Dr. Arnie Serota was furious.
On February 27, 2002, a young man had fallen while rock climbing at Mount Lemmon near Tucson. He died of a head injury a few days later at Tucson Medical Center. The death was tragic, the 19-year-old strong and healthy.
As medical director of Donor Network of Arizona, Serota was flabbergasted over what happened in the hours after the man was declared brain dead. The family consented to organ donation, and the man's kidneys and liver were successfully removed. But his heart among the most precious of the seven organs that can be taken after death went untouched. According to Serota, the most basic tests to determine if the heart could be transplanted were never conducted by the nurses employed by DNA and trained to coordinate organ donations.
Harvesting organs is tough. Fewer than 1 percent of hospital deaths result in a viable donor because the deceased must be a relatively healthy person who died of trauma that did not injure the internal organs. Then it can be difficult to get a family to consent, even if the victim wanted to be an organ donor.
And hearts are particularly hard to come by. Another Tucson hospital, University Medical Center, runs the state's only heart transplant program. Every year, about 20 patients die on UMC's waiting list because healthy hearts come along so infrequently especially here in Arizona.
In Arnie Serota's world, to lose the heart of a teenage rock climber was untenable. Worse, this was the second healthy heart lost in Arizona in a week, according to Serota. Days earlier, a similar situation had taken place with a 26-year-old man in Scottsdale.
After the rock climber's death, Serota called Dr. Larry Koep, chairman of the board of Donor Network of Arizona. Koep agreed to meet Serota after work that day. The two sat outside at AJ's Fine Foods at Central and Camelback in Phoenix, and Serota told Koep what had happened.
Koep was supportive and sympathetic, Serota recalls. "He told me, Oh, we need to do something about those coordinators....The board's behind you 100 percent.'"
Less than a week later, on March 7, Serota presented his findings about the two lost hearts to the full board of directors.
That night, Koep and the board asked Serota to resign. When he refused, they fired him for exhibiting poor leadership.
But Serota thinks he was fired because, over the nine months he was medical director of DNA, he continually pointed out problems with the program problems he says the board did not want to hear, problems that, according to Serota, may have cost people their lives.
Arizona has one of the worst organ recovery records in the country. In 2001, Donor Network of Arizona ranked 57th out of the 59 organizations that harvest organs, according to figures adjusted to population. In the past five years, the number of organ donors in Arizona has ranged between about 70 and 80.
Last year, 60 people in Arizona died while on the waiting list for transplanted organs.
An investigation last year by an expert for the federal agency that oversees donor networks agreed with Serota on many points, including that DNA was missing too many opportunities for organs, especially hearts.
For several years, Serota was a member of the DNA board of directors, just on the edge of this highly politicized little world. But it wasn't until he became medical director that he found himself in the middle of a maelstrom and learned, he says, how screwed-up that world really is.
Serota, who is now suing DNA, has reams of records documenting mistakes, bad decisions and troubling behavior by people who are supposed to be better prepared to deal with the critical business of organ donation and transplantation. Some of his paperwork details the night a cardiologist who, although on call, refused to come to the hospital on a weekend to evaluate a potential heart donor resulting, Serota contends, in the loss of yet another healthy heart.
Or the family physician who erroneously declared a young woman in Verde Valley brain dead and an overzealous organ recovery coordinator who wanted to act too quickly almost resulting in the harvesting of her organs.
He talks about an organ coordinator who tried to bar the doors of an operating room to keep Serota, who was performing surgery, from continuing to take a patient's organs after a distraught father changed his mind about donating his daughter's organs.
Serota also says he got resistance from nurses who didn't like a new medical director overseeing their work. He contends that nurses sometimes don't tell transplant doctors the truth about the condition of an organ in order to manipulate where a particular organ goes a practice that is strictly forbidden under federal rules governing organ donation.
The former medical director also believes he may have been caught in a power play between DNA and the Mayo Clinic over who would control organ procurement in Arizona. It's big business, and much is at stake because a hospital that can get a steady supply of organs can make more money through costly transplant operations. Serota believes Mayo officials have been trying to wrest the state's organ donor program away from DNA.
Serota had been recruited to work at DNA the previous year by the organization's longtime CEO, Jack Cremin.
Cremin left DNA the same evening Serota was asked to resign. An Air Force retiree with no experience in the organ donation field, Cremin was unpopular with much of the staff and some of the board, and maligned for Arizona's poor donor numbers. Serota was widely viewed as Cremin's sidekick.
