Oregon Mulls Kidney Transplant for Death Row Inmate

In May 27 UMATILLA, Ore., story headline "FEATURE-Oregon debates kidney transplant for death row inmate," please read in second paragraph Two Rivers Correctional Institution instead of Umatilla State Prison. In paragraph seven, please read Clatsop County instead of Clackamas County. (Corrects name of prison and county.)

UMATILLA, Ore., May 27 (Reuters) - Horacio Alberto Reyes-Camarena, a convicted murderer with failing kidneys, is presenting Oregon officials with a tough choice -- how best to keep him alive until they can execute him.

The cash-strapped state, struggling to provide basic education and health care to its citizens, pays $120,000 a year to clean Reyes-Camarena's blood with a dialysis machine at Two Rivers Correctional Institution. That treatment could continue for a decade as he appeals his death sentence in the 1996 murder of an 18-year-old woman.

After Reyes-Camarena's prison doctor last month concluded he was a good candidate for a transplant, state officials may consider giving him a priceless donated kidney. The $100,000 operation could save the state money but would deprive someone outside prison of a life-giving organ.

"If they offer it to me, I'll take it but I never want to ask for a kidney," Reyes-Camarena told Reuters by telephone "I'm on death row now. Someday, if it got allowed, I'm going to go through appeals and then the man (executioner) has to do his job. Why take it with me?" he said.

Many people around the state agree, and news that Reyes-Camarena was a potential candidate for a transplant set off a furious debate last month.

"It's a conundrum because you clearly are required to give medical care to prisoners whether they are on death row or not," said Josh Marquis, district attorney for Clatsop County, Oregon, and a staunch death penalty advocate.

Some hospitals have refused to put state health plan members on transplant waiting lists because the plan has cut prescription drug benefits, raising the risk that transplant patients won't be able to pay for expensive drugs that help ensure their bodies do not reject the new organs.

Reyes-Camarena, who stabbed Maria Zetina to death and repeatedly stabbed her sister who survived the attack and testified against him, could be placed on those transplant waiting lists ahead of other state clients.

"The idea that he would live while someone else would die is absurd," said Marquis.

Seventeen people die each day in the United States while waiting for kidneys. The national waiting list has 57,000 names. The irony of his preferential treatment is not lost on Reyes-Camarena, who has followed the debate about state cuts and his own care in the news.

"I know people on the outside. They need things and they don't get it. Sometimes being here is better," he said.

Patricia Backlar, who served on the National Bioethics Advisory Commission in the Clinton administration, said a death row inmate should not have greater access to medical resources than the state's other health care clients.

But Backlar also cautioned that the state is on a slippery ethical slope if it tries to determine who deserves a transplant based on things like criminal history.

"A lot of people are convicted of crimes they didn't commit," she said. "It's very hard to put a value on someone's worth, so you would want to be cautious before you put yourself in the position of being the God squad."

Death penalty opponents and health care advocates bristle at the very thought of making such a decision. Reallocating federal funds could provide health care for everyone, said Peter Bergel, director of Oregon PeaceWorks, an agency which opposes the death penalty.

"We need to structure our social policy in such a way as nobody has to make a decision like that," Bergel said. "When we make judgments as to the value of one person's life over the value of another person's life we are making judgments that the creator has reserved for him or herself. We're not gods."

A $2 billion state budget shortfall, blamed for everything from suicides by mentally ill people who could not get treatment to big cuts in education, has intensified the debate, which might have been avoided in fatter economic years.

"If the state pays (for Reyes-Camarena's kidney) and we don't have enough money to look after our school children or our mentally ill, then that may be an unfair distribution, just because the benefits of it are limited," Backlar said.

And look how much Oregon taxpayers are paying for this, either way:

Prison officials struggle with ethical issues, costs of caring for a killer.

ALAN GUSTAFSON
Statesman Journal
April 28

Oregon taxpayers are shelling out more than $120,000 a year to provide life-saving dialysis for a condemned killer.

Horacio Alberto Reyes-Camarena was sent to death row six years ago for stabbing to death an 18-year-old girl and dumping her body near the Oregon Coast.

At the Two Rivers Correctional Institution in Eastern Oregon, Reyes-Camarena, 47, gets hooked up to a dialysis machine for four hours three times a week to remove toxins from his blood.

Without dialysis, he would die because his kidneys are failing.

Each dialysis session costs $775.80 for treatment and medication, according to Corrections Department figures. At that rate, his dialysis costs $121,025 a year.

