How Rush became front-page news

Hospital CEO responds to article

Rush-Presbyterian-St. Luke’s Medical Center in Chicago unwillingly found its heart transplant program in the spotlight after a front-page article in the Wall Street Journal focused on how the fast-growing program was being run.

The newspaper noted that government and private insurers often approve payment for organ transplants only at institutions with high volumes. That policy can induce a hospital to attempt to boost its numbers, even by means some would term inappropriate, stated the Wall Street Journal article.

According to the article, Rush had placed 52% of its candidates on HeartMate, a left ventricular assist device. Patients on the machine are bumped to the top of the wait list for donor hearts.

The article compared the percentage of Rush’s patients on the machine with, for example, 14% at Columbia-Presbyterian in New York City and 5% at the University of Alabama, Birmingham. The implication was that Rush placed those patients on HeartMate to assure a beneficial position. The article quoted some area physicians who claimed the condition of some of the HeartMate patients didn’t warrant their being placed on the machine.

But Rush officials, noting the article was based on a draft internal quality improvement document, claim the newspaper article did not reflect the complexities of a transplant program.

In a Dec. 16 letter to the editor, Leo M. Henikoff, MD, President and CEO of Rush, stated that the Wall Street Journal article contained serious errors. Answering the insinuation that heart assist devices were used in order to advance patients on the list, the letter says, ". . . not true. . . . Rush physicians proposed regulations, which were subsequently adopted, that removed the use of assist devices as a means for advancing the status of patients listed for heart transplants. Rush used as many heart assist devices after this rule was changed as before . . ."

"The survival rate at Rush," said Henikoff’s letter, "is comparable to the rate for other major transplant centers in the United States. . . . The national average, for one- and two-year post transplant survival, is 79% and 75%, respectively. At Rush during the past 2 1¼2 years, our survival rates are 77% and 75%."

While the article criticized Rush for not giving patients a "voice" in the selection of donor hearts, Henikoff says that the facility’s "consent procedures do not differ from other centers in the U.S."

Regarding the alleged "reckless" policy of using "donor hearts that are too small for recipients," Henikoff’s letter states that "donor body weight alone correlates poorly with heart size. In fact, a number of major heart transplant centers have successfully transplanted donor hearts from smaller adults or children into larger patient recipients."