Almost six months after going into hospital with Covid-19, and a double-lung transplant as a last resort, patient is heading home

Staff members congratulate Victor Gonzales-Villatoro on his discharge at UK. (Photo by Hilary Brown)

By Hilary Brown

University of Kentucky

Staff at UK HealthCare gathered Wednesday to celebrate the discharge of patient Victor Gonzales-Villatoro, who was hospitalized with Covid-19 in October. The disease ravaged his lungs, Victor’s family was told he had almost no chance of survival, and they considered withdrawing life support.

As a last effort, UK doctors considered Victor a candidate for a double lung transplant and placed him on extracorporeal membrane oxygenation (ECMO) to see if his body could recover enough to withstand the transplant surgery.

For several months, while on ECMO, Victor remained unconscious. He awoke, and with a determined spirit, worked hard to gain the strength to receive a transplant — including getting up and walking while still connected to ECMO. On March 1, after five months on ECMO, Victor, 37, got a new set of lungs. Within a week, he was off the ventilator and walking.

Victor’s fighting spirit and unwavering determination endeared him to his care providers. After almost six months in the hospital, Victor was discharged amid a chorus of cheers and applause. He will spend the next few weeks at Cardinal Hill Rehabilitation Hospital in Lexington, where he will work to regain his strength and endurance.

Factory worker and bodybuilder, 43, is first person in Kentucky to get a double lung transplant because of damage from Covid-19

Dave Hoover and family (UK HealthCare photo)

The first Kentuckian to get a double lung transplant because of damage from the coronavirus is a 43-year-old competitive bodybuilder who is "the kind of healthy, younger person who isn’t statistically likely to develop severe complications from Covid-19," Daniel Desrochers reports for the Lexington Herald-Leader.

Read more here: https://www.kentucky.com/news/coronavirus/article251839643.html#storylink=cpy

Dave Hoover, a factory worker and hobby farmer from Stanford, "thought it was allergies or a minor illness," Desrochers reports. "Even after he checked into the hospital, he had seemed mostly fine." But he gradually got worse, and "developed a complication from being on the respirator that allowed air to seep into his chest, so they had to catheterize his throat in order to inject oxygen directly into his veins. He was put on the lung-transplant list, where he waited for a month."

Hoover the bodybuilder

About 15 percent of those on the list don’t make it through the waiting period because too few people are organ donors, Dr. Maher Baz, medical director of lung transplants at the University of Kentucky, told Desrochers.

Hoover went home April 23 to his wife and son. "“They were very brave for this, very motivated, and that’s what kept him on his feet,” Baz told the Herald-Leader. “That’s what really got him through the waiting time, his motivation and courage.”

Hoover told the newspaper, “I don’t think I knew exactly how critical I was until after the transplant. After I started feeling better, my wife started sharing some things with me and I was speechless. I’m just very grateful.”

Read more here: https://www.kentucky.com/news/coronavirus/article251839643.html#storylink=cpy

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.

As black lung surges in Appalachia, so do lung transplants

A new study published in the American Journal of Industrial Medicine shows that, as black-lung cases have surged in the Central Appalachian coalfield, so have lung transplants. The expensive surgery can be risky, and most transplant recipients die within five years. The study, conducted by researchers from the National Institute for Occupational Safety and Health, "found that 62 black lung patients had lung transplant surgery over the past two decades, and most of the miners lived in Kentucky, Virginia, and West Virginia," Benny Becker reports for Ohio Valley ReSource. "The study also found that more than two dozen patients were placed on a wait list for transplants. Of those, 11 died while waiting."

The study's lead author, David Blackley, said that the rate of lung transplants for black-lung patients increased nearly threefold in the last decade. "That suggested pretty strongly to us that this is a problem that's getting worse," he told Becker.

Insurance from coal companies and other private sources paid for about one third of the lung transplants. Nearly two-thirds were paid for with public insurance, including 26 percent paid for by Medicare and up to 24 percent paid for by the federal Black Lung Disability Trust Fund. "That fund has paid more than $45 billion to cover benefits for miners who can’t seek benefits from their employer, because the responsible company has either gone bankrupt or can’t be identified," Becker reports. A federal study is looking into how long the fund can stay solvent given the rise in cases.