Cremin, who won't talk about his departure, signed a confidentiality agreement and accepted a severance package. Serota refused to sign an agreement.
DNA officials simply refuse to talk about most of Serota's allegations, citing pending litigation as a reason to remain silent.
Current and former DNA employees have been told to refer all calls to the public relations department. And DNA board members have been told to refer calls to Koep.
He's not saying much.
"I know this sounds really strange, but Arnie is a friend of mine," says Koep, a transplant surgeon at Good Samaritan Hospital in Phoenix. "However, I'm in a tough spot about what I'm going to get deposed about. I really can't talk about that termination or the due process issues. But I think Arnie is honest and there are unfortunately issues on both sides with extremely well-meaning people on both sides."
Tim Brown, the new CEO of DNA, released this statement: "Our attorneys continue to advise that we should not discuss the details of the unproven allegations in the lawsuit brought by former DNA Medical Director, Arnold Serota. In addition, due to the confidentiality of donor medical records, we are not at liberty to refute point-by-point statements that are apparently being made by Dr. Serota. We can state, however, that we are confident DNA will prevail in the pending arbitration because Dr. Serota's allegations are not based on the facts."
It would have been easier for Arnie Serota to agree to the gag order and take the money, but he says he wants the public to know what happened while he was medical director of DNA. And he is concerned because many of the organ recovery coordinators he had trouble with at DNA still work for the organization.
Mistakes do happen in the organ donation/transplant arena, as they do in all areas of medicine. But word rarely travels beyond an intimate group of medical professionals.
Not so last month, when the nation's attention was riveted by Jesica Santillan, the 17-year-old girl who received a heart and lungs with the wrong blood type at Duke University Hospital in North Carolina. She died after a second transplant; the university later confirmed that no one had cross-checked Santillan's blood type with the blood type of the organs.
Dr. Jack Copeland, who runs the heart transplant program at University Medical Center in Tucson, calls the mistake an aberration. Yes, he says, such problems used to occur (including at UMC), but for many years the system has been automated, with cross-checks in place.
Still, Copeland admits, medicine is not perfect.
"People are people. Doctors are doctors. Doctors make mistakes, just like everyone else in the world including reporters and bus drivers," Copeland says.
But Serota says he saw too many mistakes at DNA, including the two hearts he contends were wasted.
Because Serota's background as a transplant surgeon is in kidneys, not hearts, he asked a Scottsdale cardiologist, Scott Robertson, to review the records in the two cases. Robertson concurred that the hearts were likely usable, according to documents Serota provided to New Times. Serota says he also showed the patients' records to Dr. Jack Copeland, who agreed that the hearts were probably good.
Copeland refused to talk about the hearts to New Times, saying only, "I think that line of questioning is going to be divisive and negative, and I have nothing to say about that."
He's not the only person affiliated with DNA who fears negative publicity bad press could discourage people from donating organs.
Glenna Shapiro, executive director of the Arizona Kidney Foundation and a DNA board member, referred questions to Larry Koep. She says getting people to agree to be organ donors is far more important than internal squabbles over whether donated organs were wasted.
"The only thing that we all can agree on is there aren't enough donations," she says. "We lose many more than two hearts because people don't have a comfort level for saying yes or no."
Arnie Serota doesn't buy Shapiro's approach. He thinks the problems go deep, and need to be brought out publicly before the board or federal overseers will fix them.
In a February 26, 2002, letter to the DNA board, he wrote, "Before accepting the medical directorship, I believed that the problems related to organ donation were primarily those related to public education. I quickly found out that there are, unfortunately, many professional barriers to the organ donation process. It was only recently that I discovered that there are other more insidious problems within our organization that adversely affect our ability to recover organ donors."
Since his termination, Serota, who closed a successful kidney transplant program in Scottsdale and took a substantial pay cut to be DNA's medical director, is more emotional.
"The whole situation sucks. It really makes me sick. There are a whole lot of people in this business here who really should not be doing it, because their motives aren't what they should be, you know?
"It's really awful, it really is. I'm so pissed at myself for being an idealist and thinking I was going to walk into this organization you know, closing my program down, here I had a great practice and thinking I could change things here, and basically getting clobbered by these people. I was really naive. I thought this was going to be an apolitical job. And here it was probably the most political job I ever had."
