San José, Costa Rica, since 1956

Transplant Center Move Worries Patients

Tanya Simpson’s 5-year-old son Kyom has a set of scars arching across his round belly like two rainbows, and a third scar that crosses them vertically, from surgeries he has undergone during the past four years. Kyom is one of 69 patients who have had a liver transplant at the Hepatic Transplant and HepatobiliarySurgeryCenter, the only place in Costa Rica where such procedures are done, currently housed at the National Children’s Hospital in downtown San José.

A decision by leaders of the Social Security System (Caja), which runs the nation’s socialized health-care system and public hospitals, to move the center’s services to the CalderónGuardiaHospital on the other side of downtown San José has Simpson and a few dozen more patients and their family members up in arms.

Yesterday, a group of patients and their families filed suits before the Constitutional Chamber of the Supreme Court (Sala IV) in hopes of stopping the move.

“My concern is that the Caja made this decision without consulting anybody – not the professionals and not those affected,” Simpson, 26, said Jan. 12 at a press conference organized by the center’s patients and their families. “It’s like moving to a new house, and we don’t know if there are cockroaches, or if it’s been fumigated.”

Dr. Amalia Matamoros, a surgeon and one of two coordinators of the center, told The Tico Times in a phone interview that nobody from the center was consulted before the decision was made to move it, and the only call she received was “just to tell me about the move,without giving any reasons.”

“They made a quick decision without our technical support,” she added. “It’s as if I were going to start a special heart surgery unit and didn’t talk to heart surgery specialists.”

The families are angry with the Caja not only for surprising them with the announcement of the pending move, but for giving them no information about their future with the program and for cutting the unit’s budget from ¢1.5 billion ($2.8 million) to ¢700 million ($1.7 million).

Eduardo Doryan, executive president of the Caja, however, assured The Tico Times Jan. 15 that the transfer of services is “a step forward” and would only strengthen the care given to patients with liver problems. He added that though the budget has been cut, if the center needs more funds, it would receive them, and pointed out that the child patients would continue to receive their treatment at the National Children’s Hospital.

According to Luis Porras, spokesman for the center’s patients, 14 patients are on the center’s waiting list for transplants, and another 44 people receive varied services from the center’s staff of 22.

The move, decided by Caja leaders Dec. 21, 2006, came in response to a Sept. 23 ruling by the Sala IV ordering the Caja to establish a “National Liver Transplant Program for Adults in a stable, permanent, efficient and continual manner,” according to an internal Caja letter provided by Porras. The ruling was the latest in a series of court decisions marking a battle by the liver transplant patients and those in charge of the center to improve services.

With administrative offices in the San Juan de Dios Hospital, the center’s doctors have been performing transplants and related surgeries, as well as exams, at the National Children’s Hospital, several hundred meters west of San Juan de Dios along San José’s choked central avenue, Paseo Colón. The Children’s Hospital has only two beds dedicated to the center, and adult patients are transferred to San Juan de Dios for post-operational care, and occasionally for the actual surgeries. According to the Sala IV, as well as those involved with the center, these fractured services are inadequate – though the patients and representatives raved about the skill, professionalism and dedication of the center’s staff.

Mario Buzo, 46, a spokesman for the group of patients at the press conference and whose 16-year-old son Eric had a liver transplant in July 2005, called on the Caja to leave services as they are while it looks for a new location for the center where it could remain autonomous. Buzo and others present said they are worried that the center would pass from an autonomous clinic to “just another service at the Calderón Guardia,” an already-overcrowded hospital which has yet to fully recover from a devastating fire in July 2005 that took the lives of 16 patients and three nurses (TT, July 15, 2005).

The staff at the current center “is available to the patients 24 hours a day. They are not just another hospital service, with long lines and bureaucratic delays,” reads a statement signed by Buzo and three others.

Buzo also told the press that he doubts the experience of the doctors at Calderón Guardia, where “there have been no successful liver transplants for more than six years.” He and others are particularly upset that the directors of the center were not consulted before deciding the center’s fate.

Dr. Matamoros, the center’s coordinator, has studied medicine in Germany and Japan and has been performing liver transplants for 12 years. She told The Tico Times she has no idea whether she will be working in the new unit, and has been given no details by the Caja about her own future. Patients have good reason to be worried, she added.

Caja president Doryan, however, insists that “the people in charge of the center now will continue to be in charge” after the move, and that the Caja’s board of directors did not have enough time to consult the center’s staff before making a decision because it had to notify the courts before they closed for Christmas.

“According to our own internal report, this type of service needs to be in a national hospital,” Doryan said. The idea of renting or buying a new location between the Children’s Hospital and San Juan de Dios, as Dr. Matamoros has suggested, is impossible because “it would imply building new infrastructure in a place that is already very congested. What we are trying to do is decongest San Juan de Dios,” Doryan said.

The Caja exec said the planned location at Calderón Guardia will need approximately $53,000 in work to prepare it for the center. He declined to give an estimate of when it might be up and running.

“Nobody is saying that tomorrow Calderón Guardia is going to do an operation. It is about forming a team, together with the team that is doing the transplants (at the center) and empower, hopefully multiply and strengthen them in their reach and sustainability.”

As for the patients’ protests, a Caja statement released after the Jan. 12 press conference said it is “sorry that the patients were reacting based on inexact information and being manipulated.”

Doryan chalked it up to confusion, saying there “has always been confusion around this, since before I was president of the Caja.”


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