The researchers who conducted the study had also recently discovered that the spike in late-stage black lung in Central Appalachia is the largest cluster of the disease ever recorded.

Winchester woman with COPD gets a double lung transplant; Kentucky has second highest rate of COPD in nation

 Dr. Maher Baz, UK HealthCare lung transplant
medical director, and Glenda Brown, recipient.

Glenda Brown smoked for 30 years before she quit in 2000. She then spent the next 20 years gasping for air after being diagnosed with chronic obstructive pulmonary disease, which got so bad she eventually needed a double lung transplant, Allison Perry reports in a University of Kentucky news release.

Brown is not alone in this diagnosis. Kentucky has the second highest rate of COPD in the nation, which is largely a result of its high smoking rate, 26 percent. It is the third leading cause of death in the U.S. and affects at least 16 million Americans and millions more who don't know they have it, according to the Kentucky Department for Public Health.  

Brown, a 62-year-old woman from Winchester, told Perry that she used to wake up in the middle of the night unable to breathe and had to race to an open window just to get a breath of cold air to soothe her cramping chest.

While Brown quit smoking in 2000, she told Perry that her breathing worsened over the years and eventually caused her to quit her job once she required oxygen around the clock. She added that she largely became responsible for herself in 2008 after her husband died.

Brown first learned she needed a lung transplant during a 2009 hospitalization for bronchitis. She said she was referred to UK HealthCare for an evaluation, but didn't go because of fear. "I was trying to fool myself," she said. "I put off going to UK for years because I was so scared."

Brown finally decided to go in for the evaluation, but told Perry she still wasn't ready to do the full transplant work-up at that time.

"She was barely able to live independently," said her lung doctor, Maher Baz. "She was on oxygen around the clock and couldn't do much outside the house."

It wasn't until nearly two years later that she was finally ready for the full work-up, and on March 9, 2016, she was officially added to the transplant list. And just four days later they found a match, though most transplant patients have to wait months or even years for a match.

"I decided to leave it all in God’s hands and had the attitude that if this is to happen, then it will happen," Brown told Perry.

Baz, who is also the medical director of the lung transplant program at UK, said: "I think she decided to throw caution to the wind once she convinced herself that this is not a life she wanted to live. She embraced change, and decided to replace it with an active and independent lifestyle."

Brown said she expected to wake up from her surgery and feel instant relief in her breathing, but instead had to retrain her body how to breath normally because she had been taking short, shallow breaths for so many years.

Almost 18 months after her transplant, Brown told Perry that "her quality of life has dramatically improved and she's been more active than ever – even taking Zumba for the first time."

"I get to live again," Brown said. "I'm doing things I haven't been able to do in years."

Brown told Perry she had no desire to smoke again, especially after the gift she had been given.

"I know exactly what I went through when smoking, and what it did to my lungs," she said. "And I would never disrespect the person who gave me these new lungs… I'm so blessed."

Perry writes that the average lifespan of transplanted lungs averages 5-6 years, though some patients are able to keep their lungs for a decade or more. She added that improving lung transplant outcomes continues to be a point of focus for medical teams across the country.

UK continues to build its lung transplant program and was recently recognized as the program with the best one-year survival rates for lung transplants in the country, Perry reports.

Anyone can sign up to become an organ donor by joining the Kentucky Organ Donor Registry. To join visit www.donatelifeky.org or sign up when you renew your driver’s license.

Lung transplant recipient who battled bureaucracy to get coverage, dies five days after being widowed; funeral Sunday

"Katie Prager, the Kentucky lung transplant recipient whose story with her late husband, Dalton, touched millions, has died," reports Cheryl Truman of The Lexington Herald-Leader. Katie and Dalton met online and married in 2011. "Both had cystic fibrosis, and both had lung transplants that failed."

(Lexington Herald-Leader photo.)

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Katie, 26, died in her Flemingsburg home early Thursday, a family member said.

