UofL Health-Jewish Hospital team is second in U.S. to implant a new type of artificial heart; Indiana man 'doing well' after 5 days

The University of Louisville announced Wednesday that UofL Health-Jewish Hospital had implanted a new type of artificial heart in a Southern Indiana man, making it the second U.S. hospital to implant the French-made device.

Mark Slaughter, M.D. (University of Louisville photo)

The heart was implanted Aug. 20 by a surgical team led by Dr. Mark Slaughter, the lead cardiothoracic surgeon at the hospital and chair of cardiovascular and thoracic surgery in the U of L School of Medicine. "The recipient, whose identity is being withheld upon request . . . is doing well," a U of L news release said.

The Aeson heart "serves as a bridge to transplant for patients with end-stage biventricular heart failure – heart disease affecting both left and right sides of the heart – allowing more time for the patient to receive a permanent heart organ transplant," the release said. "The new device is designed to solve the limitations of left-ventricular assist devices, which pump blood in just one chamber, by pumping blood in both heart chambers."

It also has sensors that detect blood pressure and position and adapt blood output accordingly, and has an external power supply, the release said: "The device is medically approved in Europe, where approximately 20 devices have been implanted. The first Aeson artificial heart in North America was implanted in July at Duke University," in a 39-year-old man from North Carolina.

The release noted past pioneering cardiac efforts at U of L and Jewish, which the university took over in 2019 "to preserve its storied organ-transplant program," notes Deborah Yetter of the Courier Journal. "On July 2, 2001, U of L cardiothoracic surgeon Laman Gray led the surgical team that implanted the first self-contained artificial heart in the United States at Jewish Hospital," the release said. "The AbioCor artificial heart was implanted into Robert Tools, who lived five months on the device. The UofL surgical team also performed the first heart transplant in Kentucky at Jewish Hospital in 1984."

U of L moves to maintain heart transplants at Jewish Hospital

Doctors perform a heart transplant. (Photo from WBUR, Boston)

The heart-transplant program at Jewish Hospital in Louisville may continue after all, now that the University of Louisville plans to take over the facility on Nov. 1.

KentuckyOne Health, which is selling the hospital and other facilities to the university, is asking the national organ-donor network to disregard its July 18 request that the program be put on long-term inactivation, Kentucky One and the university announced Friday. Letting the program go inactive could have required recertification by the Centers for Medicare and Medicaid Services, which would take more than a year and cost millions of dollars.

The university has collaborated for 35 years on the program, which is linked to its medical school.  “The heart-transplant program is simply too important for our university, our community and the patients who are depending on this life-saving procedure,” U of L President Neeli Bendapudi said in a news release. “We thank KentuckyOne for working with us to maintain the program. We are taking steps to shore up our efforts, and very soon we will have a plan in place to ensure the viability of the program for the future.” 

The release noted, "The first heart transplant in Kentucky took place on Aug. 24, 1984, at Jewish Hospital. Last year KentuckyOne and UofL celebrated a major milestone after the 500th heart was transplanted."  However, the number of transplants at the hospital has declined greatly; KentuckyOne blamed a change in how hearts are allocated by the United Network for Organ Sharing.

Jewish Hospital also performs lung, liver, kidney and pancreas transplants, "making it one of a select group of hospitals transplanting all five solid organs," the release said. However, kidney and liver transplants at the hospital have also become less frequent.

University of Louisville is buying Jewish Hospital after all, with the help of an unusual $50 million loan to be backed by Ky. taxpayers

The University of Louisville is buying Jewish Hospital and associated facilities after all, with help from the state and two foundations, to head off a threatened closure of the hospital, which is an important transplant center.

"U of L has searched for months for ways to save Jewish Hospital, which has been losing money for years but is also home to valuable clinical and research programs intertwined with U of L's academic mission," reports Grace Schneider of the Louisville Courier Journal.

KentuckyOne Health's "parent company, CommonSpirit Health, accelerated efforts by U of L and the state to save Jewish when the company's executives notified them early this month that they intended to shut down the facility in about two months – and to go public with the plans on Thursday, Aug. 15," Schneider reports. The school's trustees endorsed the deal Aug. 14.