As the state keeps Reyes-Camarena alive, thousands of older, poor, sick and disabled Oregonians are trying to survive without medications and care that vanished amid state budget cuts.

Some Oregon hospitals are considering closing dialysis units because of Medicaid-related reductions.

Reyes-Camarena said he wants to sever his ties to the dialysis machine. The convicted killer wants to be the first Oregon inmate to receive a taxpayer-financed organ transplant.

“It’s much better for me, and them, too,” Reyes-Camarena said, referring to his desire for a kidney transplant, a procedure sought by nearly 57,000 Americans.

The prisoner cited medical reports indicating that transplant costs prove to be cheaper than dialysis in the long run.

Even so, transplant surgery is costly: $80,000 to $120,000. It also requires $500 to $1,200 a month in lifelong drugs to keep the recipient from rejecting the new organ.

Studies have found that the death rate for dialysis patients is about 23 percent a year. A successful transplant reduces that risk to about 3 percent a year.

But the number of transplants is severely limited by a national scarcity of available organs. As of this month, 56,895 Americans, including 192 Oregonians, were waiting for kidney transplants, according to the Virginia-based United Network for Organ Sharing, which maintains the nation’s waiting list for organs.

Because the waiting list is long and there aren’t enough organs to go around, some people die before a transplant becomes available.

Overall, 86,157 Americans are waiting for organ transplants — mostly kidneys, livers, pancreases and lungs. Officials estimate that about 700 will die this year while waiting.

Lifesaving care for Reyes-Camarena raises questions about the bounds of medical treatment for prisoners.

Is the society he violated legally obligated to prolong his life? How much money should be spent on his care? What are the limits of compassion for a condemned man?

Doing hard time

Deep within a 1,450-inmate lockup along the Columbia River, dialysis takes place in a small, nondescript room.

“Remain seated and quiet,” reads a sign on the wall. “Failure to do so will result in disciplinary action.”

Reyes-Camarena rolls from his cell to the dialysis room in a wheelchair.

Besides Reyes-Camarena, seven other inmates are undergoing dialysis at Two Rivers.

Each prisoner rests in a comfortable blue chair while he is hooked up to a machine for four hours, the blood pumped to remove waste and excess fluid.

“It’s like when you change the oil in your car,” Reyes-Camarena said. “You’re good for another run.”

Prison officials would not discuss Reyes-Camarena’s medical condition or care, citing confidentiality requirements.

Although dialysis keeps him alive, Reyes-Camarena criticized his care.

The room temperature soars when the machines are running, he said, and two large fans don’t provide sufficient air conditioning. He also complained that the nurses don’t give him ice.

Reyes-Camarena also objected to the lack of a television in the dialysis unit. TV viewing would break up the monotony for patients tethered to the machines, he said.

“It’s four hours to do nothing but look at the ceiling,” he said.

Contrast in care

Carol Hutson doesn’t know anything about Reyes-Camarena. But she has one thing in common with the killer: Her kidneys are failing, too.

When kidneys shut down, the fluid and waste normally flushed out by urination build inside the body. Staying alive requires dialysis or a new kidney.

For Hutson, 58, of Salem, state budget cuts made her impending need for dialysis a secondary concern.

Weeks ago, the state notified Hutson that she would lose her disability assistance as of April 1. That threatened her with eviction from her room at a Salem assisted-living facility.

She also was slated to lose aid that pays for her medications, including twice-daily shots of insulin, pills for a heart condition and anti-depressants.

Divorced and without family able to give her shelter or financial support, Hutson felt abandoned.

“It’s horrifying,” she said. “I kind of feel like a throwaway animal right now.”

Recently, another notice came in the mail. It informed Hutson that she would keep her benefits — at least through June 30.

“I guess I’m safe for the time being,” Hutson said.

But she remains nervous because the two-year budget that starts July 1 has not been settled.

“I don’t know if there’s going to be another huge cut,” Hutson said. “I just have to wait and see. I guess we all do.”

A killer’s tale

Before death row, Reyes-Camarena’s life was predicated on hard work.

Born in Mexico on June 30, 1955, he entered the United States in 1969. He was 13.

The Mexican immigrant worked as a restaurant dishwasher in San Antonio, Texas. He later toiled in farm fields in California and Oregon.

Following a well-traveled path taken by migrant workers, Reyes-Camarena ventured into the Willamette Valley to pick fruit. He progressed from picker to field boss.

Reyes-Camarena was 40 when he committed the brutal crimes that left one woman dead and another forever scarred by violence.