Debra Donovan, Katie's mother, said it was Katie's wish to be surrounded by loved ones in her final moments. “Early this morning she gained her wish of being at home, in her bed, surrounded by her mom, dad, brother and her dogs, dying peacefully away from the hospital, tubes, IVs,” Donovan, wrote Thursday morning on Facebook.

"By the time Katie's close-knit Fleming County family gave her a Christmas-in-September party on Saturday, she was underweight, her once-abundant blonde hair sparse, her color waxen." Truman writes. "She had made a decision to discontinue all life-extending measures except for dialysis and had entered hospice care. She was sleeping a great deal, using an oxygen tank and getting weaker by the day."

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Hours before the start of the family gathering, Dalton died in his hometown of St. Louis. "He had been trying to get to Kentucky to see his wife, who was in Hospice care after her own failed lung transplant, one last time," Truman writes.

Read more here: http://www.kentucky.com/news/local/counties/fayette-county/article102599882.html#storylink=cpy

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Katie and Dalton received national attention because they both had "the Burkholderia cepacia infection, which limited the number of surgery centers specializing in their conditions," Truman writes. "Dalton received his lung transplant in November 2014. Katie, after a lengthy bureaucratic snafu over insurance coverage, received her new lungs at the University of Pittsburgh medical center in July 2015." Both transplants were unsuccessful.

"During the Saturday Christmas party, Katie said that she believed in an afterlife and would see her husband again," Truman writes. "At the family gathering in Ewing after Dalton’s death, Katie said, 'I’ll see him soon.'”

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Visitation for Katie will be 4 to 9 p.m. Sunday at Elizaville Christian Church in Flemingsburg. Funeral services will be at 10 a.m. Monday at the church.

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Kentucky woman finally gets lung transplants

After months of waiting, the 24-year-old woman who received national attention over her financial and policy battle with Medicare and Medicaid to get lung transplants has new lungs and is resting comfortably in a Pittsburgh hospital, Cheryl Truman reports for the Lexington Herald-Leader.

Katie Prager and her mother, Debra Donavan, left, at UK
Chandler Hospital in April. (Photo: Lexington Herald-Leader)

Katie Prager's case received national attention because she has cystic fibrosis with a Burkholderia cepacia infection, and only two hospitals in the U.S. are qualified to do lung transplants on such patients. Further complicating matters, Prager's insurance, a combination of Medicare and Medicaid, considered the hospital that would do her surgery, the University of Pittsburgh Medical Center, out of network.

"That left Prager sick at University of Kentucky Chandler Hospital, her only in-network option," Truman writes.

In April, the University of Pittsburgh Medical Center applied to the Kentucky Cabinet for Health and Family Services for a limited permit to take Prager's case, which eventually cleared the way for Prager to get her lung transplants.

Prager's husband, Dalton, had the same condition as his wife, but was able to get a double lung transplant in November 2014 through his parents' insurance.

Prager, 24, is on a ventilator, but is communicating with a dry-erase board.

"I'm sore, but I'm so, so happy and blessed. God has blessed me so much and I am forever in debt and grateful to my donor and their family," she wrote.

Debra Donovan said of her daughter: "It's amazing how well she's doing. She looks really well. ... She just looks beautiful."

Plight of woman needing lung transplant, who has fallen through the cracks of the health-care system, gets attention from CNN

Update: CNN reports that Kentucky issued a Medicaid provider number to the University of Pittsburgh Medical Center, and the hospital confirmed that they now have enrolled in Kentucky Medicaid and are working to complete the enrollment of some of their physicians, all of which helps clear the way for Katie Prager to get her lung transplant.  "Kentucky Medicaid executives are helping us to get this done in a streamlined fashion that overcomes previous administrative hurdles and misunderstandings in this complex case," Wendy Zellner, a spokeswoman for UPMC, told CNN. Dalton, Katie's husband, has since been discharged from the Pittsburgh hospital where he received his lung transplants in November and has returned to Kentucky. CNN reports Katie and Dalton were only able to communicate through the doorway of her University of Kentucky hospital room because of his risk of getting Katie's infection, which could kill him.