U of L said in June that it had failed to find a necessary partner to buy the hospital. Now, instead of a partner, it has a friendly lender – the Commonwealth of Kentucky – and two philanthropic benefactors: a foundation controlled by CommonSpirit, and one created when the hospital was bought by the old Catholic Health Initiatives firm in 2012.

Because the hospital's main tower is estimated to have a life expectancy of only three years, U of L plans to merge Jewish with nearby University of Louisville Hospital. U of L will also own Sts. Mary and Elizabeth Hospital in south Louisville, Our Lady of Peace psychiatric hospital, Jewish Hospital Shelbyville, "four outpatient centers and a 740-employee medical group," the CJ reports. "The health system has operating losses of about $43 million a year in earnings before interest, taxes, depreciation and amortization."

"U of L will pay $10 million for the local KentuckyOne facilities and have CommonSpirit forgive a $19.7 million promissory note," Schneider reports. "The sellers, which include KentuckyOne and certain affiliates, are expected to provide $76.4 million in 'net working capital,' including accounts receivable," and the purchase price is to be adjusted if that amount is different, the CJ's Morgan Watkins reports in another story.

The two foundations "have committed a total match of $50 million toward the effort," Schneider reports. "The state is to loan U of L another $50 million," through an unusual loan from the Kentucky Economic Development Finance Authority.

The loan will be for 20 years, "with no principal payments or interest accrued for the first five years," and "is contingent on gaining the after-the-fact authorization for an additional appropriation from the fiscal 2019-20 budget with a bill prefiled at the start of the General Assembly's 2020 session," Schneider reports.

The authorization is needed because the loan amount "far exceeds the agency's maximum of $500,000," as does the length of the loan, and KEDFA "usually doesn't provide financing up front," Schneider reports. "Not all Kentucky lawmakers are on board, despite the insistence of House Speaker David Osborne, R-Prospect, that the plans have gained broad bipartisan support."

Gov. Matt Bevin "said U of L's search for an industry partner to help buy KentuckyOne's facilities led to a dead end because the prospective companies took a 'buffet' approach," Schneider reports. "They wanted to pick and choose properties they'd like to own and leave others, and that wasn't going to work, the governor said. Bendapudi acknowledged that the university's board of trustees had similar concerns about taking on a money-losing venture and turning it around."

However, a combined hospital run as "a true non-profit, not subject to the whims of the markets, should [be] less costly to operate and less pressured to post large profits, she said."

The combined operation will be huge, and the deal is "fueled by an ambitious vision to create a top-notch academic medical center," Schneider writes. "KentuckyOne's payroll is 4,539 employees and there are more than 3,100 working at U of L Hospital, for a total of 7,639. KEDFA listed full-time Kentucky resident jobs for the combined venture at 6,736. That doesn't include Hoosiers and people from other states who work at the facilities. The state list shows that between the years 2025 and 2039, the combined health system should have at least 5,880 full-time Kentucky resident jobs to meet the wage and payroll requirements."

Jewish Hospital quits heart transplants; U of L says there's less need for them, and can't start a program of its own right now

Jewish Hospital is in downtown Louisville.

Financially ailing Jewish Hospital, which was once a national leader in heart transplants but has done only one this year, says it is putting the program on "long-term inactivation" while maintaining other transplant programs.

Hospital President Ron Waldridge said in an email to employees that the Organ Procurement and Transplant Network, which directs human-tissue transplants in the U.S., "changed how heart donation are allocated" last October, Chris Larson reports for Louisville Business First. "The change resulted in fewer heart transplant cases being sent to Jewish Hospital. . . . Transplant programs must perform at least 10 heart transplant procedures over a rolling 12-month period to stay in compliance with federal standards."

The University of Louisville collaborates on the program. "U of L President Neeli Bendapudi and other U of L leaders who spoke to media downplayed the impact that stopping the program would have on the university's education mission or on U of L Health, the organization that oversees the clinical aspect of the school's medical endeavors," Larson reports.

