Distance, delays and denial: VA's broken transplant system

A federal law that is supposed to limit how far veterans must travel to receive transplants at VA hospitals is not always followed, a San Antonio transplant manager says.

A federal law signed two years ago that is supposed to prevent veterans from needing to travel hundreds of miles to get transplant surgeries at VA hospitals is not always followed, a San Antonio VA transplant program manager said.

Meanwhile, a study of VA patient outcomes found that veterans who need to travel 100 miles or more to get a liver transplant, for instance, have a higher likelihood of mortality.

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After five years working at the VA, Jamie McBride is putting his job on the line to speak up about the problem.

“I know deep down we can change this,” he said.

Transplant denied by the VA

Tammy Baggett is living off borrowed time. In 2014, the 42-year-old Navy veteran went to a VA hospital in Atlanta after falling ill. After hours of prodding, exams and blood draws, a test revealed she likely had been living with leukemia for years.

“[Doctors] said your only chance at survival would be the bone marrow transplant,” Baggett said in July.

Baggett received a transplant, but not from the VA. She said the VA told her it would only do the procedure if chemotherapy put her leukemia in total remission for safety reasons.

She never went into total remission and the VA denied the transplant. So, Baggett got another opinion from Emory University Hospital, about two miles away. Emory surgeons agreed to do the transplant.

While the transplant did not eradicate the leukemia, Baggett believes the surgery kept her alive for two years longer than if she had stayed with the VA transplant program.

“I think I would be dead,” she said after a recent chemotherapy appointment. The Atlanta-area mother is not expected to live through August.

An investigation conducted by TEGNA TV stations across the country uncovered that Baggett isn’t the only veteran denied by the VA. According to a 2012 Inspector General’s report, three different VA transplant centers denied a Minnesota veteran a liver transplant.

“[I was denied] three times for liver transplant by three different [VA] transplant centers. I was given three different reasons,” wrote the veteran in the report.

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The veteran received a transplant from a non-VA hospital after a surgeon determined the veteran was “a good candidate from a surgical point of view.”

‘It’s an unimaginable burden’

Jamie McBride is program manager for the VA transplant system in San Antonio. In June, he submitted a compliant to the VA inspector general outlining other transplant denials.

Nothing happened.

“I've gone through every channel we can, and the reason that I'm here speaking about it is because the problem has not been solved,” McBride said.

The registered nurse says on multiple occasions, the VA had the opportunity to pay local transplant centers to perform operations, but still required the veteran to travel thousands of miles to a VA center instead.

“They’re uprooted from their homes. They’re uprooted from their jobs. They're uprooted from their families,” McBride said. “It’s an unimaginable burden for these people to be uprooted.”

McBride believes ineffective transplant polices have likely contributed to thousands of veterans’ deaths.

'I think he died unnecessarily'

Pam Moore believes her husband, John, is one of those veterans. The VA put the Minnesota army veteran on a liver transplant waiting list in 2012.

While the nearby University of Minnesota Medical Center performs liver transplants, the VA wouldn’t pay for it. Instead, it required the 60-year-old to travel hundreds of miles away to Houston’s VA transplant center to wait for a liver.

“We had to go to Texas every three months,” Moore said.

After four years on the waiting list, Moore died in February 2015.

“If it would have been done here, I think he would have had it. I think he died unnecessarily. That’s truly what I believe.”

Study: Transplant travel hurting veterans

In most cases, the VA will only pay for a veteran’s transplant if they use one of its 13 transplant centers across the country. So, if a veteran lives in another state, they’re required to travel no matter how sick they become.

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Map: VA transplant centers

The VA’s policy could be putting veterans in danger.

According to a 2014 University of Pennsylvania study, veterans waiting for liver transplants who traveled 100 miles for treatment had a “lower likelihood of receiving a transplant and increased mortality.”

Dr. David Goldberg is the lead author of the study.

“They have less access to a lifesaving transplant, which directly correlates to a higher chance of dying from liver disease,” he explained.

Link: University of Pennsylvania VA organ transplant study

If the VA had approved Baggett’s transplant, she would have been forced to travel to Nashville.

San Antonio Army veteran Aaron Arch, in need of a lung transplant, will soon have to travel 1,200 miles to Madison, Wisc., for his operation.

“If something doesn’t go as well as hoped, that would be where my story would end. It’s a long way from home,” Arch said.

McBride: VA not following its own rules

In 2014, President Obama signed the Veterans Access, Choice and Accountability Act to address treatment delays at VA hospitals. It is supposed to help veterans receive care from local healthcare providers if veterans live more than 40 miles from VA hospital facilities.

McBride says the VA’s transplant program has not followed its own rules.

“If the VA is not going to offer the service that they need, then at least allow the veterans the opportunity to go to the community; get the insurances they need, Medicare, Medicaid that sort of thing, and pursue transplant locally,” McBride said.

Watch: President Obama signs Veterans Access, Choice and Accountability Act into law

The VA administrator in charge of the transplant system is Dr. William Gunnar, national director of surgery. For nearly a month, we requested an interview with him about the problems we uncovered.

The VA said he was “on leave” and unavailable.

In an email, the agency wrote, “VA’s Transplant Program outcomes compare favorably to all United States Transplant Centers as publicly reported by the Scientific Registry for Transplant Recipients (SRTR).”

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While the VA explains it “has the authority to refer a veteran for transplant care in the community in the case that the VA Transplant Program is not feasibly accessible,” it also admits when that happens, it negatively impacts the efficiency of its transplant program.

McBride believes the VA is more concerned with keeping its transplant program efficient than doing what’s best for veterans.

“We’re basically trying to sell them on something that we don’t necessarily believe in ourselves,” McBride said.