A 24-year-old Kentucky woman with cystic fibrosis who needs a lung transplant to live is caught in the middle of a financial and policy battle among Medicare, Medicaid, a state agency and the University of Pittsburgh Medical Center, one of only two hospitals in the United States qualified to do lung transplants on patients with her specialized condition.

Prager at University of Kentucky hospital (Image from CNN)

"I feel like they're putting a dollar sign on my life," Katie Prager of Ewing, in Fleming County, told CNN. "I don't want to die because of money. That's stupid. Nobody should have to do that." Katie's story was first reported by The Ledger Independent of Maysville and excerpted in Kentucky Health News.

Katie longs to be with her husband, Dalton Prager, but can't until she gets her lung transplant because in addition to cystic fibrosis, she has an infection, Burkholderia cepacia, that is "horribly dangerous" to him, Elizabeth Cohen and John Bonifield report for CNN. Dalton, who also has cystic fibrosis, received his lung transplants Nov. 17 at the Pittsburgh hospital, and the immunity-suppressing drugs he takes for the transplants make him highly vulnerable to infection.

"I just want to make it to see our four-year anniversary in July and be able to hold hands and just hug. That's all I really want -- to be able to hug my husband on our fourth anniversary," Katie told CNN.

Katie and Dalton met on Facebook in 2009 when they were 18 and Dalton lived in Missouri and Katie in Kentucky. And though Katie's doctors had warned her many times that it was dangerous to be around other CF patients because of the risk of shared infections, Katie decided to meet Dalton, even after he had told her he had Burkholderia cepacia, CNN reports. They married two years later.

Photo from CNN

"I told Dalton I'd rather be happy -- like really, really happy -- for five years of my life and die sooner than be mediocre happy and live for 20 years," she told CNN. "That was definitely something I had to think about, but when you have those feelings, you just know."

Their health "quickly deteriorated, and within months, they went on oxygen full time" and had to quit work, CNN reports. They entered the Pittsburgh hospital together in August 2014 to wait for new lungs. Dalton got his in November; Katie is still waiting.

One month after Dalton got his transplants, UPMC discharged Katie because they told her "It would be psychologically good for her to get out for a while," she told CNN. After only three days out she began to have "serious trouble breathing" and tried to go back into the hospital, but was told she could not return because "she had used up her supply of Medicare days."

Medicare wouldn't pay for another hospitalization until Katie had been out of the hospital for 60 days. She is too sick to do that, and has since been a patient at the University of Kentucky, where she relies on the federal-state Medicaid program for the poor and disabled to pay for her care, and doctors have predicted that she won't live a year without new lungs, CNN reports.

Medicaid cannot pay the Pittsburgh hospital because it is not in the state's network of health-care providers. CNN reports that Katie's doctor wrote a letter to Medicaid begging them to make an exception, but the state denied his plea. In a statement to CNN, a spokeswoman for the state Cabinet for Health and Family Services said the hospital had declined to enroll as a Kentucky Medicaid provider. "Medicaid policies allow for a simplified enrollment process for out-of-state providers in such situations," Gwenda Bond, spokeswoman for the cabinet wrote, offering to expedite their application when they choose to sign up.

Hospital officials counter that Kentucky officials said they would have to "sign up hundreds of their doctors to accept Kentucky Medicaid patients," which hospital spokeswoman Wendy Zellner said is "an unusually restrictive approach and contrary to single-case agreements that we have signed with other state Medicaid programs. . . . It is up to Kentucky Medicaid to address this situation."

Katie has also since had a discussion with a federal Centers for Medicare and Medicaid Services caseworker that "didn't go very well," CNN reports. Katie told CNN that the caller was "rude, mean, and angry" and "acted like it was just a pain to have to be talking to me," but said "she would look into her situation." On April 1, CMS spokesman Aaron Albright told CNN that the federal agency was "reaching out to the state agency," and later in the day Zellner said the state agency "has reached out to us to talk. So stay tuned."