Toni Ganzel, dean of U of L's School of Medicine, told Larson that many medical schools do not have transplant programs, "but we saw [the program] as a really valuable part of being an academic medical center."

Tom Miller, CEO of U of L Health, told Larson that advances in technology have diminished the need for heart transplants. "And he added that U of L doesn't have the space to add a heart transplant program to U of L Hospital, which is currently operating at capacity." Miller said, "That doesn't mean that we won't some time in the future —we just don't have that today." 

KentuckyOne Health and its new corporate parent CommonSpirit Health have been trying to sell Jewish Hospital and other facilities in Louisville and Shelbyville for more than two years. "U of L announced in June that it was abandoning its plan to buy assets from KentuckyOne, citing an inability to find a partner within the timeline KentuckyOne set for the talks," Larson notes.

As Jewish Hospital struggles, so does its organ-transplant program, with bad implications for U of L and regional health care

"Jewish Hospital’s pioneering transplant program is in trouble, and its demise could produce far-reaching repercussions" on the greater Louisville area, reports Boris Ladwig of Insider Louisville.

"Surgical teams have performed only one heart transplant in the first six months of the year, according to the most recently available data, running afoul of federal minimum requirements," Ladwig reports. The program is also under threat that the hospital, which has been unable to find a buyer, might close altogether.

The transplant program is linked to the University of Louisville's hospital and its medical school. U of L told Ladwig that it would keep supporting the program, “either at Jewish or in another location.” That would require new certification from the federal Centers for Medicare & Medicaid Services, "which would take more than a year and cost the university millions of dollars," Ladwig reports.

"Even more worrisome, the national consultant told Insider that an interruption of the transplant program could prompt an exodus of transplant surgeons, which could lead to departures of medical staff in transplant-related subspecialties," Ladwig adds. "Those developments could jeopardize UofL Hospital’s status as a Level 1 trauma center [one of only two in the state], and cause it to lose medical residency spots."

That helps explain "the increasing desperation with which university officials in the last few months have tried, so far in vain, to save the struggling Jewish Hospital, which, together with related facilities, has been losing more than $1 million per week."

KentuckyOne Health, has been trying to sell Jewish and seven other facilities in Louisville, and Jewish Hospital Shelbyville, for more than two years. The university in December "tried to find a partner to acquire the properties, primarily to save Jewish Hospital," but that failed, Ladwig notes.

U of L declined to comment on why the number of heart transplants has declined, but KentuckyOne blamed a national change in how hearts are allocated. The United Network for Organ Sharing told Insider that it changed the allocation policy in October, partly "to better identify the most medically urgent transplant candidates," Ladwig reports.

Insider Louisville chart

That does not seem to have had as much impact on other transplant centers in the region. "The University of Kentucky Medical Center is on pace to perform 24 heart transplants this year, which would be a drop of 17 percent," Ladwig reports. "Nationally, transplants are on pace to be down 12.6%."

Other types of transplants "have seen a precipitous decline at Jewish Hospital," Ladwig writes. "Kidney transplants are down 56%, liver transplants are down 29%. Both have fallen just 11% nationally. Only lung transplants at Jewish are in line with national declines.

Under the bylaws of the Organ Procurement and Transplantation Network, "heart-transplant programs that fail to perform at least one transplant every three months are deemed to be functionally inactive," Ladwig notes. "OPTN and UNOS manage the U.S. organ transplant network by contract with the federal government. The agency’s website lists no action against Jewish Hospital. UofL said it has not been notified by anyone to say the program is inactive or out of compliance."

Dr. Peter Hasselbacher, an emeritus professor of medicine at U of L, "who has written extensively about the transplant program at Jewish," told Ladwig that any heart-transplant program that does fewer than five a year “shouldn’t be doing any,” due to lack of practice.

"CMS guidelines call for transplant programs to perform 10 heart transplants over any 12-month period to retain certification," Ladwig reports. "The agency could not be reached to explain what happens to programs that fail to meet that threshold."

