R.I. Hospital not giving up on marrow transplants

Rhode Island Hospital is making new efforts to set up an adult and pediatric bone marrow transplantation program, with an appeal of a decision by the state Health Services Council to reject a revised version of a previous application and a new plan in the pipeline.
The hospital, which already has a comprehensive cancer program and some of the most advanced technology in the state, had applied to the R.I. Department of Health in January 2007 to set up a facility with five adult beds, two pediatric beds and a specialized lab.
To get approval for the plan, which Rhode Island Hospital estimated would cost $5.6 million to set up and $10.2 million per year to run, it had to show there was a public need for the program, that it was affordable, and that there was no less-costly or more-effective alternative.
But Roger Williams Medical Center, which currently has the state’s only bone marrow transplantation program – for adults only, with 17 transplants done last year – argued that the new facility wasn’t needed and that a collaboration between the hospitals would be better.
After more than a year of hearings and deliberations, the Health Services Council asked Lifespan, Rhode Island Hospital’s parent company, to consider a collaboration, and Lifespan agreed to a 13-point plan to work together to enhance cancer care.
Yet that wasn’t enough to end opposition to the Rhode Island Hospital plan. And after members of the Health Services Council suggested a compromise – a scaled-down program with two adult and two pediatric beds – the council as a whole rejected it by a 7-to-5 vote.
Lifespan isn’t giving up, however. It has filed an administrative appeal and is preparing a brief to the R.I. Department of Administration, said spokeswoman Jane Bruno, and an administrative judge will review the appeal and allow Roger Williams to chime in as well.
The judge can uphold the council’s decision, overturn it, or send it back for a new review by the Department of Health, and whatever the decision, either party can appeal in the Superior Court, Bruno said. There is no time frame for this process.
Separately, Lifespan last month filed a new application for a bone marrow transplantation program, following the basic terms of the compromise that was rejected in April.
The new plan includes two adult beds, two pediatric beds and a stem cell lab, with the two adult beds housed in a unit that is already being renovated as part of a separate project to meet new standards of care for severely immuno-compromised cancer patients.
The patients to be served by that four-bed unit include those with lymphoma and leukemia as well as those with complications from chemotherapy, and their needs are very similar to those of bone marrow transplant patients, the hospital notes in its application: isolation, careful water-quality control, specially filtered air, and highly specialized nursing care.
The outpatient adult unit, on the other hand, would be set up within the hospital’s Comprehensive Cancer Center. For the pediatric unit, there would be two inpatient beds that are already set up for children who’ve undergone bone marrow transplants, and an outpatient unit in a new, relocated and expanded pediatric oncology program.
The bulk of the estimated $870,000 capital cost of the revised plan, however, $488,000, would go to a new lab that will process blood, marrow and other items to be infused in the transplant recipients. Operating the entire program would cost about $4.7 million per year.
In its application, the hospital notes that bone marrow transplants are the only service not already provided at Rhode Island Hospital and Hasbro Children’s Hospital. The facilities offer a full range of screening, diagnostic procedures, radiology, surgical treatment, chemotherapy, radiation (including gamma knife) and radio frequency ablation, it notes, and many doctors and staff members “have established a solid record in this service in other locations.”
The application also directly addresses a key question for state health officials, whether the program would add to already fast-rising health care costs. Many Rhode Islanders now go out of state for transplants, it notes – 44 did so in Massachusetts in 2006 alone.
“The proposed program will bring a portion of those patients back and keep the health care dollars in the Rhode Island economy,” according to the application.
Lifespan is also using the Health Services Council’s own expert to bolster its case. In a July 2007 report, Harvey Zimmerman of Spectrum Research Services Inc. concluded that given the incidence of cancers of the type that can be treated with bone marrow transplants, there is a need for about 10 adult beds and two pediatric beds in this area.
That need can be met by expanding the Roger Williams program, Zimmerman noted, but it’s “unclear that it can attract additional patients,” given its record of a low volume so far. Alternately, he said, local patients can continue to use out-of-state programs, or the Rhode Island Hospital plan could be approved – which would involve extensive new investments and “might also have a negative effect on utilization at the Roger Williams program.”
Bruno said Roger Williams has requested a public meeting on the new plan, though none has been scheduled yet. A spokesman for Roger Williams did not respond to a call or an e-mail seeking comment for this story. &#8226