Taxpayers object to prison inmate's $1 million transplant

Pamela J. Podger

San Francisco Chronicle

Published Feb 5, 2002

SAN FRANCISCO -- Who can judge the ethics of giving a California inmate a heart transplant better than the man who didn't get that organ?

Mike Miraglia, 55, shared an intensive care unit room at Stanford University Medical Center for eight days with the prisoner and his two guards. He had been waiting 68 days for a heart and missed receiving the organ when it became available late Jan. 2.

Both men have B-positive blood type and other shared characteristics that made them candidates for the heart. But Miraglia was recuperating from a surgery earlier that same night, before the heart became available - a surgery he needed to tide him over till there was a donor organ.

So doctors instead gave the ``premium'' heart to a 31-year-old twice-convicted robber from Los Angeles, who suffered from a viral infection that had weakened his valves. It is believed to be the first heart transplant in the nation for a prisoner, although inmates have previously had kidney and liver transplants.

The decision to give a scarce resource like a heart to a prisoner who has broken his pact with society - while 4,139 people nationally are waiting for a new heart - has angered many.

But when Miraglia's wife, Cheryl, asked him how he felt about the controversy, he fired back: ``What, are they kidding? Since when is it unethical to save someone's life?''

``The fact that the heart went to a prisoner was never an issue to us,'' said Cheryl Miraglia. ``But I was devastated at the time because we had waited so long.''

A spokeswoman for Stanford University Medical Center said medical criteria not social criteria - were the deciding factors in the inmate's undergoing the three- to six-hour transplant surgery.

News of the transplant - which will entail about $1 million in after-care expenses - did not surface right away. When it did, the state Department of Corrections found itself hammered on talk radio and elsewhere.

At the same time, the department was reaching a tentative settlement in a class-action lawsuit that charged it with not providing medical care at the other end of the spectrum, failing to deliver basic services such as filling cavities and changing catheters. Last year, the state spent $2 million resolving medical-care lawsuits.

Faced with an aging and ailing prison population, top corrections officials say they expect to build a geriatric prison in the next decade. In addition, they have doubled their medical spending to $750 million in recent years to comply with court decisions that guarantee its 160,000 inmates decent health care.

Officials are besieged by medical demands that range from treatment for hepatitis, AIDS and HIV to feminization hormones for 35 transsexuals.

To curb costs, some correctional agencies outside California have commuted sentences or released inmates early so private insurance or Medicaid would pick up the tab. Jails in some Midwestern states and in Virginia, facing expensive bills for inmate bone marrow transplants, unsuccessfully tried to discharge them early.

California does have a compassionate release program for low-risk inmates who are expected to die within six months.

``But we don't engage in patient dumping of acutely sick inmates, nor does California commute sentences,'' said Stephen Green, assistant secretary for the Youth and Adult Correctional Agency.

The inmate who got the heart - who hasn't been identified because of medical confidentiality laws - returned on Jan. 17 to the California Medical Facility in Vacaville. Corrections department spokesman Russ Heimerich said he is serving a 14-year sentence for a 1997 robbery in Los Angeles and could be paroled in 2008.

Miraglia, of San Leandro, Calif., had his own heart transplant Jan. 29. He delivered a card to the inmate in the recovery room. Perhaps, the message said, the inmate's new heart heralded the beginning of a new life.

That sentiment comes closer to the issues that doctors weigh when evaluating potential transplant patients.

``I don't ask if the person is a bad guy or a good guy or an alcoholic - just who will live longest with a good quality of life,'' said Dr. Lawrence Schneiderman, medical professor at the University of California at San Diego.

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