During summer 1995, he was employed as a farm foreman in Woodburn. That’s where he met Angelica Zetina, 32, and her sister, Maria Zetina, 18.

On Sept. 17, 1995, Reyes-Camarena agreed to drive the sisters to Washington to help them find work. But after reaching the Oregon Coast, he drove south instead of north on Highway 101.

Stopping the car near Sea Lion Caves outside Florence, Reyes-Camarena attacked Angelica Zetina. He stabbed her 17 times, then pushed her down an embankment. She survived, and a hunter later found her walking along the highway.

Maria Zetina’s stabbed body was found near Reedsport.

In October 1996, a Douglas County jury found Reyes-Camarena guilty of aggravated murder.

A desperate escape

Two days after his murder conviction and before the punishment phase of his trial, Reyes-Camarena and a second inmate escaped from a holding cell at the Douglas County Jail in Roseburg.

The pair escaped at night by unbolting a metal screen and breaking an inch-thick pane of glass in the cell. As they were climbing down a makeshift rope made of knotted blankets and clothing, Reyes-Camarena fell four stories and landed on his buttocks.

He couldn’t walk, so his companion dragged and carried him to a nearby church. They holed up in the church basement for nearly three weeks before they were recaptured. All the time before he was caught, the injured Reyes-Camarena lay in a closet, hidden behind Christmas decorations.

After spinal surgery, Reyes-Camarena returned to finish his trial. A jury sentenced him to die by lethal injection.

Reyes-Camarena declined to talk about the jail break during a recent interview.

He also had little to say about his grisly crimes.

“I was too drunk,” he said. “I don’t even know if I did it.”

Costly treatment

In early 1997, Reyes-Camarena became the 25th inmate on death row at the Oregon State Penitentiary in Salem.

Reyes-Camarena claimed that his kidneys shut down after he arrived at the maximum-security prison. He blamed his condition on a medication mistake by a prison doctor.

Corrections officials denied the allegation but refused to elaborate.

Penitentiary employees said Reyes-Camarena initially received dialysis in the Intensive Management Unit. That is an ultra-secure wing where disruptive inmates normally are confined to their cells for 23 hours a day.

His treatment was handled by a nurse who ventured inside the unit. When that arrangement ended, Reyes-Camarena was transported to a Salem dialysis center three times a week.

Every time Reyes-Camarena left the penitentiary, he was shackled and escorted by three corrections officers, prison employees said.

A year ago, Reyes-Camarena and several other inmates who had received dialysis in Salem were moved to Two Rivers, a new, medium-security lockup near Umatilla. The $121 million prison opened in 2000.

By centralizing dialysis care at Two Rivers, prison officials said they pruned hefty transportation and security costs that arose from taking inmates to community dialysis centers.

It now costs nearly $1 million a year to provide dialysis for eight inmates behind prison walls, according to the Corrections Department. But prison-based dialysis saves nearly $390,000 a year when compared with outside treatment, agency figures show.

A right to treatment

Ask Reyes-Camarena why taxpayers should finance a kidney transplant to extend his life, and he pauses to consider his answer.

Peering through sunglasses that shade his sensitive eyes, he said he is legally entitled to the same medical treatment that is provided in the “free world.”

In fact, numerous court rulings have established that inmates are entitled to medical care that conforms with community standards. Prison systems that fail to provide inmates with necessary care can be held liable for violating the constitutional ban against cruel and unusual punishment

In some cases, courts have ordered prison officials to give organ transplants to inmates whose requests had been denied.

But ethical questions abound when it comes to Reyes-Camarena and his desire for a transplant. Does a death row inmate have a right to an organ transplant?

“There are a lot of complex issues here,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University in Portland. “But the biggest issue is, should he be considered at all? Is he eligible at all? Or is this not part of the basic package of health care?”

Only months ago, Tolle said her stance on the issue would have been clear. Simply put, prisoners — even death row inmates — should have an equal-opportunity right to transplants.

Her reasoning: Prisoners should get the same medical services provided to low-income residents covered by the Oregon Health Plan — transplants included.

But now, the foundation of her ethical stand has been rocked by budget cuts.

Cuts to the Oregon Health Plan are prompting some hospitals to remove poorer uninsured patients from waiting lists for organ transplants or to keep them off the lists altogether. They fear that such patients won’t be able to afford the expensive drugs necessary to keep new organs from being rejected.

“So we’re now holding on those patients,” Tolle said. “If we’re holding on those patients, I’m not in a position to say prisoners should get something more.”

