Gulf Coast Medical Center has performed 23 kidney transplants since the surgery program partially re-opened one year ago. Frank Gluck/The News-Press
When Lee Health reopened its kidney transplant program in 2017 after a multi-million dollar overhaul stemming from an organ donor’s death, it predicted that patients would flock to what was sure to be a model new program.
Instead, documents obtained by The News-Press show that the now-shuttered Transplant Institute at Gulf Coast Medical Center almost immediately suffered from poor relations with private-practice specialists – resulting in too few patients referrals. Its top administrator also questioned the competency of one of the program’s two primary surgeons early on, ultimately resulting in his firing. Dr. Lynsey Smith Biondi speaks during a press conference Monday morning at Gulf Coast Medical Center announcing the reopening of Lee Health’s kidney transplant program. (Photo: Ricardo Rolon / The News-Press) And, because of its relatively small size and the fact that it only offered one type of transplant, the program had trouble procuring organs, according to one planning memo circulated within Lee Health last year.
Lee Health officially closed the nearly three-decade-old transplant program in south Fort Myers last month, forcing more than 60 Southwest Florida patients needing new kidneys to seek care elsewhere. Gulf Coast Medical Center (Photo: File) “This program has a long history of issues, a patient death, and fractured relationships with private practice surgeons and nephrologists (kidney specialists),” stated a planning document authored in July by Terry Mainous, director of nursing and clinical services, that recommended ending the program. “The program has also been challenged by limited medical staff support as well.”
This followed the firing of one of its two transplant surgeons, Dr. Jacfranz Guiteau, after documented concerns that he was too inexperienced to conduct transplant surgeries on his own and that he “performs worse under situations of stress or complication.”
More: Kidney transplants on hold at Gulf Coast MC because no surgeons are available
Guiteau, who graduated from the Emory University School of Medicine in 2006 and completed a transplant fellowship from the Baylor College of Medicine in 2015, was notified of his termination in April and given 180 days notice. Lee Health spokesman Jonathon Little denied that Guiteau was fired for cause, despite the stated concerns of Dr. Lynsey Biondi, the program’s director. He added that the program completed 33 transplant surgeries without complications during his tenure at Lee Health.
“Our program did not have the volume to allow him to grow as a surgeon, and Lee Health and Lee Physician Group had no reason to doubt his surgical competency, nor was it factored into the decision to part ways,” Little said.
Guiteau did not respond to interview requests for this story.
Lee Health administrators never found “a good fit” to replace Guiteau, internal documents show, despite considering three candidates for the job.
Biondi, the only other transplant surgeon, went on maternity leave last fall – prompting what was then billed as a temporary program shutdown. Two months later, Lee Health put an end to the transplant program altogether and terminated Biondi’s employment.
She could not be reached for comment for this story but warned five months ago that the program could collapse if Lee Health did not move to hire a qualified, replacement doctor.
“Even temporary closure will create safety, financial, regulatory and public relations concerns that will be detrimental or even terminal for the program,” she wrote in a July memo. Tampa General sees an opening to expand
Tampa General Hospital now leases space within Gulf Coast Medical Center, the former home to Lee Health’s program, to provide outpatient care for transplant patients.
While pre- and post-operative transplant care continues locally, the surgeries themselves will now only take place in Tampa.
And it will likely stay that way, said Tampa General’s president and CEO John Couris.
“That kind of work should be done in big programs that do lots of (surgical) volume,” Couris said. “Because, in the health care industry, lots of volume tends to equal proficiency. And proficiency in something tends to drive quality and great clinical outcomes in a safe environment.”
The hospital offers heart, kidney, liver, lung and pancreas transplants.
Last year, it performed 440 transplants of all organ types, making it the 16th busiest in the nation, according to the United Network for Organ Sharing (or UNOS), the regulatory body that oversees transplant programs. It has done more than 10,000 since transplants at the hospital started in the 1970s.
U.S. News & World Report ranked Tampa General as the 18th best kidney program in the nation for 2018-19.
