Miami-Dade County

Doctor, nurse: UM administrator assaulted us

In this photo from July 2008, surgeons remove a kidney from a live donor patient at the Miami Transplant Institute, a joint program between the University of Miami Miller School of Medicine and Jackson Memorial Hospital.
In this photo from July 2008, surgeons remove a kidney from a live donor patient at the Miami Transplant Institute, a joint program between the University of Miami Miller School of Medicine and Jackson Memorial Hospital. MIAMI HERALD STAFF

A doctor and a registered nurse are heading to court Monday over startling accusations that a University of Miami supervisor at South Florida’s only organ bank physically struck them during a 2013 staff meeting in an attempt to silence their complaints about personnel shortages, inadequate training and other concerns with UM’s leadership.

The former UM employees claim in separate lawsuits that the assaults — the nurse called the blow “a karate chop” to her back — were witnessed by about 50 colleagues, and that university administrators barely addressed their complaints afterward.

In interviews with the Herald, the two women employees said the attacks occurred as university administrators stepped up the pressure to harvest more organs for transplant surgeries, sometimes at the expense of quality and safety measures.

UM officials deny the allegations in the lawsuits, calling them character attacks by “a small group of employees.” They say an internal investigation failed to back up the women’s assault accusations.

And they label as untrue the employees’ statements to the Herald that medical quality or patient safety has suffered from their push to procure more organs — an effort driven, UM officials say, by the overwhelming number of patients on waiting lists for a transplant.

While a judge sorts out the legal claims, court documents and interviews offer a look at the world of organ transplants and the emotional work that comes with saving lives in an increasingly competitive and expensive arena of healthcare. It’s tough territory for health professionals: Difficult calculations of organ viability and accusations of rationing come with the territory.

Today, nearly two years after the alleged assaults, the women are no longer employed at the Life Alliance Organ Recovery Agency, or LAORA. One was fired; the other says her contract is not being renewed. But the UM administrator accused of striking them remains in the same leadership position.

“I didn’t really expect anything different, although I’m a little bit surprised that they won’t just own up to it,’’ Susan Ganz, 61, the physician and former medical director of LAORA, said in an interview.

After filing her lawsuit in October 2013, Ganz said, she was excluded from meetings and ignored by university administrators. Ganz said she was notified last August that after 17 years with UM her contract would not be renewed.

Both Ganz and Marla Geltner, 49, a registered nurse and former director of clinical operations for the organ bank, claim in their suits that they were struck in front of dozens of witnesses at the same meeting by the same supervisor: Rafic Warwar, vice chair of administration for the surgery department at UM’s Miller School of Medicine, which oversees the organ bank.

“The university has failed to protect me and any other employee in that institution,’’ Geltner said in an interview. She was fired in August 2013 after about eight months with the organ bank, and filed suit two months later. Last year, she filed another suit against UM in federal court, accusing the university of firing her in retaliation for taking medical leave in August 2013. She had previously worked at UM Hospital as a cardiology nurse for two years.

UM officials said their investigation of the original complaints lodged by Ganz and Geltner found no wrongdoing by Warwar. But they wouldn’t divulge details of the investigation to the Herald. Questions directed to Warwar, who has worked at UM for 14 years, were addressed by university officials.

Dan Gelber, an attorney and former state legislator acting as a university spokesman, said UM investigated as soon as it learned of the assault accusations. “The allegations in the lawsuit are strongly disputed and the investigation results support that position,” he said.

Alan Livingstone, a physician and surgery department chairman at UM, said two human resources managers attended the disputed meeting, and they said the attacks did not occur.

Miami-Dade Circuit Judge Abby Cynamon has scheduled a hearing Monday in her chambers to consider whether portions of the lawsuits will proceed.

ALLEGED ASSAULT

The suits accuse Warwar of striking both women during a general staff meeting on May 21, 2013, in LAORA’s offices at UM’s Life Science and Technology Park building. About 50 people attended the meeting, the lawsuits allege.

