Series: Heart Failure The Decline of a Historic Transplant Program

This article was produced in collaboration with the Houston Chronicle.

In June 2016, Ernest “Chris” Keys received a heart transplant at Baylor St. Luke’s Medical Center in Houston, giving him and his family hope he would finally return home after months in the hospital battling chronic heart failure.

Things went downhill “almost immediately after surgery,” according to a lawsuit filed last month against St. Luke’s and its affiliated Baylor College of Medicine, as well as three Baylor doctors who treated Keys.

After several follow-up surgeries, Keys, then 44, left St. Luke’s in August 2016 with a new heart — but also a severe brain injury that left him unable to speak or walk.

“It’s horrible what he’s been through,” said Michelle Wan, a Houston lawyer who filed the lawsuit in Harris County District Court.

A hospital spokeswoman said she could not discuss pending litigation and declined to respond to questions about the care Keys received.

Ernest “Chris” Keys cannot walk or talk after a heart transplant at Baylor St. Luke’s Medical Center in Houston. He requires a tablet to communicate. (Courtesy of Catherine Keys Jackson)

Wan said an expert hired to review Keys’ medical records concluded that doctors did not act quickly enough to address problems with his new heart in the hours after surgery, leading to a lack of blood flow to his brain and leaving him permanently disabled. Keys, a father of five, now lives in Florida with his mother, Catherine Keys Jackson, who cares for him full time.

Keys and his mother are the latest in a series of patients and surviving family members who have raised concerns about the quality of care provided by the St. Luke’s heart transplant program, which has come under scrutiny from federal regulators.

In May, an investigation by ProPublica and the Houston Chronicle revealed that the once-renowned program performed an outsized number of transplants resulting in deaths in recent years and has lost several top physicians. Those issues surfaced after the hospital was purchased in 2013 by Catholic Health Initiatives, a Colorado-based nonprofit hospital chain.

Two weeks after the stories were published, the hospital voluntarily suspended the heart transplant program following the deaths of three patients in the first five months of 2018. The program resumed operations on June 15, after officials said they made internal changes to improve surgical processes and patient selection. But just one week later, the program absorbed yet another blow: The Centers for Medicare and Medicaid Services notified St. Luke’s that the federal government would stop reimbursing the hospital for heart transplants in August, saying hospital leaders had not done enough to fix shortcomings that endanger patients.

The loss of Medicare funding might cause private insurers to follow suit, experts say, putting the program at risk of closure, though St. Luke’s could still appeal to federal officials. In an email Tuesday, a St. Luke’s spokeswoman said the heart transplant program “is continuing to serve the needs of critically ill patients and we anticipate engaging in substantive discussions with CMS.”

Hospital leaders have repeatedly maintained that the transplant program’s problems were confined to 2015, the year before Keys received his transplant, when six out of 21 heart recipients died within a year of surgery. The hospital said it made changes, including hiring a new surgical director, Dr. Jeffrey Morgan, and that in the two years that followed, 94 percent of heart recipients survived at least a year, better than the national average.

However, ProPublica and the Chronicle investigation found that multiple heart transplant recipients have suffered unusual complications since the start of 2016, including two who had major veins stitched closed during surgery, according to numerous sources. One died. Yet another patient’s heart transplant failed this year after operating-room equipment malfunctioned during a key stage of surgery, and he died as well.

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Although St. Luke’s was aware of problems back in 2016, regulators said that as recently as this year, “the program continued to identify the need to improve intraoperative surgical methods” and reduce the amount of time patients spend on the heart-lung bypass machine, which increases the risk of complications such as bleeding.

Lawyers representing Keys cited the government’s findings in their lawsuit and specifically blamed administrators at St. Luke’s and Baylor College of Medicine for failing to fully address the program’s problems before agreeing to perform Keys’ transplant.

“Defendants’ decision to delay changes to its heart transplant program to improve intraoperative surgical methods … caused and contributed to Mr. Keys’ immediate right heart failure” and permanent brain injury, the lawyers wrote in an amended complaint filed last week. The lawsuit was first reported by the SE Texas Record, a legal publication.

Keys, who suffered from chronic heart failure and pulmonary hypertension, spent two months at the hospital awaiting a new heart and a kidney, according to Wan and the lawsuit. On June 25, Dr. Steven Singh and Dr. George Letsou performed the heart transplant, the suit says. Singh has since left the hospital and is a surgeon in Boston.

Immediately after surgery, the lawsuit said, Keys was receiving high doses of drugs to increase his blood pressure, but four hours later, his blood pressure remained critically low. Around that time, Dr. Leo Simpson, a cardiologist, “ordered an emergent insertion” of a circulatory support device to help Keys’ struggling heart pump blood throughout his body. More than four hours passed before the procedure was performed, the lawsuit said.

At some point, either while he was waiting or afterward, Keys suffered cardiogenic shock, and went without a pulse, the lawsuit said.

“Singh then performed emergent open heart surgery, followed by at least four other open heart surgeries in next ten days to remove extensive bleeding, clots, a collapsed lung, infection, as well as surgeries for insertion of a tracheotomy, and numerous heart catheterizations,” the lawsuit said.

Despite those efforts, Wan said, the damage was done. Keys’ brain had been deprived of oxygen-rich blood for “several minutes,” according to the lawsuit, which faults the physicians for failing to respond with more urgency when it became clear Keys was in distress.

Singh, Letsou and Simpson are each named as defendants in the lawsuit; none replied to requests for comment. A Baylor spokeswoman noted that Letsou “has not been a primary surgeon on a heart transplant for at least five years.”

This isn’t the only legal action involving the heart transplant program. Last week, a Harris County District Court judge granted a request from a patient’s widow to subpoena medical records related to the donor heart St. Luke’s accepted on behalf of her husband, David Kveton. He died a week after he received a heart transplant in January 2017, at the age of 64, and his story was featured in the ProPublica-Chronicle investigation.

Two months after his death, his wife, Judy Kveton, received an anonymous letter stating that hospital administrators had failed to correct problems in the program and that her husband was not given a fair shot at survival.

Kveton said she doesn’t know whether the records will lead her to file a lawsuit. She’s didn’t share her husband’s story publicly to make money off the hospital, she said.

“I wanted the deaths to stop. I wanted somebody to do something about this.”

Broken Hearts David Kveton died after a failed heart transplant at Baylor St. Luke’s Medical Center. At first, his wife thought he had just been unlucky. Then she received an anonymous letter from someone at the hospital.

Mike Hixenbaugh is an investigative reporter at the Houston Chronicle. Email him at [email protected] and follow him on Twitter at @Mike_Hixenbaugh. Tell Us Your Story: Are you an employee, patient or a family member of a patient at the Texas Medical Center? We’d like to hear from you about your experience. Please fill out this confidential questionnaire.