Healthcare for People Not for Profit: Transplants and Amanda Trujillo

Organ transplantation is a complex and challenging undertaking for both the patient and providers. It can offer the appropriate patient opportunities for greatly improved quality and length of life and it can also offer an opportunity for profiteering and conflicted behaviors. As outlined below, transplantation produces significant revenue dollars, even for a “non-profit” hospital.

Estimated U.S. Average 2011 Billed Charges Per Transplant:

Heart Only – $997,700

Liver – $577,100

Kidney – $262,900

Nurse Amanda Trujillo identified that a patient she cared for at Banner Del E Webb Medical Center of Arizona lacked full information about what a transplant evaluation and post-transplant self-care entailed. She says she referred the patient for a hospice case management consultation. She was then fired for overstepping her scope of practice. Arizona’s scope of practice for nurses clearly dictates a nurse’s role to promote the client’s best interest.

Banner Del E Webb is one of only three liver centers in Arizona, and the only one that appears to be  aggressively expanding their liver transplant program(the link takes you to a site where you have to build your own report).  In 2011 Banner performed 50% more liver transplants than the year before, while the other centers showed no change.

AZGS-TX1 Banner Medical Ctr.    –   70 in 2011; 46 in 2010

Clinic Hospital    –  59 in 2011;  60 in 2010

AZUA-TX1 University Medical Ctr.   –  16 in 2011; 20 in 2010

Banner has also heavily invested in their ability to perform surgeries, and “recently completed a 136,000 square foot expansion and renovation designed by HKS, Inc. hosting 20 state-of-the-art operating rooms, 76 preoperative and postoperative bays” as part of four $300 million construction projects that started around 2010.

These multimillion dollar levels of prospective financial gain and loss expose a potential for conflict of interest at a minimum, and offer one possible explanation why a hospital and providers might be so committed to protecting their surgical alternative versus hospice for a patient.

It is not possible to advocate for a patient if one treatment option enriches the provider and the other would not. Why would physicians not disclose financial conflicts of interests? Informed consent as defined by the AMA only covers risks and benefits of the proposed intervention and any alternatives but never addresses conflicts of interest.

Where is the protection for nurses caught between patients and profits? The American Nurses Association recommends that “nurses attend to and are aware of conflicts of dual loyalty to patients, health care institutions, employers, and agencies that provide payment for services.”

Why is there not a policy of protection for patients from organizational or provider conflicts of interest? Fully disclosing the financial conflicts of interest should include the incentives and bonuses for surgeons and staff to perform procedures as well as the “needs” of a hospital to fill its new surgical suites.

It is time for every informed consent for a medical or surgical procedure to include a written, enforced policy on financial conflict of interest.

Nurse Richard, alias Richard Dorritie, RN

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