U of L's pass on buying Jewish Hospital raises fears about the hospital's future, including its large number of low-income patients

University of Louisville President Neeli Bendapudi says there is no immediate risk of Jewish Hospital closing, in the wake of the university's decision not to buy the money-losing but medically significant facility. But there is much worry in the Louisville region about its future.

Courier Journal photo

CommonSpirit Health, formerly known as Catholic Health Initiatives, have been trying to sell Jewish and eight other facilities under the KentuckyOne Health brand for two and a half years. U of L said it could not find a suitable partner to help fund the acquisition and couldn't afford to do it alone.

Bendapudi said June 13 that there is also no immediate plan to reduce the services that the university provides through Jewish, including a wide range of care provided by U of L physicians, including its cardiology and transplant services, and training of residents from the university's medical school. She added that the university must receive at least 90 days' notice before its contracts with KentuckyOne can be terminated.

KentuckyOne spokeswoman Lannette VandeToil said there were no current plans to close Jewish or any other facilities, adding that two other organizations have been in ongoing talks with KentuckyOne Health about a possible deal: hedge fund BlueMountain Capital Management an anonymous entity, Morgan Watkins reports for the Louisville Courier Journal. 

Despite all of these assurances, local health experts worry about the future of Jewish Hospital and the tens of thousands of patients that it cares for,  Boris Ladwig reports for Insider Louisville.

Ladwig reports that Jewish and Sts. Mary & Elizabeth hospitals have been incurring operating losses of more than $1 million per week.

Dr. Peter Hasselbacher, emeritus professor of medicine at U of L, told Ladwig that he was disappointed in the university's decision to walk away, but not surprised. He added that he didn't see "any signs that instill confidence in the facility's future," Ladwig writes.

"All I see are warning signs that the community should be prepared to take up the slack to take up the medical needs of urban Louisville," he told Ladwig. "I'd love to be more optimistic, but I can't be. I see us slowly circling the [drain]."

Hasselbacher also expressed his concern about what would happen to the tens of thousands of patients that Jewish Hospital cares for if it were to close or reduce its services, many of them without insurance or covered by the federal government, which Ladwig notes generally pays hospitals less than it costs to provide the care. Hasselbacher notes that the financial issues that come with taking care of this population will follow them to other hospitals in the area if Jewish were to close.

"I'm seeing challenges . . . to the city and state that they are going to be very reluctant to" address, Hasselbacher told Ladwig, who reports: "According to recent filings, Jewish and Sts. Mary & Elizabeth hospitals have a combined 78,000 annual emergency-room visits, compared to 65,000 at nearby University Hospital. Bendapudi said University is “at capacity” and Norton Healthcare’s downtown hospital, too, sometimes has to divert patients to other facilities."

U of L can't find a partner to buy Jewish Hospital, but will continue professional partnership on education, transplants etc. 'for now'

Jewish Hospital and its Rudd Heart and Lung Center

Failing to find the partner it says it must have, the University of Louisville has suspended efforts to buy Jewish Hospital and the other Louisville-area assets of Catholic Health Initiatives, operated as KentuckyOne Health. The failure leaves in limbo the future of a major Kentucky hospital and its affiliated health-care facilities.

“U of L officials were not willing to put the university at financial risk by taking on the acquisition alone,” the university said in a news release. “We regret ending our talks with CHI but we must do what is fiscally responsible for the University of Louisville,” U of L President Neeli Bendapudi said in the release. “Without a viable partner, we do not have the resources necessary to make the acquisition a reality.”

"KentuckyOne and U of L will continue their professional partnership for now, including the academic affiliation agreement that ensures undergraduate and graduate/resident medical education programs continue at Jewish Hospital and Frazier Rehab Institute," report Morgan Watkins and David Harten of the Louisville Courier Journal. "If the programs cannot be continued at those facilities, CHI will assign those residencies to another facility requested by the university, according to U of L’s statement Wednesday."

University spokesman John Karman "said U of L is continuing to make progress on contingency plans that it has been working on since last year concerning the transition of its service lines from Jewish Hospital to other health care facilities," the newspaper reports. "More than 1,000 employees work at the hospital. Jewish also serves as the only adult organ transplant center in the city, and all of the physicians who perform lung, kidney, liver, pancreas, heart and dual organ transplants at Jewish are employed by U of L."

