St. Luke’s in Houston Replaces Heart Transplant Surgical Director After Program Loses Medicare Funding

by Mike Hixenbaugh, Houston Chronicle, and Charles Ornstein, ProPublica

Baylor St. Luke's Medical Center announced Friday that it has hired two new cardiac surgeons to lead its embattled heart transplant program as it works to regain Medicare certification.

The surgeons, Dr. Kenneth Liao and Dr. Alexis Shafii, will together take over leadership posts previously held by Dr. Jeffrey Morgan, the heart program's surgical director since 2016. A St. Luke's spokeswoman said Morgan is still a member of the medical staff at St. Luke's, but she did not directly answer whether he will continue performing transplants.

Morgan declined to comment through a representative, and the hospital did not make Liao or Shafii available for interviews.

The staffing announcement comes two months after the Centers for Medicare and Medicaid Services cut off funding for heart transplants at St. Luke's, long regarded as one of the nation's top hospitals for cardiac care. The federal agency concluded that the Houston hospital had not done enough to correct problems that led to a high rate of patient deaths following transplants in recent years.

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Liao comes to St. Luke's after several years as the top heart transplant surgeon at the University of Minnesota Medical Center in Minneapolis. When he arrives in January, he will be St. Luke's senior cardiac transplant surgeon, serving as the hospital's new chief of cardiothoracic transplantation and mechanical circulatory support.

Shafii joined St. Luke's in September after a stint as the surgical director of the lung transplant program at the University of Kentucky Transplant Center. At St. Luke's, Shafii has already taken over as the surgical director of heart transplants.

Additionally, St. Luke's announced it has hired Deborah Maurer, a longtime transplant program administrator in Chicago and Arizona, to serve as vice president of transplantation, a newly created position overseeing clinical and administrative operations for all organ transplant programs.

"The addition of two expert surgeons and an experienced executive who specializes in transplant program administration demonstrates Baylor St. Luke's continued and growing commitment to heart and lung transplants," said Gay Nord, St. Luke's president, in a statement announcing the new hires.

These changes follow a series of investigative reports by ProPublica and the Houston Chronicle into troubles at St. Luke's. In recent years, the articles revealed, the hospital's heart program performed an outsized number of transplants resulting in deaths or unusual complications while continuing to promote itself based on its storied past.

In 2015, seven out of 21 heart transplant recipients at St. Luke's died within a year of their surgeries, significantly higher than the national average. Hospital leaders said that the program slowed down that year and identified subtle ways to improve care. At the start of 2016, the hospital brought in Morgan to replace the program's longtime leader, Dr. O.H. "Bud" Frazier.

St. Luke's officials have said the heart transplant program's one-year survival rate improved in 2016 and 2017 under Morgan's leadership. But some heart transplant recipients suffered unusual complications since then, the ProPublica and Chronicle investigation found, including two who had major veins stitched closed during surgery, according to numerous sources. In one of those instances, Morgan has said the man's previous cancer treatments complicated his surgery. He has declined to comment on the other, citing patient privacy.

Several physicians left the program in recent years, including a couple of top cardiologists who said they expressed concerns to administrators about the care provided to heart failure patients and started sending some to other hospitals for transplants.

In an earlier interview and responses to written questions, Morgan defended his leadership of the heart program, which he said has improved under his watch.

"We only have had one year with below-expected outcomes in the recent past, 2015, and that's been corrected," Morgan said earlier this year.

In June, following the ProPublica and Chronicle reports, St. Luke's temporarily suspended the heart transplant program in order to review deaths of two additional patients in May following heart transplants. Hospital officials reactivated the program after two weeks, saying they had found no "systemic issues related to the quality of the program."

Two months later, Medicare cut off funding after concluding that St. Luke's leaders had not done enough to fix the problems that led to poor surgical outcomes. The termination prohibits the hospital from billing federal health plans for heart transplants and, according to experts, could threaten the program's overall viability. St. Luke's is appealing the decision.

In announcing its new staff members on Friday, hospital officials characterized the moves as part of "ongoing efforts to strengthen the program which started in January." When reporters met with Nord and other St. Luke's leaders that month, they did not mention any ongoing efforts to make improvements. Instead, they said the heart program had already completed changes necessary to improve outcomes and was operating at a high level.

In the statement Friday, Nord said the hospital would continue striving to make improvements: "Advancing our hospital programs is a never-ending process, and these latest appointments are part of our ongoing commitment to our patients, our physicians and staff, and our community."

Asked about Morgan's future role, spokeswoman Vicki Amalfitano said, "Dr. Morgan's status has not changed," emphasizing his continued position on the St. Luke's medical staff and on the faculty at Baylor College of Medicine, where he holds the academic title of chief of cardiothoracic transplantation and circulatory support.

When pressed on whether Morgan had been replaced as the hospital's surgical director, Amalfitano said, "The announcement is about the new staff, so I'd love to focus on them."

In a follow-up email, she clarified: "I can confirm that Dr. Morgan no longer holds the title of 'Surgical Director, Heart Transplant & Mechanical Circulatory Support' at Baylor St. Luke's Medical Center."

Alexander Aussi, a San Antonio-based transplant consultant, has been critical of St. Luke's handling of problems within its heart program. But he said the changes in surgical leadership announced Friday seem to indicate that the hospital is now taking meaningful steps to improve.

Aussi also applauded the decision by St. Luke's to add a high-level executive to ensure that all of the hospital's transplant programs meet regulatory requirements.

"These changes are a good indication that the senior administration is committed to rebuilding the program," Aussi said, noting that the hires amount to a multimillion-dollar commitment to a transplant program that still must regain Medicare approval.

"Given that they recruited really a star surgeon and made these other changes, that's obviously a commitment from senior administration to move the program forward."