A heated competition has developed among Washington area hospitals over transplanting human hearts, despite protests of federal officials and health planners that there aren't enough donor hearts to keep existing transplant centers in Baltimore and Richmond operating at capacity.
The rivalry intensified this week as four District hospitals -- Children's Hospital, Georgetown University Hospital, Howard University Hospital and the George Washington University Medical Center -- sought permission from D.C. health planners to perform heart transplants.
A fifth D.C. hospital, the Washington Hospital Center, applied in January for authority to do heart transplants and is awaiting a decision.
Fairfax Hospital, after a lobbying campaign by famed heart surgeon Christiaan N. Barnard, won approval last month from Virginia health commissioner James Kenley to transplant hearts. Virginia health planners had denied the Fairfax application twice before and are planning to sue to overturn Kenley's approval.
"These D.C. applications mean nothing but adverse consequences for the whole metropolitan region," Dean Montgomery, executive director of the Northern Virginia Health Systems Agency, said yesterday. "To maximize patient safety and cost, we should use the excellent centers already in operation.
"What you'll get is several very expensive, low-volume centers where the patient outcomes are not as good and the costs are much higher," he said. "What is being considered is institutional image and a form of competition that's negative."
A number of local doctors said that hospitals aggressively seek authority to do heart transplants to boost their prestige and to attract top surgical staffs.
"It is turf wars," said Dr. Lewis Scott, director of cardiac surgery at Children's Hospital. "Our survival will depend on our giving highly complex care to the region."
Washington's reputation as a medical center would suffer, administrators said, if local patients continue to rely on the existing centers, which are at Johns Hopkins Hospital in Baltimore and the Medical College of Virginia in Richmond. Last year the Richmond center performed 44 heart transplants.
Officials of D.C. hospitals also argue that if their cardiac surgeons are medically proficient, they shouldn't be hindered from peforming heart transplants.
"It's an easier operation than a coronary bypass," said Dr. Vincent Roux, medical director of Howard University Hospital. "We all have our teams in place and already do the tissue typing and organ harvesting because of our kidney transplants."
Surgeons consider heart transplants so similar to current heart surgery that officials from at least one hospital, George Washington University Medical Center, argued that a heart transplant program should not be subject to regulation as it is not a new service. Only new services or equipment valued at more than $650,000 are regulated by health planning laws.
As a result, George Washington informed D.C. health planners on Jan. 28 that it had an "existing heart transplantation program," according to Carlissa Hussein, director of the D.C. State Health Planning and Development Agency. Hussein told the hospital the services were "unauthorized and must be discontinued immediately."
Hussein said no transplants were performed.
The local fight over heart transplants comes at a time when federal officials are trying to close some of the 82 heart transplant centers throughout the country in an attempt to minimize duplication. The federal Department of Health and Human Services has issued guidelines that would limit payments to hospitals that perform at least 12 heart transplants a year and have survival rates of at least 72 percent.
The guidelines, while not mandatory, have prompted a flood of new applications for heart transplant centers to state health planning agencies, which are charged with issuing "certificates of need" for necessary health services and equipment.
"Hospitals are trying to beat each other out and get started before there's any real federal crackdown," said an aide to Sen. Albert Gore Jr. (D-Tenn.), author of the National Organ Transplantation Act.
The four D.C. hospitals that sought approval this week initially intended to apply as a group, according to hospital representatives. However, at a meeting last Friday with an official of the State Health Planning and Development Agency, questions were raised as to whether "it rang true as a consortium," Hussein said.
Instead of filing as a group, Children's Hospital and Georgetown University Hospital each submitted a letter of intent to the health agency yesterday. Representatives of Howard and George Washington University Medical Center said they intend to form a new group for their transplant application.