996 robbery in Los
Angeles. Prison officials say he will not be eligible for parole until late
2008 because this is his second felony conviction.
After a longtime heart problem caused by a viral infection became critical,
he was transferred to the Stanford Medical Center from the prison system's
medical institution at Vacaville. He received a new heart from an unidentified
donor Jan. 3, and has been returned to Vacaville.
A spokeswoman for the medical center said the cost of the procedure was
$150,000 to $200,000. But that does not include security costs, aftercare or
post-transplant medication that can run as much as $21,000 per year.
Department of Corrections officials have estimated that total costs could
reach $1 million before the inmate is released. After his release, he will have
to seek private insurance or qualify for government-run medical coverage such
as Medi-Cal.
Faced with a prison population that is growing, aging and plagued with
communicable diseases such as AIDS and hepatitis C, California's medical bill for
its 160,000 inmates has swelled in recent years.
The department will spend an estimated $663 million in the current budget
year for medical treatment, an 11 percent increase over the previous year. Like
most government agencies, the department does not have medical insurance
because premiums would be prohibitively expensive and comprehensive policies
difficult to obtain.
In the case of organ transplants, cost is not the only issue. A paucity of
donated livers, hearts, kidneys and lungs means thousands of people who need a
new organ die each year while waiting.
As of Wednesday, according to United Network for Organ Sharing (UNOS), the
nonprofit group that manages national transplant waiting lists for the federal
government, there were 4,139 people waiting for new hearts nationally, 549 of
those in California and six in the Sacramento region.
"We're essentially giving a heart to an inmate when there are other people
out there, potentially more productive members of society, who are in line as
well," said the Department of Corrections' Heimerich. "It's a tough problem."

In 1976, the U.S. Supreme Court held that "deliberate indifference" to a
prison inmate's health problems constituted cruel and unusual punishment and
thus violated the Eighth Amendment of the Constitution.
Since then, hundreds of subsequent cases have established that inmates have a
right to medical care equal to that of the public in general.
Last April, the governor's office reported there were more than 700
individual lawsuits pending by prison inmates over medical care issues.
The state paid out $2 million to settle prison-medical care lawsuits in the
fiscal year that ended in June, including $350,000 to a female inmate who
claimed a prison doctor for years ignored signs she had breast cancer.
"Medical care is probably the biggest cause for (inmates) bringing suits
against the states, because they are not providing adequate medical care," said
Kara Gotsch, an attorney with the American Civil Liberties Union's National
Prison Project. "Certainly costs are going to rise as the population ages and
medical procedures become more expensive ... but prisoners have a
constitutional right to medical care. It's as simple as that."
Similarly, prison inmates are not discriminated against when it comes to
deciding who gets what organ.
"Whether someone is in jail is not going to enter directly into
consideration," said Anne Paschke, a spokeswoman for the United Network for Organ
Sharing.
"It could enter into consideration indirectly when it comes to criteria like
their history of following doctors' orders, drug and alcohol use and so on,
things that many prison inmates might have trouble meeting. But just being in
prison doesn't disqualify someone."
Under the network's procedure, a patient diagnosed by a transplant center as
needing an organ is placed on a waiting list.
When an organ becomes available, the information about it, such as the age
and gender of the donor, is entered into the computer.
Those on the waiting list who are not a good match are dropped from
consideration for that organ, and the rest are ranked according to a number of
factors such as immediacy of need, geography and likelihood of the
transplantation's success.
Some states have attempted to avoid the issue by simply releasing very ill
inmates.
"What they do is trigger early release or compassionate release to get the
inmate out of the system," said Scott Chavez, vice president of the National
Commission on Correctional Health Care, a not-for-profit organization of
medical providers that focuses on better health care in prisons, jails and juvenile
detention centers. "That way they avoid having to do the transplantation and
having to pay for it."
But Heimerich said early release was never a consideration in the case of the
heart patient at Vacaville. "Compassionate release" is generally granted in
California, he said, only when the prisoner has less than six months to live
but is not in imminent danger of dying.
In this case, the inmate's condition was critical when he received the
transplant.
Statistics show that heart transplant recipients in the inmate's age range
have a 70 percent chance of living at least five additional years.
"The judge did not sentence this guy to death," said Heimerich, "and who
knows? He may get out and become a productive citizen."