The Prisoner With the Million-Dollar Heart

The prison inmate who got the heart transplant last month at the prestigious Stanford Medical Center is recovering nicely, but my own heart skipped several beats this week when I found out about the first bill received by the state for the procedure.

It came to $913,000.

Stephen Green, assistant secretary of the state Youth and Adult Correctional Agency, was almost as surprised as I was. The average cost of a heart transplant in the United States is just over $200,000.

Green had predicted that after-care costs could run the inmate’s tab as high as $1 million over time, but no one expected this kind of damage so soon.

Then again, we’re talking about one of the premier hospitals in the world. As taxpayers, we got this inmate--a two-time felon serving 14 years for a robbery in Los Angeles-- the best second chance money could buy.

A Stanford spokeswoman told me the cost of transplants varies widely but, due to patient confidentiality, she couldn’t divulge why this particular one broke the bank.

The good news, Green said, is that the state won’t pay the full amount. It will try to negotiate a settlement closer to what Medicare or Medicaid would pay. He guessed that will be somewhere between $200,000 and $400,000.

Green said the inmate ended up at Stanford because, although California has a dozen or more hospitals that do heart transplants, the state had contracts with only three. Stanford, as of the first of this year, is no longer on the list, but UCLA and UCSF are.

Let me repeat that if we’re going to continue to lock up more people than any other country in the world, it isn’t going to be cheap. And I think inmates deserve decent health care, whether they’ve got the flu or a heart condition.

But as the prison population ages, we’re going to have more inmates in need of organ transplants. Now would be a good time for state officials to shop for deals at something other than the most elite hospitals on the planet.

Last time I wrote about this, I had another question besides why Stanford? Why did this inmate get a new heart when more than 4,100 people were on a waiting list nationwide?

That decision is based entirely on medical need, said officials with the United Network for Organ Sharing, which maintains the list for the federal government. Social standing should not be a consideration, the network and various ethicists agreed, warning that we’re on a slippery slope if we start making moral judgments like that. Wouldn’t we be playing God?

I appreciate the complexities behind the sentiment. But roughly 7 million people in California have no health insurance and might have a better chance of seeing a doctor if they were in prison.

What moral imperative says we should care more about the health of 160,000 inmates than of uninsured people, one-quarter of whom are children?

As for all this righteousness about equal treatment of everyone on the organ recipient waiting list, someone is playing God in determining who gets on the list in the first place.

If you’ve got no insurance and no money, you might not make the cut. The inmate was a good candidate because the state was on the hook for his bills.

Anne Paschke of the United Network for Organ Sharing said the network offers people referrals to organizations that can help raise money. But, she said, “Some people do fall through the cracks.”

Frank Salgado, 41, was one of them. He grew up in San Diego, started a physical therapy business in Las Vegas with his wife, and raised two sons.

A year and a half ago, he was diagnosed with congestive heart failure, and, after the first medical procedure, his health insurance company dumped him and his entire family.

His doctors at UCLA told him he wouldn’t survive without a new heart, but with no insurance, getting onto the national waiting list for a transplant was a six-figure problem.

“They said I had to raise $150,000 as a down payment,” says Salgado, who didn’t have anywhere near that kind of cash.

Salgado did everything but mortgage his house, wiping himself out for a chance to salvage his life. Friends and church groups threw fund-raisers, and finally he scraped together the $150,000 that put him on the list. He wears a beeper now, waiting for the call.

Did the California inmate get the heart that could have saved Salgado’s life, and, if so, are you as comfortable with it as the ethicists claim you should be?

“I’ve tried to be a good husband and father, a good person in the community. I paid my taxes. I worked in a profession that helps people. My insurance cancels me, and it’s a tremendous amount of money that I don’t have,” Salgado says.

“I’ve had patients who came to my office after being in this country two months. They can’t speak English, but they get Medicare because they’re over 65. It makes no sense to me. Prisoners get health care and I can’t. Something’s wrong with that picture.”

The problem isn’t that inmates get medical coverage, but that people on the outside have to wage battle for decent care. And so the average Joe, who’s getting squeezed by his chintzy HMO, has palpitations when he opens the paper to see that he just bought a Stanford heart transplant for a con.

Maybe, after all the hand wringing about ethics and morality, we’re left with one more argument for universal health care. If you happen to get sick, like Frank Salgado, it shouldn’t bankrupt your family.

One last thing. About 80,000 people are on the waiting list for hearts, kidneys and other organs. On average, 16 people die each day before getting the call that could save their lives.

If you’d like to know more about organ donation, check www.shareyourlife.org.

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Steve Lopez writes Monday, Wednesday and Friday. He can be reached at steve.lopez @latimes.com.