This story was co-published with NJ Advance Media.
NEWARK, NJ (October 2019)--Newark Beth Israel Medical Center placed the director of its heart transplant program on administrative leave Thursday while the hospital awaits the results of investigations into whether a vegetative patient was kept alive to boost the program’s survival statistics.
“As the most prudent course of action to ensure the complete independence of these internal and external assessments, we have placed the program’s director, Dr. Mark Zucker, on administrative leave pending the conclusion of our review,” Barry Ostrowsky, chief executive of the hospital’s affiliated network, RWJBarnabas Health, and Newark Beth Israel CEO Darrell Terry wrote in an email to employees Thursday night.
In the email, which was obtained by ProPublica, Ostrowsky and Terry also told employees that federal and state regulators were on site at Newark Beth Israel and that the staff was “cooperating fully.” The hospital and RWJBarnabas Health “take the recent allegations involving its heart transplant program extremely seriously,” they wrote.
The hospital, which has also started its own internal audit, confirmed Zucker’s administrative leave in an email to ProPublica. The program remains “fully operational” and “the team continues to see patients and perform transplants,” spokeswoman Linda Kamateh wrote. She didn’t respond to questions about whether Zucker would be paid during his absence, or if anyone else on the team has been placed on leave.
The hospital’s action and the flurry of investigations by the New Jersey Department of Health and the federal Centers for Medicare and Medicaid Services come in the wake of an Oct. 3 ProPublica report that Zucker instructed his staff to keep a patient named Darryl Young on life support, and not to discuss options such as hospice care with his family, until the one-year anniversary of his surgery. Young suffered brain damage during heart transplant surgery in September 2018 and never woke up; he remains hospitalized at Newark Beth Israel.
Zucker has led the transplant program for three decades. It is one of the 20 largest programs in the nation by volume, and it has performed 1,090 heart transplants to date, according to the hospital.
According to current and former employees and audio recordings of transplant meetings, Zucker was concerned about the program’s one-year survival rate — the proportion of people undergoing transplants who are still alive a year after their operations. Newark Beth Israel’s one-year rate for heart transplants had dipped below the national average, and Zucker was concerned that the program might attract scrutiny from federal regulators.
Six out of 38 patients who received heart transplants at Newark Beth Israel in 2018 died before their one-year anniversary. That translated to an 84.2% survival rate, considerably worse than the 91.5% national probability of surviving a year for heart transplant patients, according to the Scientific Registry of Transplant Recipients, which tracks and analyzes outcomes for the government.
The one-year survival rate has been a key statistic for transplant programs since it was introduced as a performance metric by CMS in 2007. As part of its push to reduce regulations, the Trump administration finalized a rule in September that relaxes performance requirements for transplant programs. Starting in November, they won’t have to submit data on outcomes, including one-year survival rates, to CMS in order to receive Medicare reimbursement.
At two separate team meetings, Zucker acknowledged that the program’s approach to Young’s care was “unethical,” according to the recordings. “This is a very, very unethical, immoral but unfortunately very practical solution, because the reality here is that you haven’t saved anybody if your program gets shut down,” he said in May.
ProPublica found that the one-year survival rate was a consideration in the hospital’s treatment of other patients as well. “A lot of you weren’t here for our first lung transplant when we reopened, after we reopened the program,” heart transplant surgeon Dr. Margarita Camacho said at a meeting this past May, according to a recording obtained by ProPublica. “The first lung transplant stayed at the hospital until day 366, was sent out to rehab and died that day.”
Ostrowsky told New Jersey lawmakers this week that RWJBarnabas Health would make public the findings and recommendations of the independent consulting firm it had hired to conduct a review of the hospital’s transplant team, NJ Advance Media reported Thursday.
In an email to legislators, Ostrowsky said that he was “appalled and infuriated” after hearing the recordings, and that the statements “misrepresented our commitment to patient centered care.”
He said the hospital’s “initial review of this complicated case indicates information that conflicts with the reporting,” but gave no specifics. He added that “records we have reviewed confirm that the care this patient received was appropriate and in keeping with medical guidelines.” Newark Beth Israel has not answered any of ProPublica’s specific questions about Young, even though his sister and health proxy, Andrea Young, gave the hospital permission to discuss her brother’s care with ProPublica. Informed by ProPublica of Zucker’s leave, Young said, “It has been my hope all along that the hospital will do the right thing.”
State Sen. Joseph Vitale, chairman of the Senate Health, Human Services and Senior Citizens Committee, told NJ Advance Media in an email that he questioned what Ostrowsky meant by “appropriate care,” adding that the larger question is whether the hospital was honest with Young’s family.
“Gaming a system that rewards a program for its excellence is deceptive and malpractice,” Vitale said.
published here with permission of ProPublica