Setback for Scripps Transplant Program : Federal Regulations Bar Proposed Chief of Surgery From Clinic Post

Scripps Clinic & Research Foundation in La Jolla has suffered a major setback to its plan to establish an innovative heart and lung transplant program--the surgeon hired by the clinic does not meet with the federal government’s approval.

Hospital administrators learned this month that the United Network for Organ Sharing intended to refuse approval of Dr. Patrick Maguire, who was hired by Scripps over a year ago specifically to head the fledgling program.

Length of Time to Learn

The problem lies with the length of time the surgeon spent learning to perform the still-experimental procedure. Maguire participated in a six-month fellowship at Stanford University Medical Center, but UNOS requires a one-year training program.

All transplant programs must be formally approved by UNOS, which is under contract with the federal Department of Health and Human Services. A nonprofit agency, UNOS coordinates the procurement of donor organs for needy patients nationwide.

Scripps officials say they don’t intend to give up on the dream of a transplant program and are now looking into alternatives, which include sending Maguire to do an additional fellowship or setting up a joint transplant program with another hospital.

Maguire, an experienced heart surgeon who trained in the combined heart-lung procedure at Stanford and in London, met the agency’s requirements at the time Scripps filed an application for approval of the program, on June 1, 1988. UNOS, however, changed its guidelines on May 31, the day before the application was filed, according to Scripps spokeswoman Sue Pondrom.

The UNOS approval committee works slowly, meeting only four times a year to review applications, and the Scripps application was not reviewed until this May, Pondrom said.

Scripps formally withdrew its application June 16, but is not ready to concede defeat.

“I personally am committed to Dr. Maguire as our man,” said Dr. James Oury, head of the department of cardiac surgery at Scripps. Maguire, he said, performed 15 heart-lung transplants while training in London, and has assisted in another 40 to 50.

“Our intention is to continue to pursue the goal of having transplantation here,” Oury said. “At this point our relationship with UNOS has been very good, and we plan to continue working with them until we satisfy every question they have.”

Sharp Memorial Hospital is currently the only hospital in San Diego County with a heart transplant program.

No hospital in the county is now doing combined heart-lung transplants, but UCSD Medical Center announced in April the hiring of Dr. Stuart W. Jamieson, a controversial but internationally acclaimed heart-lung transplant surgeon. Jamieson, now at the University of Minnesota, is expected to arrive in San Diego on July 1, but no specific date has been set for starting the heart-lung transplant program, according to a hospital spokeswoman.

Enthusiasm Cited

Oury said he spoke with Jamieson this week about setting up a joint program. “He is personally enthusiastic about that possibility,” Oury said. “A combined program would have the advantage both in terms of the scientific data that would accrue as a result of the interaction with the university and simply in terms of patient care.”

The advantage to UCSD to engage in such an agreement would be having access to the clinical research facilities at Scripps, as well as the clinic’s prestigious reputation, which draws patients nationwide, Oury said.

Leslie Franz, a spokeswoman for UCSD Medical Center, said there has been no formal proposal from Scripps or any kind of discussion on collaboration. “The administration here is not in any kind of position to comment on a partnership with Scripps Clinic,” Franz said. “It’s even more premature when you consider that Dr. Jamieson isn’t even here yet.”

However, Franz said, “There is a sense that the department of surgery and the school are prepared to talk with the community hospitals once Dr. Jamieson is here and the program is in place about any possible partnerships down the road.”

Oury said he also informally discussed the possibility of a joint program at Loma Linda University Medical Center in San Bernardino County with Dr. Leonard Bailey, chief of that hospital’s infant transplant program.

“He also expressed his willingness to be considered in that framework,” Oury said. Bailey was unavailable for comment.