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Transplant unit another LHSC program eroded by cuts, departures: Veteran doctor

Posted: February 6, 2020

(February 5, 2020)

By: Norman De Bono, The London News Press

Another high-profile London doctor is sounding off about budget cuts at the London Health Sciences Centre, this time involving its organ transplant program, saying he quit his job because “I was tired of banging my head against the wall.”

The  program’s budget has eroded and about a half-dozen, high-level people have left, said Paul Marotta, who recently quit as the medical director of liver transplantation, adding he’s concerned about LHSC’s ability to recruit replacements.

“There is a threat, an immediate threat,” said Marotta. “We are losing people with 20 to 30 years’ experience, and there is not a real strategy to recruit. The deficit grows, cuts are happening. It is difficult.”

But LHSC’s chief medical officer insists that while the hospital has lost doctors, it has been actively recruiting and the quality of care the hospital delivers remains high.

“I am not concerned about the status of our transplant (program),” said Adam Dukelow, adding the care is “high quality every day.”

LHSC last fall lost its top heart doctor, Bob Kiaii, who left for a job in California, charging that LHSC no longer considers cardiac care a top priority as it makes cuts to reduce its budget shortfall.

Marotta, who has gone part-time, said he stepped down from his position frustrated by continuing cuts to budgets.

“It is why I left administration . . . I left my position because I was tired of banging my head against a wall.”

His concern, he said, is the future of the multi-organ transplant program, which has been a source of pride for LHSC.

In an email, Marotta said he couldn’t be specific about program cuts but that its budget is based on LHSC’s budget. When that’s in a shortfall, cuts occur and the program hasn’t been good at either asking for or getting money, he said.

Besides Kiaii, the former director of cardiac care and a transplant surgeon, Marotta points to the following high-level departures from the hospital:

  • Qingyong Xu, former director of the transplant immunology lab, who left months ago and is now at the University of Pittsburgh
  • Roberto Hernandez-Alejandroz, a liver transplant surgeon and former surgical director of liver transplantation, who left more than three years ago for the University of Rochester
  • Two hepatologists and liver transplant doctors, who haven’t been replaced since leaving in 2016, also for Rochester, N.Y.
  • A transplant infectious disease specialist who recently left for Toronto.

“The multi-organ transplant unit has had its budget cut repeatedly over the years,” Marotta said, adding nursing and other support staff have also been cut.

“We are down and we are well over capacity. Our volume has increased. There is frustration and there is no light at the end of the tunnel.”

Transplant doctors are highly specialized and not easy to land, Dukelow said, adding recruitment demands patience.

“It is challenging. We always want to recruit the right candidate and many people are involved (in the hiring process),” he  said. “It can take time, but we have the right people at the table leading recruitment.”

LHSC has a $24-million deficit and will lose 38 full-time equivalent nursing jobs to attrition and 11 more to layoff. It also has closed 11 surgical beds.

“We are making difficult decisions in allocating resources. We have to provide care. We are looking at recruits, we are hiring quality people,” said Dukelow.

On its website, LHSC describes its multi-organ transplant program as one of the leading programs in Canada, performing nearly 200 transplants a year. More than 6,000 Canadians have received transplants at the hospital, including kidney, liver, heart, kidney-pancreas, pancreas and multi-organ procedures, it says.

The hospital is “meeting all of the patient care needs for transplantation surgery as organs are donated,” LHSC said in a statement. The hospital has not closed any cardiac beds and there has not been a decrease in cardiac surgery volumes, LHSC said.

While the hospital said it’s moving to fill vacancies, only one has been filled and the replacement for Xu is scheduled to start in February. The other positions remain unfilled or with interim appointments.

Kiaii, former director of cardiac care at LHSC and a nationally renowned heart surgeon, left for a job at the University of California. He voiced concerns similar to Marotta’s over the fallout of budget cuts at LHSC and his belief that the cardiac program, considered one of the best in Ontario, has been diminished.

“We have lost a lot of senior people. It is frustrating,” said Marotta. “We can lose doctors and replace them with junior people, but the administration has to accept that we need a strategy. We are managing crises as they occur.”

Natalie Mehra, executive director of the Ontario Heath Coalition, said she found it “shocking” concerns are surfacing about LHSC’s cardiac program, but worries budget cuts are common among hospitals, she said.

“There are very serious concerns about quality of care and a shrinking of the scope of services the hospital delivers. We have had so many years of budget austerity and real dollar cuts to hospitals,” she said.

“It is shocking to hear about the extent of this in London. It is a hub, one of the largest hospitals in Ontario. If cardiac care is compromised by budget cuts, that is outrageous.”

Marotta said he has tried to voice concerns over budget cuts and staffing losses, but questions whether he’s being heard by senior administration at LHSC.

“There are a lot of layers to administration here. Our urgency has not reached the top. It goes to middle management and falls short,” he said.

“We can help them save money. There are so many areas operating inefficiently.”

Dukelow said his door is open for Marotta and others with concerns.

“They are welcome to contact me and have a conversation. I want to hear about those concerns,” he said.

LHSC was recently caught in a controversy for spending $75,000 to send five hospital executives and the London Health Sciences Foundation president to Dubai, Oman and Qatar, on a junket funded by the foundation. The trip was to attend a conference and meet with hospital executives there in a bid to land work in London to train their doctors, the hospital said at the time.

“When you see them spending money on a trip to Dubai, you lose confidence in the hospital and foundation,” said Marotta.

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