Clearly, though, Reyes-Camarena thinks the law is on his side.

“They can’t discriminate against me because I’m a prisoner,” he said.

The desire to live

A new kidney could give him more time to live and more time to pursue his appeals.

Unless Reyes-Camarena decides at some point to relinquish his rights to appeal, he could stave off execution for many years.

Death-penalty appeals can take a decade or longer, sometimes far longer, to wend their way through state and federal courts.

Automatic Oregon Supreme Court scrutiny of Reyes-Camarena’s death penalty case occurred in 2000. That was the first of 10 steps of appeal available to him.

Reyes-Camarena and his public defender attempted to convince the justices that the trial judge made numerous mistakes.

In one of the more unusual claims, they claimed that statements that Reyes-Camarena made to police after his arrest should not have been allowed into evidence because authorities violated terms of the Vienna Convention.

Under the Vienna Convention, law-enforcement officers are supposed to inform foreign detainees of their right to get in touch with their national consulates. The United States is a party to the treaty.

Police failed to notify the Mexican consulate of his arrest, Reyes-Camarena said, and they failed to tell him that he had a right to contact consulate officials.

Although the Supreme Court acknowledged that the treaty was violated, it found that the lapses did not constitute sufficient grounds to throw out statements Reyes-Camarena made to police.

In July 2000, the state Supreme Court affirmed his murder conviction and his death sentence.

Even so, no execution date is near. Reyes-Camarena has many years worth of appeals left to pursue before the state can legally execute him.

Inmate transplants

Last year, Oregon doctors performed 313 organ transplants; about three-quarters were kidney transplants.

The bulk of the transplants were done at Oregon Health & Science University and Legacy Good Samaritan hospitals in Portland.

Although Oregon’s prison system has not allowed an organ transplant, two inmates received bone marrow transplants in the past two years. Both surgeries were performed at OHSU.

Bone-marrow transplants replace diseased blood-making cells with a transfusion of healthy cells from a matched donor.

One inmate died after receiving new bone marrow. The other is recuperating at the Oregon State Penitentiary.

Price tags for those transplants: $108,000 and $178,000, according to Corrections Department figures.

Corrections officials cited a key distinction between bone-marrow transplants and organ transplants.

“Bone-marrow transplants are not the same as organ transplants because you don’t use up a scarce resource when you’re transplanting bone marrow,” said Perrin Damon, a Corrections Department spokeswoman.

Nationwide, numerous inmates have received organ transplants, according to published reports. But data are hard to come by.

When inmates receive transplants, the public often doesn’t find out because of strict medical confidentiality.

Still, some transplants have ignited public outrage.

Last year, a furor arose in California when news reports revealed that a prison inmate serving 14 years for robbery had been given a heart transplant.

In that case, the inmate received the heart at Stanford University Medical Center on Jan. 3, 2002, after an ethics committee there approved him and put him on the waiting list.

The cost of the prisoner’s transplant was put at nearly $1 million with follow-up care. It came as 500 Californians were waiting for heart transplants.

In December, less than a year after getting his new heart, the 32-year-old inmate died at the same medical center where he received the controversial transplant.

Waiting for a kidney

The United Network for Organ Sharing has an ethics policy that puts prison inmates on equal footing with others.

A similar policy exists at the transplant program at OHSU.

“The best way to describe it is that we treat all patients who are here the same, whether they are somebody famous or somebody with no money,” said OHSU spokeswoman Christine Pashley.

To get on a kidney waiting list, a prison inmate first would have to be referred to OHSU by the Corrections Department, Pashley said. “Then we would evaluate him to see if he met the criteria and need for a kidney transplant.”

Within Oregon’s prison system, high-cost medical procedures — from expensive medications to bone-marrow transplants — are evaluated by review panels in Salem, Pendleton and Ontario. Prison system doctors and nurse practitioners make case-by-case calls on whether to authorize specific treatments.

No inmate requests for organ transplants are pending, Damon said.

Reyes-Camarena said he is exploring his options. One way or another — via the prison system or the court system — he sees hope for winning a transplant.

As the condemned man fights to stay alive, the thought of dying — by natural causes or a lethal injection — apparently does not faze him.

“When the Lord says it’s your time, it doesn’t matter what you do,” he said. “Everybody’s got his time.”

Alan Gustafson can be reached at (503) 399-6709.

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28 May 2003 19:47:19 GMT CORRECTED-FEATURE-Oregon debates kidney transplant for death row