Early attempts at organ transplants were made on animals in the 18th century. In 1870, a Swiss doctor grafted human tissue, and by the early 1900s surgeons had figured out how to join blood vessels to make transplantation possible.
The first successful kidney transplant in the United States was done in Boston in 1954, and the first viable heart transplant 14 years later in California. Anti-rejection drugs and surgical techniques advanced rapidly. Today, organ transplantation is still serious surgery, but in many ways it's a routine procedure.
In 1979, the first successful heart transplant in Arizona was performed at University Medical Center in Tucson, one of only six facilities in the nation doing such work at the time. For years, UMC has had a strong heart and heart/lung program; that facility and others around the state have regularly done liver, kidney and pancreas transplants.
But while progress continued in the scientific end of transplantation in Arizona, the organization responsible for recovering organs struggled. Up until 10 years ago, the state's organ bank operated out of facilities owned by Good Samaritan Hospital in Phoenix.
It is not unheard of for a hospital to house such a program, but it's generally considered a bad idea, since there is so much competition among medical institutions for much-needed organs, and there can be negative feelings if one institution is perceived to have any more control than another. Donor Network of Arizona was created as a nonprofit agency called an Organ Procurement Organization to work independently with the national United Network for Organ Sharing (UNOS) to get organs to patients on waiting lists according to geographical location and need.
DNA gets much of its funding from Medicare, which reimburses the organization for tissues, eyes and some organs, including kidneys, as the body parts are harvested and used. A kidney is worth $19,000, according to DNA, which declined to provide any other figures.
In some instances such is the case with hearts Medicare does not reimburse. In those instances, the DNA board sets a fee per organ; DNA officials refused to release those fees. DNA also collects money through private fund raising. The organization's operating budget for 2002 was roughly $13 million.
For years, DNA has had one of the best tissue and eye banks in the country. But Medicare doesn't pay much for tissues and eyes not like the money it will pay for organs.
According to DNA's most recent tax filings, in 2001 the organization received almost $5.5 million for placing 212 organs, and about $1.75 million for more than 1,000 cornea transplants and 24 eyes donated for research.
Since DNA doesn't do well at organ procurement, it's losing out on a lot of money.
And, if Arnie Serota is right, it's also losing out on a lot of organs that could be going to people in desperate need of lifesaving transplants.
Outside of Arizona, the federal agency that monitors organ procurement organizations has long been aware of DNA's shortcomings. In 2000, an investigation was launched into Arizona's organ donation rate, which that year hit rock bottom, nationally.
DNA officials often explain that organ donation rates are low in Arizona for a number of reasons beyond DNA's control: It is hard to get people to agree to be organ donors, and even harder to get family consent after a death; fewer potential donors are dying, due to more use of better seat belts and other safety precautions; and studies have shown that Arizona's large Hispanic population drives donation rates down because of an anti-donation sentiment.
But inside the organization, some believed there was another contributing factor: that organ donation rates were low because some usable organs were being missed.
Two years ago, Jack Cremin, who had been the organization's CEO and executive director since 1993, told his board that one way to improve organ recovery rates would be to hire a full-time medical director. DNA relied on registered nurses working as "organ recovery coordinators" to manage organ donations from the time a possible donor was phoned in to the time the organs were removed from the body, packed in coolers and sent elsewhere. A part-time medical director was available for phone consultations, but he was not a transplant surgeon and could not procure organs himself.
The idea, Cremin told the board at a February 2001 meeting, was that a full-time medical director who was also a transplant surgeon could do organ procurements and consult on cases in part justifying his salary by bringing in Medicare reimbursement dollars.
One board member, Dr. Joe Zamora, a transplant surgeon from Tucson, said he didn't like the idea because it would take money away from transplant surgeons who get paid to do the procurements. But Cremin told the board that surgeons aren't always available, pointing out that in 2000 two organ donors had been lost because no one was around to procure the organs in a timely manner.
Cremin suggested Arnie Serota for the job. Serota, who had served on the DNA board for years, ran a kidney transplant program at Scottsdale Healthcare's Osborn campus. He was willing to close his practice of 16 years and take a pay cut.
The board hired Serota in the spring of 2001.
The transplant surgeons weren't the only ones who had questions about DNA's decision to hire a full-time medical director. Many of the organ recovery coordinators particularly Chris Wingard, head of DNA's organ recovery program were reportedly furious. Wingard was, by and large, master of his domain. That would change with a surgeon on staff.
