Las Vegas Sun

April 24, 2019

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Fighting for its life, UMC program loses patient

But hospital CEO says kidney transplant had nothing to do with death, according to review


Cathleen Allison / Nevada Appeal

Kathy Silver, CEO of University Medical Center, testifies at a hearing Wednesday at the Legislature. Silver defended UMC’s decision to end outpatient cancer treatment at the hospital, run by Clark County.

A recent death of a kidney transplant patient is a blow to the reform efforts at University Medical Center.

The Centers for Medicare & Medicaid Services, the administrator of the federal government’s health insurance plans, almost cut off its funding to the UMC transplant program in 2008 because of an unexpectedly high number of deaths. Losing the government’s reimbursements would have shuttered the program, the only one of its kind in the state.

The hospital addressed the crisis in several ways, including a $1 million contract to bring four surgeons from the University of Utah’s transplant team to expand the depth of and skill within the program.

Medicare officials responded by extending the potential termination of the program to June 8, while adding that the improvements had made it unlikely the program would be terminated.

UMC reported the death to Medicare on March 10.

Kathy Silver, the hospital’s CEO, said officials initially feared there had been a problem during the transplant surgery, but that a recent review by Medicare surveyors found the death “had nothing to do with the transplant itself.”

Furthermore, the surveyors found no deficiencies with the plan to improve the program and commented on UMC’s dramatic improvement, she said.

Medicare officials said the patient’s death is still being reviewed.

• • •

Assemblyman Mo Denis’ efforts to address Nevada’s prescription drug crisis are being slowed by lobbyists.

His bill had initially required pharmacists to consult the state’s online database of controlled substance prescriptions if they suspect a patient is shopping for drugs among multiple doctors.

The Las Vegas Democrat sees pharmacists as an additional line of defense in keeping prescribed narcotics out of the wrong hands.

A Sun analysis of Drug Enforcement Administration data shows that Nevadans consume more narcotic painkillers than residents of almost any other state.

The Nevada Pharmacy Board supported requiring pharmacists to check the database if suspecting a patient had found multiple doctors to prescribe the potent painkillers. But Assembly Bill 326 left committee only after striking that provision.

Liz MacMenamin, director of governmental affairs for the Retail Association of Nevada, convinced lawmakers that a pharmacist’s access to the database must remain voluntary to accommodate those stores unable to protect patient privacy while using the online database.

The bill, which is still being considered by lawmakers, would also require training to encourage more use of the database, as well as a written report on the abuse of prescription narcotics in Nevada.

• • •

A bill to force UMC to reopen its outpatient cancer clinic to care for the indigent seems unlikely to help the very patients who have lost access to that therapy.

UMC, which is overseen by Clark County commissioners, closed its costly outpatient cancer clinic in November in the wake of $21 million in state funding cuts. County officials say those indigent cancer patients — the ones targeted for help by the proposed legislation — are not going without care because the county is paying for them to receive it from other providers.

The patients affected by the clinic’s closure are uninsured but non-indigent cancer patients — the middle class — who can’t afford to pay for care themselves. Assembly Bill 433, championed by Assembly Democrats, would do nothing to help those non-indigent patients.

The bill would allow Clark County to define which patients qualify as indigent, entitling them to outpatient cancer care at UMC. The county categorizes its indigent patients as those with incomes of about $17,000 annually for an individual, about $24,000 a year for a household of two and about $34,000 a year for a family of four.

Anyone stricken with cancer with an income of more than the county’s limits would be unlikely to receive assistance for outpatient cancer therapy, though the county does make exceptions in some cases.

“We see it as unnecessary,” Clark County Social Services Director Nancy McLane said of Assembly Bill 433.

The bill is moving through the Legislature.

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