Convicted Rapist Kenneth Pike Next in Line for Heart Transplant

April 26, 2011— -- Convicted rapist Kenneth Pike, of Auburn, N.Y., is expected to undergo a life-saving heart transplant that could cost up to $800,000 -- a price that will be paid courtesy of New York state taxpayers.

The expense has outraged many crime victim advocates and community members, who say they cannot understand how the justice system can provide big-tag services for convicted felons arguably at the expense of innocent patients.

"From a moral standpoint I think everyone should have a chance at life," said Carol Speach, a media sales professional in Auburn. "But realistically, I think no he shouldn't. I know innocent people with health problems who have medical bills coming out of their ears and can't afford it."

The question has been the talk of the small suburban New York town: Should taxpayers shell out for convicted criminals to receive services that some payers could probably never afford themselves?

"We do think that prisoners are treated much better than those on the outside," said Speach, who also suggested that Pike and his family should foot a larger portion of the bill.

"Everyone else is expected to pay for some of their health care," she said.

And the question of whether prisoners should receive equal, if not better, health care than law-abiding citizens has been the heart of a decades-long debate among medical ethicists.

Transplant centers have the right to turn patients away, but physicians are required to care for every patient they see, according to Art Caplan, director of the Center for Bioethics and the Sydney D. Caplan Professor of Bioethics at the University of Pennsylvania in Philadelphia.

In 1976, the U.S. Supreme Court ruled that prisoners were entitled to the same medical and dental treatment as everyone else in their community. Prisons that withhold necessary care from inmates can be held liable for violating constitutional bans against cruel and unusual punishment.

Prison facilities often pay a negotiated reduced fee with certain contracted hospitals across the state, according to Peter Cutler, spokesman for the New York State Department of Corrections and Community Supervision. But Strong Memorial Hospital in Rochester, where Pike is reported to have been transferred, is not one of them.

"We are constitutionally obligated to provide health care services to any inmate," said Cutler, citing the 8th Amendment of the Constutition. "We're a state agency doing our job."

Many transplant centers undergo what Caplan called a "wallet biopsy" as one of their first steps to add a patient on the transplant list.

"Before you're even put on the list, you need to show a way that you can pay," Caplan said.

That may put some prisoners, whose medical bills are covered by the state, at a competitive advantage, he said. But other factors, such as medical necessity and geographic location, also play a role.

But, many transplant centers offer ways to help patients pay for transplants, according to Dr. Andrew Cameron, surgical director of liver transplantation at Johns Hopkins Medical Center. Medical necessity is the overwhelming factor that knocks a patient off the list, he said.

"The triage is made only on medical grounds and not based on other values," he said.

Critics argue that efforts to ensure prisoner rights have compromised the lives of law-abiding taxpayers who are paying inmates' medical bills.

"Constitutionally you didn't sentence a guy to death, you just sentenced him to prison," Caplan said. "If the public is so turned off by prisoners to get transplants, their goal should be to legislate to change the standard of care."

Prisoner health care has posed less of a dilemma for physicians who are ethically bound to help all patients.

"No part of your punishment for a crime is forfeiting the standard of medical care," said Cameron. "It's not a contraindication to transplant."

While transplant lists do not outline a patient's criminal histories, or whether the recipient is currently in prison, Caplan said there haven't been too many cases of prisoners approved for organ donations.

"In general, the ethics of medicine is not to sort out sinners and saints," he said.