Tampa General has launched an aggressive radio, television and billboard advertising campaign in Lee County boasting that it’s now the region’s top transplant center.
And, with a firm foothold in Southwest Florida, the hospital will use it to expand its business by finding patients in need of other organ transplants, Couris said.
“We would like to be able to, over time, have a clinic that handles every type of transplant. Not just kidney, Couris said. “We would do that in collaboration with Lee Health and with local physicians.” Melissa Tuff gets emotional when she talks about the toll kidney disease has taken on her life. She hopes to convince legislators and the medial community to make changes so that less people have to go through what she has. Closure is an inconvenience for patients
David Weinstein, who received a kidney transplant through the program in 1997, said the relocation of surgeries to Tampa might be a hardship for Southwest Florida residents awaiting organs. The hospital is roughly a two-hour drive from Fort Myers.
“It’s somewhat inconvenient, but it’s not terrible,” said Weinstein, who also is the treasurer for the advocacy group, Organ Transplant Recipients of SW Florida. “It’s somewhat good that we have transplant nephrologists here in Cape Coral and Fort Myers because it’s needed.”
More: Waiting for kidney transplant, Cape Coral woman’s hopes fade
But it’s been a frustrating process for Melissa Tuff, of Cape Coral, who has been in search of a donated kidney since her last transplanted one began to fail in 2009. She has been on the official waiting list for the last three years. Melissa Tuff is on hemodialysis for more than 3 hours every other day. The process leaves her exhausted and feeling awful. Tuff, 39, had just finished all the required testings to get listed through the Gulf Coast program when it shut down for good.
And, while she said the Tampa General outpatient clinic at Gulf Coast is helpful, Tuff worries that requiring surgeries take place in Tampa will be a hardship for patients without enough resources or social support.
“Because, ultimately, you still have to make that two-hour-and-something trip up to Tampa when you get that call. And you don’t really know how long you’re going to be up there,” she said. “Some surgeries go swimmingly, and you have no problems. And then some you may have a complication, and you have to be there for weeks and weeks and weeks.” 30-year history of local transplant center
Southwest Florida’s kidney transplant program was founded by the region’s private-practice kidney specialists in 1990 at the long-ago-shuttered Southwest Florida Regional Medical Center in Fort Myers.
Lee Health inherited it as part of a $535 million acquisition of Southwest Florida Regional and what was then known as Gulf Coast Hospital in 2006. Gulf Coast, which was expanded after that buyout, then hosted the program.
The private-practice doctors who founded the program continued to effectively run it during this period and performed more than 900 successful kidney transplants.
That changed in 2015 following the death of a 40-year-old Cape Coral man, who was undergoing an operation to donate a kidney to his father.
An autopsy later determined that the man, John Donaldson, had died as a result of excessive blood loss resulting from the surgery.
The family later filed a malpractice case against Dr. Barry Blitz, who performed the surgery. They have since reached a confidential settlement with Blitz and his employer, 21st Century Oncology.
In the weeks after Donaldson’s death, UNOS, the regulatory body that oversees U.S. transplant programs, put the program on probation and recommended that Lee Health assume full control of the program and hire its own doctors.
UNOS spokesman Joel Newman said “a few” transplant programs close every year at U.S. hospitals, but noted that they are often parts of multi-organ programs. Lee Health only transplanted kidneys.
Newman would not comment on this particular closure but said such decisions are usually based on the loss of key personnel and changes in budget priorities. Millions spent While exact figures are elusive, Lee Health spent roughly $6 million to $8 million to reboot its kidney transplant program after the 2015 closure and pay for its new staff and facilities, records show.The overhaul itself was about $3.6 million. Its annual budget was at least $2.4 million — mostly to pay for salaries.Lee Health employed four physicians: Biondi and Guiteau, as transplant surgeons; and two other kidney specialists.Lee Health refused to release their salaries, citing the “trade secrets” exemption in Florida’s open records law. But […]
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