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Veteran in dire need of liver is kept off list

Mar. 04, 2002

The national policy governing liver-transplant waiting lists shifted in favor of desperately sick patients like Ronald Linscott last week, but the 53-year-old Miami man's hopes remain tangled in the red tape of medical bureaucracy.

Linscott lies near death at the Veterans Administration Medical Center, unable to get on the organ registry at the only South Florida hospital that performs the procedure: University of Miami/Jackson Memorial Hospital, just across 12th Avenue.

If he happened to be homeless he might be near the top of the list, but his status as a Vietnam War veteran may pose potentially fatal delays.

One of Linscott's VA doctors said the head of JMH's liver transplant team agreed in mid-December to accept Linscott, pending certain medical tests. It was unclear last week whether those tests had been done. The VA physician who spoke unofficially about the case didn't have all his records.

Because JMH regards the VA as an insurer, and the VA hasn't sent word from Washington that it will pay, Linscott is in limbo.

"Being a veteran, in general we'd view him as someone with benefits," Conchita Ruiz-Topinka, JMH public affairs director, said. "We have a responsibility to try to recoup whatever expenses we can. ... It's true that sometimes patients without funds are less tethered to a particular program than those with coverage."

In fact, the bitter reality is that if he were an indigent, uninsured Miami-Dade resident without a military record, Linscott probably would be closer to a transplant -- with JMH even footing the $150,000 to $200,000 bill.

Neither Ruiz-Topinka nor VA officials would discuss the specifics of Linscott's case, citing patient confidentiality.

"Anyone who was cleared [by the transplant team] means he needs one," she said. She added that he likely would be treated in an emergency regardless of the finances, all other medical factors being equal. The hospital, she said, will seek to expedite his case.

"On Monday, the finance people are going to try to pursue the case," she said.

The VA system has its own transplant registry, but Linscott's doctor said he's too sick to travel to either Pittsburgh or Portland, Ore., where the only two VA hospitals that perform liver transplants are located.

Were circumstances less complicated, Linscott probably would be high on JMH's 300-patient waiting list. The United Network for Organ Sharing last week revised its allocation policy to give sicker patients priority over less sick patients who have been on the waiting list longer.

Meanwhile, Linscott's skeletal frame continues to deteriorate. Jaundice has turned his skin a ghastly greenish-yellow.

"I was once a muscular guy," he said. "I was 180 pounds, 5-10."

But his failing liver is, essentially, "eating him alive," the VA doctor said.

Until he got too sick to work last year, Linscott was an Iberia Airlines electrician. Divorced, he has a 14-year-old son who lives in Pensacola.

His son visited recently and was visibly shocked. "I could see how upset he was in his face," Linscott said.

Linscott can only manage Jell-O and liquids. Otherwise, he's fed by a tube through his nose. Urine drains out through a catheter.

He can't get out of bed, and wept with shame as he described lying in his own excrement.

"You don't know how miserable it is. How embarrassing."

Linscott probably contracted hepatitis C while working as an Air Force fighter-jet mechanic stationed at ''Rocket City" in 1971 and '72, the DaNang base so named because it was constantly under attack.

"I had quite a few close calls," he said. "Where the planes were parked would take direct hits. Your ears and nose would be bleeding."

But this, he said, "is scarier. I'd go through that 100 times rather than go through this. I have no control over nothing."

What he wants, Linscott said, "is to get a transplant and wake up and be normal and go back to work."

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