By Carol Gentry
06/04/12 © Health News Florida
Now that Ronald Poppo has survived the initial trauma of having most of his face eaten -- although it may be too soon to know whether he'll succumb to infection -- surgeons at Jackson Memorial have begun discussing how to reconstruct the face or replace it with a transplant.
That's what surgeons do. It is not their job to figure out whether carrying out such a procedure on a patient like Poppo -- a "chronic drinker" who has lived on the streets of Miami for at least 30 years -- makes any sense.
Whose job is that? Possibly no one's. Once patients make it into the hospital, especially in cases of trauma care, they are on a speeding train without an engineer to apply brakes.
As the Miami Herald reports, the Jackson Memorial Foundation is raising money towards the $350,000 cost of a face transplant or reconstruction for Poppo. Since he is 65, presumably a case worker at the hospital will get him signed up for Medicare and, since he has no income, Medicaid.
Between the two programs, taxpayers may cover much of the substantial cost of surgery and drugs that Poppo would have to take to prevent rejection of a transplanted face. Even if reconstruction without a transplant is feasible, Poppo will need extensive and expensive follow-up care.
Would he show up for it? Would his caregivers have any way to contact him? Would they be able to persuade him to move into a nursing home or -- if he recovers enough -- a halfway house? Would a man like Poppy be agreeable to such a regimen after 30 years on the streets? Would caregivers have to seek a court order to force him to stay?
You see the problem. Maybe surgeons have the technical expertise to recraft his missing eyelids, nose and mouth. Maybe taxpayers and donors can even pay for that. But who will give Poppo the change in attitude and lifestyle that would be necessary to keep his new face?
As medical ethicist Kenneth Goodman at University of Miami told the Herald, no one at UM or Jackson does a "wallet biopsy" before giving poor people the best of care. "If there is a good clinical indication that the patient needs the procedures," he said, "then I think reasonable people would say let's try to find a way."
Predictably, many of those who wrote comments under the Herald article ranted about what they saw as a waste of money on a worthless person. Others responded that Poppo was a blameless victim of circumstance who deserves compassion and whatever medical care is necessary to restore his dignity.
But one writer, a Lily Darcey, voiced the same questions that occurred to me: "While I sympathize with this man, no one here has addressed the fact that many people with severe mental illness refuse to take their medication, because of side effects, or they feel they don't need it.
"Cognitively, is this man capable of the reasoning or rationale that will be needed to take anti -rejection medications for the rest of his life, and will his vagabond life be conducive to the clean environment he should live in once he gets the face transplant? He would probably have to be institutionalized for the rest of his life to protect him from himself, or to have someone consistently give him the medications he will need to prevent his body from rejecting his new face."
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--Health News Florida is an independent online publication dedicated to journalism in the public interest. Editor Carol Gentry can be reached at 727-410-3266 or by e-mail at Carol.Gentry@HealthNewsFlorida.org.