The organ recovery coordinators are registered nurses who work closely with intensive-care patients. Evaluating potential donors and stabilizing brain-dead patients is difficult work, particularly since coordinators also have to deal with distraught family members.
DNA spokeswoman Sara Pace Jones initially told New Times that organ recovery coordinators must be registered nurses.
But it turns out that Chris Wingard, who joined DNA in early 2001, was not licensed to work as a registered nurse in Arizona until more than a year later. Arizona Nursing Board records show he didn't get his Arizona license until May 2002. Wingard did have a license in Kansas, but it expired in 2000.
But DNA officials didn't know that Wingard was working without a license. In a recent interview in which New Times asked about Wingard's lack of a license, Pace Jones and DNA's current CEO, Tim Brown, were visibly surprised to learn that their organ recovery chief didn't have a license for much of his time at DNA. Later, Pace Jones said DNA's organ recovery coordinators are not required to be licensed nurses.
"They are only caring for patients who are dead," she says now.
Wingard could not be reached by phone. He did not respond to a letter express-mailed to his Peoria home. In addition, Pace Jones says DNA relayed a request for comment to Wingard.
Two organ recovery coordinators interviewed for this story also expressed surprise that Wingard was not licensed; both say they were required to have nursing licenses before coming to DNA.
Both women say there was clearly tension between Wingard and Serota.
Cyndi Bocchicchio, an organ recovery coordinator who had been at DNA only a short time before Serota took over as medical director, was shocked at how virulent the opposition to Serota was.
"They all had bad vibes about him before he got there," she says of her colleagues. "He didn't have a chance in hell."
Bocchicchio didn't last a year at DNA. She liked the job, but the long hours weren't compatible with her family situation, and she quit in October 2001 to return to adult critical care nursing. She liked Serota, who she thought was passionate about the job not only rushing out to do organ procurements but also working in the Arizona Legislature to get pro-organ donation legislation passed, writing grants and offering seminars.
"His door was always open," Bocchicchio says. "He was so into it and it was just kind of cool, because now we had a full-time guy, in my eyes, who could make this a better place....I thought it was awesome."
Diane Devers, who worked as an organ recovery coordinator for several months before quitting in February 2002, says Wingard often overrode Serota's orders and made it clear he intended to get rid of the doctor.
"He said, We don't need a medical director, and if I have anything to do with it, we won't,'" she recalls. When Devers asked what that meant, Wingard "would just roll his eyes."
She adds, "They treated [Arnie] really badly, and everybody that wasn't a follower of Chris ended up quitting or getting fired because they wouldn't follow his controlling, manipulative ways."
Kathy Carlson, who worked as an administrative assistant for Serota and other top staff (she was terminated shortly after Serota and Cremin), says she knew the doctor frustrated some of his colleagues.
"He goes 90 miles an hour, and he expects others to, also," Carlson says. "He would drive me nuts sometimes... but he did it in a good way."
Serota says he was well aware of what was going on with Wingard and others on the DNA staff.
"They didn't want me around," he says. "To that point, [Wingard and some of the other coordinators] didn't want anybody looking over their shoulder, looking at their case management."
At the same time he was feuding with Chris Wingard and other staff members, Arnie Serota says he started noticing and often documenting behavior both inside and outside of DNA that he believes jeopardized organ donations.
In September 2001, Serota wrote to the chief of staff at Maricopa County Medical Center to express concerns regarding a cardiologist he says refused to evaluate a potential heart donor in a timely manner.
According to Serota's letter, the patient, a 41-year-old man, was declared brain dead after a gunshot wound. The family agreed to donate his organs. An echocardiogram was performed on the man's heart to see if it was a viable organ as well, and the attending cardiologist was called to interpret the results. He refused to come in, Serota says, telling staff he'd come in after the weekend.
"I called him personally and pleaded with him to perform the reading. I did explain to him that a cardiac patient on the waiting list could die as a result of his actions (or lack thereof)," Serota wrote.
The doctor never came in, Serota says, and the medical director eventually picked up the test results himself and carried them to Scottsdale Healthcare Osborn.
"As a result of this entire process, several hours lapsed," Serota wrote. "The donor became very unstable and was taken emergently to the operating room where only his kidneys could be recovered due to his instability."
