One year after losing its bone marrow transplantation chief and two other key specialists to Rhode Island Hospital, Roger Williams Medical Center has hired a new director for its bone marrow transplant program.
But Dr. Ahmad Samer Al-Homsi’s new job will be nothing so simple as re-establishing and upgrading RWMC’s transplant program. He is walking onto center stage of an ongoing battle between the two hospitals over whether there should be only one bone marrow transplant center in the state – the existing one at Roger Williams.
RWMC has been fighting the Rhode Island Hospital plan, which was filed a year ago and is still under review before the Health Services Council at the R.I. Department of Health.
Instead of starting a new program, Roger Williams is urging RIH to work out a collaboration between both institutions, building on an existing joint fellowship in hematology and oncology.
But for Rhode Island Hospital and its parent, Lifespan, offering bone marrow transplants is part of a broader vision for an academic medical center in Providence, run in conjunction with Brown University.
To get state approval for the 10-bed facility, however, which would cost an estimated $5.6 million to set up and $10.2 million per year to run, Lifespan needs to show there is a public need for it, that the plan is affordable, and that there’s no less-costly or more effective alternative.
Lifespan says there is a substantial unmet need in Rhode Island and neighboring communities – all patients who now travel to Boston. Rhode Island Hospital also offers top-notch cancer treatment services at its Comprehensive Cancer Center, officials there say, and it has the full range of intensive-care services for patients who develop other medical complications.
“As the state’s leading academic medical center and the only hospital in Rhode Island to offer a full complement of the latest cancer treatments, we believe the development of a bone marrow transplant program is an obvious and necessary next step,” the hospital said in a statement in response to a media inquiry.
Lifespan also noted that Roger Williams’ 14-year-old program doesn’t include pediatric beds, while the Rhode Island Hospital facility would have two. And by offering a new local option for patients, the new facility “would keep health care jobs local” – as well as health care dollars.
But for Roger Williams, having the only bone marrow transplant program in Rhode Island is a competitive issue as well. It boasts on its Web site that it’s the only hospital “with a complete range of cancer care that includes the latest in research, diagnosis and treatment.”
The transplant program itself, however, has always been small. Figures provided by Roger Williams spokesman Brett Davey show a peak of 29 transplants in 2002, then 18 in 2003, 21 in 2004, 27 in 2005, 23 in 2006, and 17 last year – due to the departure of program director Dr. Peter Quesenberry and two other surgeons.
Yet Roger Williams’ program is still, arguably, developing. It was only two years ago that the National Marrow Donor Program accepted the hospital as a full-service transplant program; until then, the hospital could only do transplants when a relative or friend was a good match. Then three of the five doctors left. And though the new director is already working on revitalizing the program and raising its public profile, he is still applying for licensure in Rhode Island, and he won’t be here full-time until April. (In the meantime, he’s still working in as director of the blood and marrow transplant unit at the University of Massachusetts Memorial Medical Center in Worcester.)
Meanwhile, the Health Services Council continues to review the Lifespan application.
Kimberly O’Connell, general counsel for RWMC, said the best solution is for both hospitals to run a single program together. The existing shared fellowship in hematology and oncology, she said, is “a perfect jumping-off point.”
Davey noted that collaboration would also be consistent with state policymakers’ priorities. As officials have looked at ways to strengthen community hospitals, they’ve encouraged them to work together, and “if we can come up with some resolution with Rhode Island Hospital … that could set a precedent for the state.”
“This is an opportunity for us to set an example for collaboration,” he said.
In its written statement, Lifespan did not entirely dismiss that possibility. “It is premature to talk about potential collaboration with RWMC,” the statement said, “as discussions are still ongoing.” ·
Here’s a perfect example of how collaboration could improve overall quality and save money, AND how the competition in the current system hurts efforts to improve both. Over a decade ago our State had a NIH designated Cancer Center at Roger Williams. This is a rare and valuable resource to the community, which was lost because competition between the two hospitals fragmented the key staff and subsequently diluted the necessary resources to operate a Cancer Center at the highest level as the NIH requires. I am not blaming anyone but the system, the hospitals were doing what they felt they needed to do to survive. Collaboration among our hospitals will be critical if efficient “Centers of Excellence” are to be created. If they must merge to accomplish that then perhaps that is the most expedient path.