Health Care

Patient needing lung transplant dies after Jackson Memorial declines transfer

Carlos Marquez becomes emotional on Friday, Jan. 15, 2016, as he talks about the recent death of his daughter-in-law, Maria Huaman.
Carlos Marquez becomes emotional on Friday, Jan. 15, 2016, as he talks about the recent death of his daughter-in-law, Maria Huaman. mhalper@miamiherald.com

A Miami woman in need of a lung transplant died this week after her family said they tried repeatedly to have her transferred from a West Kendall medical center to Miami-Dade’s taxpayer-owned Jackson Memorial Hospital, the only facility in South Florida capable of transplanting lungs and a designated safety net for uninsured county residents.

The woman’s family says Jackson Memorial officials denied her transfer first because they believed she was an undocumented immigrant, then because she was uninsured — and ultimately, after a week of denials, because she was too critically ill to move.

Jackson Memorial officials would not address the woman’s case, citing patient privacy laws. The woman’s family said they would waive those rights but had not completed the required legal forms as of Friday.

Maria Huaman, 38, died at West Kendall Baptist Hospital on Jan. 13, more than three weeks after she entered the emergency room with kidney failure, abdominal pain, vomiting and other symptoms, according to medical records supplied by her family.

Huaman, the mother of three school-aged children, had accidentally drunk from a cup containing weed killer the day before going to West Kendall Baptist on Dec. 18, said her husband, Carlos Marquez, 36. Miami-Dade police interviewed Marquez and Huaman’s family at West Kendall Baptist the day she died, and an autopsy was performed the following day.

Though the cause of Huaman’s death has not been released, Marquez said he initially took his wife to Jackson South Community Hospital on Dec. 17 with abdominal pain and vomiting hours after she took a gulp of the herbicide and spit it out.

Doctors at West Kendall Baptist noted in their medical records that Jackson physicians had examined Huaman, kept her under observation for several hours and discharged her the same day with a prescription for a heart burn medication.

After being admitted to West Kendall Baptist the next day, Huaman’s condition gradually worsened as her liver failed, and she suffered hypoxia and acute respiratory failure, medical records show. Doctors eventually placed Huaman in a medically induced coma.

Unable to perform a lung transplant that doctors at West Kendall Baptist said she needed, social workers at the hospital tried to transfer Huaman to Jackson Memorial’s Miami Transplant Institute, where nine patients were on the waiting list for a lung transplant as of July 2015, according to the Scientific Registry of Transplant Recipients.

Medical records provided to Marquez by West Kendall Baptist show the hospital’s staff presented Huaman’s case for transfer to Jackson Memorial on Jan. 5. The case was “not accepted,” with no reason specified.

But Huaman’s father-in-law, Carlos Marquez, 60, said he spoke by telephone with a Jackson Memorial transplant financial counselor after the denial, and that she told him that Huaman had lied and said she was an undocumented immigrant during her visit to Jackson South.

In fact, Huaman was granted legal permanent resident status in June 2014. Her husband, the younger Marquez, is a naturalized U.S. citizen.

“Maria was killed by bureaucracy, and because they didn’t see her as a human being — a wife, a mother,” the older Marquez said. “They saw her as a number.”

West Kendall Baptist staff tried again to have Huaman transferred to Jackson Memorial on Jan. 6, and again she was denied. According to medical records, Jackson officials stated that Huaman “cannot be taken in, due to inability to support transplant and post-transplant care.”

Huaman and Marquez were uninsured when West Kendall Baptist requested Huaman’s transfer, and the elder Marquez said Jackson Health requested a $350,000 deposit in order to admit her.

There is no federal regulation or legal requirement stipulating that a transplant candidate must have health insurance to receive an organ transplant surgery, said Joel Newman, a spokesman for the United Network for Organ Sharing, or UNOS, a nonprofit organization that coordinates organ donation under a contract with the federal government.

And it is not uncommon for transplant hospitals to ask for a cash deposit prior to accepting a patient, he said.

“It is always the decision of the individual transplant hospital,” Newman said.

Jackson Health System, the county’s public hospital network that includes Jackson Memorial and Jackson South Community Hospital, will receive nearly $400 million in local sales and property taxes this year in large part to help provide care for uninsured residents.

Its mission is to deliver a single standard of medical care for all Miami-Dade residents, regardless of ability to pay. But Jackson Health officials declined to say whether low-income county residents who qualify for free or reduced-cost care are eligible for organ transplant surgeries.

Jennifer Piedra, a spokeswoman, issued a statement that read, in part: “All American transplant centers adhere to complex criteria that prioritize the patients who are most likely to survive and thrive through the transplant journey. Even after surgery, patients need a lifetime of medication, doctor visits and follow-up care. Many, many people on transplant waiting lists across the country have heartbreaking stories of need — part of our job at the Miami Transplant Institute is to create the best outcomes for as many of these people as possible.”

Lung transplants are costly. The estimated charges for an entire episode ranged from $785,000 to about $1 million in 2014,according to research published by the actuarial firm, Milliman.

Carlos Marquez said he and his wife were uninsured because they could not afford coverage. The couple own an office cleaning company, and their combined income was less than $28,000 in 2015 — the minimum amount needed for Floridians to qualify for government aid to pay for an Affordable Care Act plan, also known as Obamacare.

But they also earned too much to qualify for Florida’s Medicaid program.

For two years, Florida’s Legislature — meeting in Tallahassee this month — has refused to expand eligibility for Medicaid as provided for under the ACA, turning down federal money to expand the program to include single adults and low-income parents like Marquez.

Miriam Harmatz, a senior health law attorney for Florida Legal Services, a nonprofit advocate, said the Huaman case is an example of what can happen when low-income Floridians are not afforded coverage as envisioned under the ACA’s Medicaid expansion.

“This is the kind of tragedy that's going to be happening more and more as the safety net gets more stressed,” Harmatz said.

She noted that Miami-Dade’s low-income uninsured are eligible for coverage under Jackson Health System’s charity care program, known as Jackson Prime. Harmatz has filed complaints with federal officials in the past noting that Jackson Health makes it difficult for the low-income uninsured to access the free and reduced-cost care.

The hospital system is required under the ACA to inform uninsured patients who cannot afford care about the program, but the younger Marquez said they were never told about it.

Jackson Health’s statement said hospital staff members routinely screen all uninsured patients for eligibility for any public assistance, including charity care.

After Jackson Memorial declined Huaman’s transfer on Jan. 6, the family met with a counselor at West Kendall Baptist who informed them that the health law allows subsidies for legal permanent residents with less than five years in the country, and Huaman qualified.

The younger Marquez said he applied for coverage and found a plan for Huaman at a cost of $18 a month after financial aid.

But the plan would not take effect until Feb. 1.

On Jan. 10, a transplant surgeon from Jackson Memorial visited Huaman at West Kendall Baptist, according to medical records. The surgeon expressed concern about Huaman’s ability to survive a move because her blood oxygen levels were dangerously low and unstable.

But he noted that he would present the case to Jackson Memorial administrators for acceptance and would inform West Kendall Baptist of the decision on Jan. 12 or Jan. 13. She died Jan. 13.

A day later, the family received three bills from Jackson Health for her visit to the emergency room on Dec. 17. On the billing statement, Huaman is listed as an “undocumented alien” who would pay her own way. The amount due: $9,585.30.

Sitting in the kitchen of the West Kendall home he shares with his widower son and three grandchildren, the elder Carlos Marquez said the family is going to move away to start over without the painful memories.

But he said he will not forget that Huaman was denied an opportunity for a potentially life-saving transplant.

“They never gave her a chance,” he said.

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