When Maricopa Medical Center did not respond, Serota says, he filed a complaint with the Arizona Board of Medical Examiners. The cardiologist's BOMEX file does include mention of two complaints filed against him in recent years, both of which were dismissed. BOMEX will release no additional information, including a description of the complaints, a spokeswoman said.
The doctor no longer works at Maricopa Medical Center and New Times could not locate him to ask him about the case. A Maricopa Medical Center spokeswoman says she can't comment on specifics.
Serota says that while he was medical director and even before that, when he sat on the DNA board he heard that Dr. David Mulligan, who runs the transplant program at the Mayo Clinic, was lobbying coordinators for organs, and even possibly trying to move the entire organ donation program to Mayo.
Ever since the Mayo Clinic opened its own hospital in 1998, rumors have swirled and there's brief mention made of this in DNA board meeting minutes dating back several years that Mayo wants to open its own organ procurement organization.
But under Medicare rules, that would require eliminating DNA, since the two would compete in the same geographic area. Mulligan, who runs the transplant program at Mayo, is a DNA board member. He called New Times once in response to several phone calls and left a message that he'd called, but then did not return subsequent calls.
Serota says he did not approve of some of Mulligan's actions as a board member, and made his feelings known. The DNA board had asked its members, many of whom are transplant surgeons, not to contact DNA staff other than Cremin regarding specific cases. This would avoid the appearance that board members were trying to get organs for their own patients or institutions.
Serota says that at a November 2000 DNA board meeting, Mulligan was chastised for calling organ recovery coordinators to ask why he hadn't received a particular organ, and that Mulligan apologized. There is mention in the meeting minutes of board members being asked to not contact staff directly, but no one is named as prompting the remarks.
Mulligan didn't stop contacting staff after that, Serota says. Serota contends that some organ recovery coordinators favored Mayo because they were friendly with Mulligan.
In some ways, organ coordinators have control over where an organ goes, despite guidelines mandated by the national registry UNOS. The UNOS database prints out a priority list based on geography and need, but the way an organ coordinator describes an organ to a surgeon can make all the difference, Serota says.
For example, he explains, a coordinator can tell a surgeon that a potential liver donor has track marks on his arm and a history of drug use. The surgeon will turn away a liver from what he thinks is a heroin addict, when it could be that the donor had marks from a blood draw in the hospital and a history of marijuana use.
"That was the whole issue I discovered before I left," Serota says. "If there's an organ available let's say a liver's available and the first three patients on the waiting list are Good Sam patients and the next three are Mayo patients, depending on how the patient is [described] to the surgeon, at three o'clock in the morning sometimes, the surgeon may turn down the organ."
Serota says that while he was medical director, he was at a meeting at DNA and overheard one coordinator tell another that she had directed an organ from Good Samaritan to Mayo the previous evening.
In the final weeks leading up to his termination, Serota says he saw a series of troubling incidents. In one case, which he documented in a letter to the DNA board of directors in late February 2002, he received a call in the middle of the night from an organ recovery coordinator regarding a potential donor in Verde Valley. A family practitioner not a neurologist had declared the young woman brain dead, Serota says. She'd died from an overdose of antidepressants.
Serota says he had just read an article in the New England Journal of Medicine advising that in such cases, brain death is often not real; it's necessary to wait 24 hours to see if the patient recovers.
Serota told the coordinator to wait; he says that's not what the nurse wanted to hear.
"I told her hands off, we couldn't do that donor. She questioned me, told me I was full of it and that she wasn't aware of that happening. I said to her, You are not to go to Verde Valley, you are not to evaluate this donor . . . follow up in 24 hours.' And then she hung up the phone on me."
Ultimately, Serota says, the coordinator grudgingly followed his directions, and the patient recovered.
Pace Jones says DNA records reflect that both Serota and Wingard advised the coordinator to hold off.
Another incident, which took place at Good Samaritan Hospital in Phoenix, almost resulted in the loss of organs, Serota says. A young girl had been declared brain dead and the family had given consent to the organ donation, but they had inquired about the possibility of preserving the girl's ovaries, with the hope of saving her eggs and one day conceiving her child. As it turned out, the technology to do that was not locally available. Serota says he was in the operating room had already opened the girl's abdomen, with the UCLA liver transplant team standing by when the coordinator called him out of the operating room.
"The coordinator said, The family has changed their mind. The father's out there, he's drunk. He's punched a hole through a wall. He found out that we couldn't do the procurement [of the ovaries] and he wants us to stop.'"