KentuckyOne's assets have been for sale for more than two years. Besides Jewish and Frazier Rehab, they include Sts. Mary and Elizabeth Hospital, four outpatient centers, Our Lady of Peace psychiatric hospital and Jewish Hospital Shelbyville.

U of L withdrawal of some services from Jewish Hospital puts Louisville's only adult organ transplant center at risk

Jewish Hospital has a prominent place along
Interstate 65. (Courier Journal photo by Sam Upshaw)

"The University of Louisville may soon stop providing important medical services at Jewish Hospital — a move that could jeopardize the only adult organ transplant center in the city" and one of only two in Kentucky, Morgan Watkins reports for the Courier Journal. "All of the physicians who perform lung, kidney, liver, pancreas, heart and dual organ transplants at Jewish Hospital are employed by U of L, according to the university."

U of L President Neeli Bendapudi said last month that the university was starting to move some medical services from Jewish to University of Louisville Hospital and elsewhere because of "the current uncertainty around" Jewish, which is for sale and at risk of closing.

"If the university is no longer providing the surgeons to do transplants, then there’s nobody to do the transplants at Jewish Hospital. It’s not like you can bring in somebody overnight," colorectal surgeon Wayne Tuckson told Watkins. He works for KentuckyOne Health, the Catholic Health Initiatives subsidiary that owns Jewish. CHI, which has had financial problems, is merging with Dignity Health of San Francisco.

"U of L has been making contingency plans for its solid organ transplant program, but shifting such operations from one hospital to another isn't an easy or quick process, according to Laura Aguiar, principal and managing partner of Transplant Solutions LLC, which works with transplant programs around the country," Watkins reports. The other transplant programs in Kentucky are at Norton Children's Hospital in Louisville and the University of Kentucky.

Two big contracts between KentuckyOne and U of L expire at the end of this month, Watkins notes: "Under those agreements, KentuckyOne agreed to provide a minimum of about $35.6 million to the university for 56 medical resident positions at Jewish Hospital and the Frazier Rehab Institute, as well as for a variety of services performed by U of L employees, including heart and brain surgeries. . . . Also, U of L physicians serve as medical directors for the lung and liver transplant programs at Jewish. Even Jewish's chief of surgery works at U of L's school of medicine."

KentuckyOne spokesman David McArthur told Watkins, "An agreement is not required for U of L physicians to practice at Jewish Hospital, and we welcome and encourage their continued service. Our desire and intent is to continue to provide comprehensive services for the community. If the university chooses to relocate their physicians to other area hospitals, it will impact the services available at Jewish Hospital." He said the company and the hospital are still in "productive discussions." Watkins reports KentuckyOne has agreed to fund the 56 U of L residents at Jewish Hospital and the Frazier institute through June 30.

UK sets record for most heart transplants in a year

The University of Kentucky Transplant Center recently performed its 38th adult heart transplant for 2015 and set a record for the most heart transplants performed by a Kentucky medical center in a single year, according to a UKnews release.

"This has truly been a banner year for the UK Transplant Center and the UK Gill Heart Institute," Dr. Navin Rajagopalan, medical director of heart transplantation at UK HealthCare, said in the release. "Never before has a transplant center in Kentucky performed more than 30 heart transplants in one year. Our outcomes remain good, a testament to the strong team we have assembled at the University of Kentucky."

The previous state record was 27 heart transplants performed in a single year. Historically, only 20-25 medical centers in the country perform more than 30 heart transplants in a single year, says the release.

Transplants are a team effort that begins with the Kentucky Organ Donor Affiliates, who work "tirelessly" to encourage more Kentuckians to sign up, enabling more patients to receive the gift of life.

UK HealthCare's surgical transplant team, in conjunction with UK Gill Heart Institute's Advanced Heart Failure Program, offers a comprehensive and multidisciplinary approach to treating heart disease.