The news cheered the Pragers, who continued to talk via Skype and work on their fundraising Facebook page, while dreaming of a future together, CNN reports.

Woman needing lung transplant falls through cracks of health-care system, says she's treated as nothing more than a 'price tag'

Katie Prager, a 24-year-old cystic fibrosis patient from Ewing in Fleming County, needs a lung transplant, but has been denied one because she has met her lifetime maximum on Medicare, Christy Hoots reports for The Ledger Independent in Maysville.

Photo from The Ledger Independent

"They've put a price tag on my name. That's all I am to these people right now," Prager told Hoots from her hospital bed at the University of Kentucky's Chandler Medical Center.

Prager has had cystic fibrosis her entire life, but it was a diagnosis of an infection called burkholderia cepacia in 2009 that caused her lung function to rapidly decline and caused the need for a lung transplant. She was told in 2013 that the UK Center for Cystic Fibrosis does not do transplants on cystic fibrosis patients with this infection, so she was sent to the University of Cincinnati hospital, Hoots reports.

She and her husband Dalton Prager, who also has cystic fibrosis, were then sent to the University of Pittsburgh Medical Center because it is only one of two hospitals that will transplant a lung into a patient with this infection. They began evaluations in January 2013.

Dalton Prager was quickly approved and successfully received a double lung transplant in November 2013. Katie Prager wasn't approved until June 2013. While waiting for a donor lung, she was discharged to spend Christmas with her family, only to hear from the hospital that she could not return there because the Medicare maximum had been reached.

"At first, I thought I might be able to use Medicaid, but was told that it wouldn't cover my transplant due to UPMC being out of network," Katie Prager told Hoots. "After explaining to Medicaid that there are only two places in the country who would operate, due to cepacia, they still refused to work together to help me. In January 2015 I filed an appeal with Medicaid to have them reconsider. The appeal was denied."

She was recently told she would never be eligible to return to UPMC for a transplant and there was nothing else they could do for her, Hoots reports.

"They told me to basically stop wasting my time," she told Hoots. "These are people who we're trusting with our lives and they say that. Most people have no problems when they have to have medical treatments or transplants, and I'm being given the runaround. I'm not trying to be a burden on the system -- that isn't what I want. If I could work and get my own insurance, I would. All I want is a normal chance at life. I want to get my bachelor's degree, get up every day and go to work, run a 5K and have a normal life with my husband. I want to do all the things that young people in love get to do. Is that so much to ask?"

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.

UK surgeons first to do life-saving lung procedures in tandem

Surgeons at the University of Kentucky are the first in medical history to perform two procedures in tandem to bridge a lung transplantation. The procedures were performed first on Wanda Craig, 68, who is now the oldest person to be "bridged to transplant using an artificial lung device, also known as an extracorporeal membrane oxygenation," reports research-reporting service Newswise. (Photo of Wanda Craig and Dr. Enrique Diaz by Julia Meador)

Craig, of Lexington, had chronic obstructive pulmonary disease and emphysema for which she has been treated for the past 10 years. In November 2010, she took a turn for the worse. "I was so out of breath from walking to the kitchen ... I didn't have enough energy to even scoop ice cream out of the carton," she said. Pulmonary hypertension, from which she also suffered, had caused the right half of her heart to fail, which prevented blood from going through the lungs to fill the left side of the heart, explained Dr. Charles Hoopes, director of UK's heart and lung transplant program.

To fix the problem, Hoopes and Dr. Enrique Diaz, the program's medical director, performed a procedure called an atrial septostomy, in which a small hole is created between the upper two chambers of the heart. This procedure, along with the extracorporeal membrane oxygenation procedure, saved Craig's life, the news release says. "These procedures are novel in terms of a bridge to transplantation, and the use of an artificial lung together with an atrial septostomy for cases of respiratory and right ventricular failure have not been performed together until now," Diaz said.

Three days later, Craig underwent a double lung transplant, and has been healing since. "More than anything I am looking forward to doing those normal everyday things like going to the grocery store and watching my grandson's T-ball games," she said. "And scooping my own ice cream." (Read more)