Serota told her it was too late, that consent had already been given.
"She proceeded to close the operating room door. She threw herself in front of the door and said, You're not going in there anymore. I forbid it. We're stopping this right now.'"
Ultimately, the coordinator convinced the family to proceed, and the organs were harvested.
The coordinator, who no longer works for DNA, refused to comment for this story. She referred calls to the DNA public relations office.
A short time later, Serota says he watched first Scottsdale Healthcare Osborn and then Tucson Medical Center miss potentially healthy hearts. In both cases, basic tests including an echocardiogram were skipped, Serota says, because coordinators assumed the hearts were not viable.
Serota says he was called about the Scottsdale donor early in the process, but says the coordinator lied to him about the test results, and ultimately made the decision to turn down the heart without consulting either him or a cardiologist.
Serota says he thinks coordinators regularly rejected hearts because harvesting a heart is more time-consuming than taking the abdominal organs liver, kidneys, pancreas.
"It's a lot more work," Serota says. "The coordinators would actually complain about the heart surgeons being what they called a pain in the ass' because they asked them for a lot of things and held up things in the operating room. So I think they were purposely blocking them so they could get the procurement done more quickly."
He says that coordinator is one of those he heard complain.
In his final weeks at DNA, Serota says the staff stopped calling him about potential donors. It wasn't unusual for him to find out about a donor at the last minute when the organization's central communications center sent out an alert, indicating that a donor had been approved. That's what happened late on March 1, 2002, when the 19-year-old rock climber was set to become a donor at Tucson Medical Center.
In a March 6 letter to Jack Cremin copied to the DNA board Serota writes that he immediately called the coordinator to inquire about the donor. She declined his offer to come to Tucson. He called again at 8:30 a.m. March 2, and learned the kidneys and liver were to be retrieved shortly.
Sara Pace Jones did not respond to a request for an interview with the coordinator, who still works for DNA.
Later, Serota writes, he spoke with the surgeon who procured the liver and kidneys, who "noted at the time of organ procurement, that the heart appeared entirely normal and questioned why there was no attempt to place the heart."
Serota traveled to Tucson and reviewed the patient's chart, and wrote, "I found that the patient never had an EKG, cardiac enzymes, troponin, or a cardiac ultrasound. It had been assumed that there was a cardiac contusion."
He says, "I was literally in tears when I found out we had hearts to recover and people weren't doing it. I showed the charts to Jack Copeland and he threw up his arms and said, These were two good donors.'"
DNA now says its review of the two heart cases showed there was no violation of DNA policy. The review also does not specifically refute Serota's conclusions about whether appropriate tests were conducted on the two hearts.
Tim Brown, the current CEO, says that in one case, it was "highly unlikely" that the heart would have been accepted by the transplant center.
"In the other case, the disqualification of cardiac donation after discussion with two physicians, one of whom was a senior cardiac transplant physician, was reasonable and appropriate and no violation of Donor Network of Arizona's policies or procedures."
Arnie Serota's career at DNA was probably dead long before that 19-year-old rock climber fell on Mount Lemmon.
On March 1, 2002, the Centers for Medicare and Medicaid Services (CMS), which monitors DNA, finished an investigation into the organization. Serota says that the investigation was initiated in an attempt to get rid of him and maybe even to get rid of DNA altogether. The complaint was filed by David Mulligan, the Mayo transplant surgeon who is also on the DNA board and the same doctor Serota had complained behaved inappropriately.
Arnie Serota has been trying with no success to get a copy of the letter through the Freedom of Information Act for a year. New Times' request for the letter was also denied. Last year, the East Valley Tribune confirmed that a letter from Mulligan initiated the investigation; Brown and Pace Jones would only say that they have never seen the letter.
CMS did release the results of the investigation, which focused on low organ recovery rates but included many other concerns about employment practices and finances. This was not the first such investigation; there had been another in 2000.
This time, DNA was warned up front that it risked having its contract with CMS terminated, which would mean no more Medicare reimbursements. The investigation was conducted by Esther Marie Carmichael, who oversees 11 organ procurement offices in the west. In an interview with New Times, Carmichael refused to discuss specifics, but her concerns are detailed in the report.
Several financial questions were raised, about the cost of DNA's building and why more than $1 million had been spent on building a database that was still not fully functional. Carmichael was also concerned that job descriptions, training manuals and strategic plans had not been approved by the board, and that there was a backlog of death records that needed to be reviewed by DNA staff to determine if the maximum number of organs possible were procured.