For example, some heart disease patients get what is called a left ventricular assist device (LVAD) for long-term, permanent support and some patients with advanced heart failure will receive a ventricular assist support device to serve as a "bridge" to transplant, enabling them to be more mobile and thus healthier and stronger, while they wait for a matching donor heart to become available. UK has implanted 29 durable LVADs this calendar year.

“Our program fulfills a need in Kentucky for many patients who otherwise may not have had the opportunity to receive a life-saving transplant,” Dr. Michael Karpf, UK executive vice president for health affairs, said in the release. “The commitment UK HealthCare has made to the program over the years has made a difference in the lives of many patients and their families and exemplifies the complex advanced subspecialty care it is important for our academic medical center to provide.”

UK's advanced ventricular-assist device program for heart patients saves and improves lives

Two years ago, John Doty was diagnosed with walking pneumonia, and though antibiotics originally helped, the pneumonia came back with a vengeance, and he went to see a cardiologist. He found out his heart was severely weakened with an ejection fraction of less than 10 percent. "The ejection fraction is a measure of how effectively the heart can pump blood volume into the body, and in a healthy heart, that number falls between 50-65 percent," Allison Perry writes for the University of Kentucky, where Doty received a left ventricular assist device (LVAD) because his heart was so weak.

UK Chandler Hospital is Lexington's only hospital, and one of two in the state, that can perform emergency VAD procedures. "When Mr. Doty was transferred to UK, he was very sick, on a ventilator and requiring two medications to support his blood pressure," said Dr. Navin Rajagopala, a heart failure cardiologist at the UK Gill Heart Institute. "He was going into kidney and liver failure. It was clear that he needed an assist device as soon as possible before the damage to his body was irreversible."

VADs partially take the place of the function of a failing heart. They're more often used for the left ventricle, but some patients need the device for the right ventricle or even two devices to help both ventricles (BiVAD). Because VADs can help the heart rest and heal, some patients receive them after a heart attack or a surgery. People suffering from congestive heart failure might need a VAD for the rest of their lives.

A viral infection damaged Andy Baker's heart, and though he originally resisted the idea of a VAD, now he says he's "happy to keep the device and has no interest in getting a heart transplant," Perry writes. "I had mixed feelings about it," Baker said about getting the VAD, "but it's given me life again."

VAD treatment can save money for the both the patient and the hospital and allow at-home recovery. VADs can allow people to return to their normal lives, participating in many of the same activities they did previously. in about 5 to 10 percent of cases, the VAD even helps the heart to heal to the point that the device can be removed. That was the situation for Doty, whose device was removed 16 weeks after he got it. "I almost feel like I never had it," Doty said. "It wasn't that great of an imposition, considering that it was keeping you alive."

UK performs about 20 to 30 VAD procedures per year, and recently received its third straight biannual Certificate of Distinction from The Joint Commission, the leading accreditor of U.S. health-care organizations. That "shows just what an outstanding job our physicians, nurses and support staff are doing when it comes to treating patients who require these assist devices," said Dr. Maya Guglin, director of UK's Mechanical Assisted Circulation Program. (Read more)

UK Healthcare says it must get even bigger, and expand its market area, to provide needed services to Kentucky

By Molly Burchett and Al Cross
Kentucky Health News

The University of Kentucky's health-care system has grown by leaps and bounds in the last decade, becoming one of the state's largest businesses, but its boss says it must expand its geographical reach to maintain its newly raised national status and to ensure access to quality care for Kentuckians.

Over the last decade, UK HealthCare’s caseload has increased 85 percent, and its annual hospital budget has increased from $300 million to $922 million, Dr. Michael Karpf, executive vice president for health affairs, said in an interview.

This explosive growth, in addition to the growth of the UK medical school, has jacked up the enterprise's national ranking. It has grown from about the 85th largest academic hospital in the U.S. to approaching the 35th largest in terms of total discharges, the benchmark it uses. That means it has jumped from the bottom third to the top third in less than a decade. (For a more precise measurement over time, based on a Council of Teaching Hospitals standard, see chart.)