During the meeting, Ganz and Geltner, seated on either side of Warwar at a table, said they disagreed with Warwar’s complaints about LAORA staff members, the lawsuits allege. Though the suits do not specify his complaints, Ganz and Geltner said in interviews that Warwar was criticizing the clinical staff.

Geltner said she spoke up in their defense. And that’s when Warwar hit her, “like a karate chop. It hit me so hard that the chair moved and knocked me to the right,’’ she said.

In an interview, Ganz, the physician, recounted a similar experience, saying that Warwar seemed “taken aback” when some of LAORA’s clinical staff questioned him, asking why he had not spoken with them about his concerns.

When Warwar made a comment about not receiving updated information, Ganz said she told him he already had received it. His response was to strike her, she said.

“All of a sudden he hauls off and he bashes me on the back,’’ she said. “He hit me. He clearly didn’t want me to say any more.”

Geltner said she was stunned after Warwar hit her and later got up and left the conference room. Ganz said she, too, was dumbstruck when he hit her, but she remained in her chair while Warwar continued to speak. As medical director, she said, “I tried very, very hard to not make a big deal out of it. Everybody was in the room, and I didn’t want to make a scene.”

Both women said Warwar struck each of them twice.

Geltner said several colleagues approached her in disbelief afterward, urging her to call police, but she said no. Ganz’s lawsuit alleges Warwar’s strikes bruised her back, and that she has photographic evidence. She refused to provide those photos to the Herald on her lawyer’s advice since the photos will be evidence in the case.

Ganz and Geltner both said university administrators interviewed them about the incidents, and that they provided written statements. In court papers, Geltner said the university’s Cane Watch compliance hotline received numerous calls from employees who witnessed the assault.

Ganz said she followed up for months after first reporting the assault to UM administrators. But she never received a final report about the internal investigation.

“It seemed like a cover-up to me,’’ she said in an interview. “I have nothing at all from them.’’

A few months after the meeting, UM fired Geltner. She said university officials sent her a termination letter, citing her failure to participate in an internal investigation of her expenses and activities while on a business trip. She said the investigation was unrelated to the complaints about Warwar’s alleged assaults. Gelber and Livingstone would not give the reason for Geltner’s termination.

Ganz, the doctor in charge of protocols for evaluating donors and for recovering and placing organs, remains on the UM payroll until August, but says she was asked not to report to work at LAORA.

Though Livingstone said Ganz’s position was eliminated “as part of a reorganization” by LAORA’s new executive director, Ganz believes her contract is not being renewed because of the suit.

“In my book,’’she said, “it has everything to do with the lawsuit.’’

UNDER PRESSURE

In interviews with the Herald, Ganz and Geltner painted a picture of an agency under increasing pressure from UM administrators to harvest more organs from potential donors.

Livingstone said that the desire to procure more organs for transplant was real. He said he instructed Warwar to work toward that goal because the list of patients waiting for transplants far exceeds the number of organ donations.

“We have almost as many people dying on the waiting list for livers as getting transplants. It’s a huge problem,’’ he said. “It’s become essential that we increase the number of organ donors.’’

Livingstone said that effort did not impact LAORA’s performance. “We have prided ourselves in not making any errors because we spend so much time on the quality assurance and quality improvement,’’ he said.

The organs LAORA recovers are transplanted as far away as Massachusetts and California, according to the Scientific Registry of Transplant Recipients, a private organization that evaluates organ transplantation. LAORA’s service area covers South Florida’s transplant centers, including UM’s program called the Miami Transplant Institute, operated with Miami-Dade’s public hospital network, Jackson Health System.

The institute, created in 1970, receives organs from LAORA and from other organ banks. And though it’s the oldest and busiest transplant center in South Florida, the Miami Transplant Institute has run into increased competition from area hospitals that have begun performing transplants.

Ganz said Warwar and Livingstone often questioned LAORA staff about the numbers of organs the bank was sending to the Miami Transplant Institute, which is housed at Jackson Memorial Hospital.