Carmichael's interviews with unidentified staff revealed that "negative working relationships" among the medical director, organ recovery coordinators and the CEO "had resulted in low morale."
She was also concerned about Serota's pay. His salary was $180,000 half of what he made in private practice, he says. But Carmichael pointed out that was enough to pay three or four organ recovery coordinators at a time when DNA was understaffed.
She interviewed several employees about the situation involving the young girl whose family wanted her ovaries, focusing on the rift between Serota and the coordinators.
Carmichael did share Serota's concerns about Arizona's low rate of organ procurement.
"Based on interview, medical record review, and other document review, the OPO [organ procurement organization] did not conduct systematic efforts to acquire all usable [organs] from potential donors," she concluded.
She was specifically critical of low heart procurement rates.
At the March 7, 2002, DNA board meeting, Serota made his presentation about among other things the two missed hearts.
"They said thank you very much. They went behind closed doors. And after about two hours of what I heard was very heated discussion, they came out and asked for my resignation," he recalls.
"They told me it was because of lack of leadership. That was the reason they gave for me being terminated. Which kind of bewildered me, because I wasn't there in a leadership role. I wasn't there to be a leader, I was there more or less to be a troubleshooter."
But clearly, the DNA board thought Serota was a troublemaker.
It has been a little more than a year since Arnie Serota lost his job. DNA immediately rehired its previous part-time medical director, who is not a transplant surgeon. Cremin's spot went to Tim Brown, a longtime administrator at the University Medical Center.
In 2002, DNA's organ donation rates crept up slightly, from 57th to 54th among 59. And DNA procured 30 hearts, twice as many as the previous year.
"DNA's current management has improved policies for the evaluation and placement of all organs to better maximize organ recovery and placement," Brown says, adding that the federal investigation critical of the organization covered the time period in which Serota was medical director.
Current DNA staffers are thrilled with their increased organ donation rates. Brown says he's got "one hell of a team" working for him. Sara Pace Jones, DNA's spokesperson, speaks of a program that educates Hispanics about organ donation, and the DNA donor registry, which will kick off next month. She says DNA's recordkeeping has improved under this new administration, and that she and others feel encouraged to be proactive and embark on new projects that will increase awareness about organ donation.
Esther Marie Carmichael is pleased, too. She visited DNA in early March and reports that "everything went very well," although she refuses to elaborate.
In addition, Brown points to a hormonal treatment used to enhance hearts and make them better for transplanting. DNA started using the therapy in the middle of last year, just before its heart donor rates increased.
But Serota says that therapy has been available for at least 10 years. Even UMC's Jack Copeland agrees that it's not a new treatment. Copeland credits DNA's new leadership under his former longtime colleague, Brown for the increase in donors.
In any case, DNA's numbers while higher than they were in the last couple of years aren't so high.
Brown points to the fact that Arizona's organ donors increased from 70 in 2001 to 82 in 2002. But a review of the past several years shows that number is not so significant. In 1996, at a time when Arizona's population was smaller than it is today, DNA had 87 donors. There were 80 in 1998.
Similarly, Brown observes that the number of hearts donated in Arizona nearly doubled, from 16 in 2001 to 30 in 2002. But Arizona's heart donation numbers were higher between 1993 and 1998, with a record 47 hearts donated in 1994.
Many of the organ recovery coordinators Serota worked with are still at DNA, although Chris Wingard is not. He left earlier this year.
"He resigned," Brown says. "We talked about it. He had family concerns and that's why he resigned."
As for Arnie Serota, he's moved to Hawaii, where he's a general and vascular surgeon at Wilcox Memorial Hospital.
Serota is still disgusted with DNA. He wonders why it took an entire year to implement the donor registry he pushed through the Arizona Legislature in 2002. The non-beating heart donor program he had ready to go when he left a method practiced around the country that Serota says could double the number of kidneys and livers DNA procures has been abandoned. Many of his public education programs have been ignored, too, he says.
This week, Serota filed a complaint with the Arizona State Board of Nursing about Chris Wingard and several other coordinators he worked with at DNA.
He will miss many things about Arizona, Serota says, but not the medical community. His parting advice is pointed.
"If you're a heart patient here [in Arizona], unless you're really, really sick on an artificial heart or something, the chances of you getting a heart here are slim. Get on a list someplace else."
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