The push for growth and development began in 2003, after UK's caseload hit a plateau even though the 1998 General Assembly had mandated it to become a top 20 public research institution. Karpf came aboard and combined the Chandler Medical Center, clinics, faculty practice plans and the College of Medicine into a single integrated system of care -- branded as UK HealthCare -- which he commands. Good Samaritan Hospital in Lexington was added in 2007.

"Ten years ago people viewed this a safety-net hospital," Karpf said of the Chandler facility. "We've had to redo the brand." Now more people are choosing the hospital, as suggested by who's paying the bills. Medicare now covers a plurality of the patients; a decade ago, it trailed Medicaid, the program for the poor and disabled. In that time, the total caseload grew 7.2 percent; Medicare cases rose 10.9 percent.

But despite the huge growth in the last decade, the enterprise is still not big enough, Karpf said.

"We want the hospital to be the first choice when it comes to complex care,” he said. “We must advance to better serve the health-care needs of Kentucky.” To do this, he said, UK HealthCare is rejuvenating its brand as "Kentucky's Best Hospital," with a broad range of advanced specialties to keep Kentuckians from leaving the state for care, and is moving to expand its geographic reach to Western Kentucky and out-of-state markets.

Karpf said UK must expand because its traditional market, approximately the eastern half of the state, is not large enough to provide the number of cases that UK will need to receive certification as a federal “Center of Excellence” for complex services like brain surgery and heart, liver, kidney and lung transplantation. He said such a designation will be necessary to get enough referrals from doctors and smaller hospitals to maintain these services and to guarantee that Kentuckians can get the care they need inside the state. "What we make money on is the complex stuff," he said.

Unless UK secures half the available business from out-of-state competitive areas over the next 10 years, Karpf said, "It becomes an issue of access for Kentuckians."

He said the out-of-state institutions that are large and advanced enough to effectively compete with UK as a major referral center include Vanderbilt University, Washington University in St. Louis, Indiana University, Ohio State University, Cleveland Clinic, the University of Pittsburgh Medical Center and the University of Virginia. Vanderbilt is the nation's 10th largest academic medical center and gets many patients from Western and Southern Kentucky. 

UK HealthCare map shows out-of-state markets and institutions it targets for its expansion.

What about Louisville, Cincinnati, Knoxville and other cities? Karpf said the University of Louisville, the University of Tennessee, the University of Cincinnati and West Virginia University are too small and too far behind to be Centers of Excellence. U of L's hospital ranks 88th in total discharges among academic medical centers.

All hospitals are facing challenges from federal health-care reform, but Karpf said at UK it has prompted a culture change centered on quality of care, which the reform law is designed to reward. As UK tries to expand its market, he said, it is critical to stay focused on, safety, service and patient satisfaction. One issue Karpf is dealing with now is the hospital's cardiothoracic surgery program for children, which has been suspended pending an internal review.

As UK seeks more referrals, Karpf said, it is building better relationships with smaller hospitals. "in the past, academic medical centers have been seen as predatory," he said. "We concluded that we need to be seen as in another line of business. . . . We have very strong relationships with community hospitals in Western Kentucky."

For example, UK is  training a cardiologist who is dedicated to practicing in Paducah once his training is complete, and kidney specialists from the area are in its transplant network. The specialists evaluate patients, send them to Lexington for transplants, and provide follow-up care upon their return. Such coordination helps community hospitals keep patients and recruit professional staff, and helps UK capture the cases it might lose to Vanderbilt and other out-of-state hospitals.

Baptist Hospitals Inc. has a large facility in Paducah and recently bought the Trover Health System hospital in Madisonville, making Baptist the largest hospital system in Kentucky, but Karpf said UK has a strong relationships with Baptist and the Norton Healthcare hospitals in Louisville. "They do not compete with us for complex care," he said. "We don't go after the bread-and-butter cases."

Complex care, for which insurance companies pay well, accounts for 5 to 7 percent of UK's cases but almost all its profits. Karpf said UK loses money on another 5 to 7 percent and breaks about even on the rest. He said the profits are invested in buildings, technological equipment and attracting nationally recognized specialists.