“We used to get yelled at a lot: ‘How come more organs aren’t going to Jackson?’’’ Ganz said. “I kept explaining that we have to follow a list. If Jackson doesn’t show up [to recover an organ] or they decline, somebody else was going to take it.”

UM administrators even asked for an accounting of organs, she said: “We had to send them a statement every month explaining where all the organs went, and where Jackson was on the list. And if Jackson was declined, why.’’

Livingstone said UM administrators never attempted to steer organs to the Miami Transplant Institute. It is against federal law for an organ bank or transplant surgeons to manipulate the allocation of an organ.

Livingstone said LAORA’s “record confirms it is one of the best run programs in the nation.’’

He added that LAORA and UM cannot steer organs to the Miami Transplant Institute — or any other transplant center — because “every single organ that is transplanted” has to be reported to the United Network for Organ Sharing, or UNOS, a nonprofit organization that coordinates organ donation under a contract with the federal government.

UNOS then assigns the organ to a recipient, he said. “So we can’t simply say, ‘Well, you know, the organ donor was one of our patients, so we’re going to transplant the organs to one of our other patients.’ You can’t do that,’’ he said. “If somebody is a higher priority, the organ must go to that patient. This is the most regulated field in medicine.’’

AGGRESSIVE PROCUREMENT

As one of 58 federally-designated organ procurement organizations in the country, LAORA is responsible for recovering organs from “donor hospitals” in a six-county area from Monroe County to St. Lucie, and also the Bahamas.

While surgeons get the spotlight for performing transplants, LAORA staff members labor behind the scenes: recruiting donors, coordinating and training area hospitals, evaluating donors and managing their medical care until the organs are recovered.

It’s hard work, Ganz said, that requires clinical expertise and an empathetic approach to grieving families. Her job as medical director was to clinically evaluate potential donors and the viability of their organs for transplant.

Ganz said that after the former executive director resigned in August 2013, Warwar began questioning her clinical processes and requiring weekly meetings of her staff, part of what she saw as his drive to obtain more organs. Transplants boost prestige and represent significant revenue for medical centers. The average billed charge — from pre-operative procedures through recovery — can run as high as $1.5 million in some cases.

LAORA is not alone in its desire to procure more organs, said Arthur Caplan, a bioethicist at New York University’s Langone Medical Center.

The number of patients waiting for an organ transplant nationwide is nearly 10 times greater than the number of organ donors — a supply-and-demand dynamic that impacts organ banks, like LAORA, Caplan said.

“At a time when there’s severe scarcity, there’s all kinds of pressures to procure organs,’’ he said. “Some OPOs chase everything. Others say, ‘We won’t go after A, B or C. But we will now think about D, E and F’. Every OPO has to make those decisions.’’

Nationwide last month, there were 123,505 people waiting for a transplant, according to the Organ Procurement and Transplantation Network, which is run by UNOS. But in the first 10 months of last year, there were only 24,382 transplants performed.

Ganz said LAORA receives about 400 referrals a month from a network of about 85 hospitals in its service area, and spent considerable resources pursuing many donations that she said wouldn’t usually be considered due to age or infection or poor function.

But Livingstone said the organ bank is becoming more efficient. For example, he said, LAORA’s donation rate — the percentage of eligible donors who consent to donate organs — was 75.6 percent from June to mid-November last year.

“Better than expected,’’ he said.

In their lawsuits, Ganz and Geltner each seek monetary damages of more than $15,000 from Warwar and UM, as well as legal fees. Both said in their lawsuits that they fear Warwar, and that his actions caused them anxiety, loss of sleep and apprehension about going to work.

Ganz, who is joined as a plaintiff in the lawsuit by her husband, William Ganz, said she is saddened to no longer be working with colleagues to save lives.

“All I ever asked was for an apology,’’ Ganz said, “and we would have gone on as if nothing had happened. I waited for three months for an apology, and all they tried to do was let it blow over.’’

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