Op-Ed: RIH Needs Bone Marrow Unit
(posted May 21, 2008)
The decision by Rhode Island Department of Health Director David Gifford to deny Rhode Island Hospital’s bone-marrow transplant application is not in the best interest of patient care in the state and our region.
The application for five adult beds and two pediatric beds was submitted in January 2007. After months of deliberations, the Health Services Council, the advisory committee to the Department of Health, asked Rhode Island Hospital/Hasbro Children’s Hospital to consider a collaborative program with Roger Williams Medical Center.
Rhode Island Hospital agreed to a 13-point plan of collaboration between the two hospitals, designed to enhance care for all of the state’s cancer patients. When Roger Williams insisted that adult beds at Rhode Island Hospital were not necessary, some members of the state Health Services Council tried to promote a compromise by giving Rhode Island Hospital only two adult and two pediatric beds. Rhode Island Hospital agreed to that proposal, which was rejected by a vote of 7 to 5.
Consider the implications of this decision. Currently, over 50 percent of all adult patients leave the state (most going to Boston) to have a bone-marrow transplant, the treatment of choice for many forms of leukemia, lymphoma and multiple myeloma. All pediatric patients leave the state.
A bone-marrow transplant is not a simple procedure — it entails high doses of chemotherapy, potentially combined with radiation and complete replacement of the patient’s immune system. Immediate risks of life-threatening infection, bleeding, liver and respiratory failure may be followed by nausea and chronic fatigue. There is significant hardship for patients and their families, separated for a month when the patient is in Boston, and significant hardship for the patient who, after being discharged from the hospital, must travel back to the hospital two to three times a week during the first three months, while suffering many or all of the aforementioned side-effects.
The decision also jeopardizes the ability of patients seeking bone-marrow transplantation in Rhode Island to benefit from the National Marrow Donor Program, which matches patients with the more than 11 million donors in its database.
Roger Williams currently is a participating hospital, but it may not qualify in the future if it does not continue to meet the threshold number of transplant procedures required for access to the program.
A joint program with the proposed adult and pediatric program at Rhode Island Hospital would have increased the likelihood that Roger Williams would continue to qualify for participation in the National Marrow Donor Program. A joint program also would have increased the amount of clinical research providing new drugs and new treatments to Rhode Island patients.
As part of the review process, the state hired an independent consultant to determine whether there was a need in Rhode Island for additional beds dedicated to bone-marrow-transplant patients. The consultant determined that even if Roger Williams were operating at full licensed bed capacity, five additional adult beds would be needed. The consultant also stated that two pediatric beds were needed. The consultant concluded that while good programs exist out of state, using these programs requires patients and their families to pay the cost of transportation and lodging for an extended period. Including readmissions, the consultant estimated that the average inpatient stay is 29 days for adults and 41 days for pediatric patients. “These costs could be avoided,” the consultant reported, “by providing services in state.”
While Roger Williams voiced support for the two pediatric beds at Hasbro Children’s Hospital, it is not possible to build a good program based on only two beds. Bone-marrow-transplant patients require an extraordinarily high level of care, not only at the level of expert clinicians, but also nursing, physical therapy, nutritional services, laboratory support, infection control, environmental support and housekeeping.
If Rhode Island Hospital’s bone-marrow-transplant program were limited to two pediatric beds, recruitment of a director of pediatric bone-marrow transplantation with sufficient expertise, and support that the hospital infrastructure needed for this very specialized and intensive care, would not be feasible. Hasbro Children’s Hospital will not provide less than the very best care to pediatric patients.
The decision to reject Rhode Island Hospital’s application forces most patients from Rhode Island to find care elsewhere. The decision tells patients to go to the Roger Williams unit, which has been unable to garner physician and patient support over the past 14 years, or travel to Boston, resulting in inconvenience, family trauma and the difficulty of traveling when ill.
A bone-marrow transplant program at Rhode Island Hospital would offer care in a large academic center, where virtually all bone-marrow-transplant programs nationally reside. It would provide an opportunity for the 50 percent of adults and 100 percent of pediatric patients who choose not to go to Roger Williams to receive their transplants in Rhode Island. It would let these patients remain close to their families and close to home.
On April 28, Rhode Island Hospital submitted another letter of intent for adult and pediatric bone-marrow-transplant beds. We are resolute in advocating a bone-marrow-transplant program at Rhode Island Hospital. Our patients deserve no less.
By Edwin Forman/Cindy Schwartz/Eric Winer
Cindy Schwartz, M.D., is director of pediatric hematology and oncology at Rhode Island Hospital/Hasbro Children’s Hospital; Edwin Forman, M.D., is a hematologist and oncologist at those hospitals; and Eric Winer, M.D., is a hematologist and oncologist at Rhode Island Hospital.