Ohio clinic pays for surgery Georgia denied to Atlantan

An Atlanta woman has received an intestinal transplant through charity care at the Cleveland Clinic, after Georgia’s Medicaid program denied coverage for her operation.

Doctors at the Ohio hospital performed the surgery two months ago, and Sabrina Holloway, a mother of eight, has progressed well, doctors say.

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Joey Ivansco/jivansco@ajc.com

Earlier this year Sabrina Holloway’s daughter Rochelle Chandler gave her a blood thinner injection. With them is Holloway’s husband, Hydrick Tiller.

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“Everything went well,” Holloway, 39, said recently. “It feels real good.”

She said she will remain at the Ohio hospital until January, when she hopes to return home. Holloway is covered by Medicaid, the insurance program for the poor and disabled. But unlike other states’ Medicaid programs, Georgia’s does not cover an intestinal transplant for patients 21 years old and older.

Georgia Medicaid turned down Holloway’s request for the transplant.

Meanwhile, her physician, Dr. Ian Katz of Decatur, contacted several transplant centers. The Cleveland Clinic eventually agreed to do the operation.

“She’s doing quite well,” Katz, a general surgeon, said recently. “It’s exciting.”

Without the surgery, Holloway likely would have died within two to three years, Katz had said.

Holloway’s medical predicament before the transplant was detailed in an Atlanta Journal-Constitution article in June.

Doctors had removed most of her small intestine last January, and Holloway had been fed intravenously since then. During that time, she was unable to eat or drink. Now she’s able to eat a regular diet, according to Cleveland Clinic physicians.

The federal government gives state Medicaid programs leeway on which transplants to approve. Georgia Medicaid allows transplants of kidney, liver, bone marrow and cornea for adults, but not lung, bowel, pancreas and heart-lung transplants, according to the state’s letter to Katz. That policy continues unchanged, a Department of Community Health spokeswoman said last week. Other states’ Medicaid programs — which have their own coverage rules — approve intestinal transplants for people Holloway’s age.

No Georgia hospital performs intestinal transplants.

The Cleveland Clinic last week declined to disclose the cost of Holloway’s surgery and postoperative care. Officials there said they “made every attempt to obtain coverage from Georgia Medicaid.”

The operation generally costs $200,000 to $400,000, doctors said recently. But Dr. Douglas Farmer, head of the intestinal transplant program at UCLA, said in June that a transplant could be less expensive for the state in the long run. He added that intestinal transplants can cost less than $200,000.

A year of nutritional intravenous feeding, as Holloway had required, can cost $150,000, Farmer said.

And in Holloway’s case, the Medicaid spending on IV treatment didn’t include the bills for several subsequent hospitalizations for infections. The intravenous feeding made Holloway prone to infection, Katz said.