Feds accuse three hospitals of skewing organ transplant list

CHICAGO -- Three Chicago hospitals were accused by the federal government on Monday of diagnosing some patients as more ill than they were as a way of speeding up their liver transplants.

Federal officials and a bioethics expert said they knew of no other case in which the government has accused hospitals of using fraud to increase the eligibility of patients for organ transplants.

One University of Illinois Medical Center patient certified as seven days away from death was discovered in a hospital lobby wearing a clown costume and putting on a show to support a blood donation drive, officials said.

Some patients were placed in intensive care units when they didn't need to be and were diagnosed as far sicker than they were, officials said.

"By falsely diagnosing patients and placing them in intensive care to make them appear more sick than they were, these three highly regarded medical centers made patients eligible for liver transplants ahead of others," U.S. Attorney Patrick J. Fitzgerald said.

The three institutions are the University of Chicago Hospitals, Northwestern Memorial Hospital and the University of Illinois Medical Center at Chicago.

The University of Chicago immediately agreed to settle with the federal government and the state attorney general's office, which joined in the negotiations. Northwestern settled with the federal government. The state attorney general's office decided not to participate in the Northwestern case.

Neither hospital admitted any wrongdoing.

The federal government, joined by the Illinois attorney general's office, asked the U.S. District Court to force the University of Illinois Medical Center, which has not settled, to pay $3 million in damages.

Its spokesman, Mark Rosati, said that "our physicians acted at all times with the utmost concern for the welfare of patients very ill with liver disease."

He said talks with the federal government are continuing.

No data on such fraud

Officials said there was no evidence that anyone had died for lack of a transplant because some patients were moved up on the list.

But some doctors said it was possible.

"The story is really who didn't get these transplants, not who did," said Dr. Steven Miles, a professor of medicine at the University of Minnesota Center for Bioethics.

He said he could find no data on how common such fraud is but said he knew of no case in which the government had sued over the use of bogus condition information to move patients into higher eligibility.

"Organ donation can be a matter of life and death," said Illinois Attorney General Lisa Madigan, whose office jointly filed suit with the federal government. "There is no room for fraud when it comes to deciding which patient receives an organ."

Livers available for transplant are in short supply, and only the most seriously ill patients are eligible.

The criteria for deciding who is sick enough are established by United Network for Organ Sharing, which was set up by the federal government.

But economics is part of the equation as well.

Hospitals must perform 12 transplants each year for two years with a survival rate of 75 percent or better to be eligible for Medicare and Medicaid payments to reimburse the cost of the operations.

Federal officials said one motive on the part of the hospitals was to make sure that they had performed enough operations to qualify.

The case stems from a whistleblower lawsuit filed in 1999 by Dr. Raymond Pollak, a University of Illinois Medical Center surgeon. The lawsuit had been under seal since it was filed and was unsealed for the first time on Monday.

Pollak has been waging a long-standing court battle with the hospital, which he said demoted him and cut his pay after he complained.

"They called me into the dean's office and said, 'What's wrong with doing things the Chicago way?"' he said Monday. "I said, 'What's the Chicago way, dead people voting?"'

He currently is a full professor of surgery and director of the abdominal organ transplant program of the University of Illinois College of Medicine at Peoria.

Under terms of the settlement with two of the hospitals, the University of Chicago will pay $115,000 and Northwestern Memorial $23,587.

A spokesman for the University of Chicago Hospitals, John Easton, said that "contrary to the government's allegations, the hospitals believe that all decisions about patient care were completely justified."

"All the patients were accurately diagnosed with life- threatening liver disease and needed the transplant," he said.

A Northwestern Memorial Hospital spokeswoman, Kelly Sullivan, issued a statement pointing out that state officials had not become involved in Northwestern's settlement.

She said Northwestern agreed with the need to investigate allegations such as those made by Pollak. But she added: "We strongly disagree with the government's position regarding those charges, including any suggestion that intensive care unit coverage of two critically ill patients, comatose and suffering from liver failure, was unnecessary."

She said Northwestern agreed to pay the settlement "in order to avoid inconvenience and expenses on both sides."

Assistant U.S. Attorney Lisa Noller said the settlements represented the loss to Medicare and Medicaid. She said the amount would have been higher with the transplant costs figured in, but most of the patients eventually would have received transplants.

U.S. Attorney spokesman Randall Samborn said Northwestern's settlement involved no Medicaid money.