The most visible evidence of that is the hospital's new bed tower, part of $1.4 billion UK Healthcare has spent revitalizing itself, mostly with its own profits. But the larger impact is probably in expansion of good-paying jobs.

Dr. Michael Karpf

"We've been the most important growth engine in this region," said Karpf. UK HealthCare went from paying $350 million in salaries and benefits in 2004 to more than $700 million last year. The College of Medicine went from 1,810 employees in 2004 to 2,337 in 2012. The hospital grew from 2,562 full time employees in 2004 to 5,544 in 2012, a 116 percent increase.

The medical school's full-time faculty has expanded from 443 a decade ago to 625 now. "We know the stronger you are clinically, the better your research profile," Karpf said. UK Healthcare hopes to achieve National Cancer Institute designation for the Markey Cancer Center, and it must continue to evolve in its clinical, education and research missions, Karpf said.

If UK HealthCare can do that, it will continue to be a major economic driver for Kentucky while ensuring that all Kentuckians have access to quality care.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

First heart-lung transplant in Ky. in 15 years performed at UK

University of Kentucky surgeons performed Kentucky's first combined heart-lung transplant in 15 years this summer, UK announced today.

Dawn Nelson, 29, of Louisville, received two lungs and a heart from the same donor in one procedure at the Albert B. Chandler Medical Center on July 7. She and her parents discussed it with Courier-Journal reporter Laura Ungar in this video by The C-J's Kylene White:


For Ungar's story, click here. Combined heart-lung transplants are rare; only 27 were performed nationwide in 2011. They are generally performed on younger patients who have a fatal disease and cannot be treated with medication or other interventions.

Nelson was diagnosed with systemic lupus erythematosus at 17 and rheumatoid arthritis at 22. Four years ago, she developed pulmonary hypertension, fatal without timely treatment. The disease destroyed her lungs, and her heart began to fail when it could no longer push blood into them.

Dr. Wesley McConnell, a transplant pulmonologist with Kentuckiana Pulmonary Associates in Louisville, began caring for Dawn two and a half years ago at KPA's Pulmonary Hypertension Center. After she didn't respond to drug therapies, McConnell referred Dawn to UK May 11 for a transplant evaluation. "Dawn was extremely ill and it became clear that her only chance for survival would be a heart-lung transplant," he said. "I knew that UK was her best option because they had the most experienced team in the state."

Dr. Charles Hoopes, director of the UK Transplant Center, performed the surgery, only the seventh such procedure to be performed at UK since it began transplantation in 1964. The last time UK performed this surgery was 1996. "Although the surgery itself is relatively simple, combined heart-lung transplants are rare because they require three donor organs and are reserved for patients who are extremely ill with heart and lung failure," said Dr. Jay Zwischenberger, chair of the UK Department of Surgery. "They also require a great deal of infrastructure and support to perform successfully. At UK, we have that team in place, and moving forward we expect to perform one or two of these combined transplants per year."

More than four months after her surgery, Nelson continues to improve and grow stronger. Dr. Enrique Diaz, medical director for lung transplantation, and Dr. Navin Rajagopalan, medical director of cardiac transplantation, both provide followup care for her at UK, and she continues to see McConnell in Louisville. "Dawn is doing quite well. At the time of transplant, she was so sick she only weighed about 80 pounds," Rajagopalan said. "Now, she feels well, is gaining weight, and is able to do things that she had not been able to do for years.”

Nelson's collaborative treatment is a prime example of the partnership UK is trying to cultivate among Louisville and Lexington doctors, said Dr. Michael Karpf, UK executive vice president for health affairs: “Our goal is to continue to provide highly advanced subspecialty care such as Ms. Nelson’s complex transplant to patients like her who otherwise would either have to leave the commonwealth or, worse, not receive the treatment needed.”

In November 2010, UK in collaboration with Norton HealthCare opened up an outreach Transplant and Specialty Clinic at Norton Audubon Hospital to provide comprehensive pre- and post-transplant care for patients. The partnership ensures that patients like Nelson will not have to leave the state to receive complex acute care or followup treatment, a UK press release said.