Dr. René Favaloro

Dr. Willem J. Kolff knew Dr. Favaloro and worked with him at the Cleveland Clinic. When René was beginning the Favaloro Foundation in Argentina, he invited Kolff to provide some help in establishing an artificial heart research program in Buenos Aires. Mr. Steven Nielsen, an engineer, and I made several trips to work in the Favaloro Research Foundation. Furthermore, two biomedical engineers and two thoracic surgeons from the Favaloro Foundation spent nearly a year in Salt Lake City, Utah.

The Foundation was expanding and doing well when René began to set up the Favaloro Cardiac Hospital. He was running low on funds and I wondered if the Falkland Islands War against England was the cause of the reduced availability of funds. I was told that René had sold two of the family’s cattle ranches near Buenos Aires in an effort to pay salaries and the drug bills. It was particularly difficult for René to sell the ranch at Jacinto Arauz in La Pampa. It was his favorite and where he grew up as a boy.

A friend, who wishes to remain anonymous, sent me a letter that Dr. Favaloro wrote, to say goodbye to his many relatives and friends. In the letter, René explained the significant events that led to intolerable conditions for which he could not determine a solution. He was trapped in socialized medical insurance corruption and was not willing to yield his honesty and integrity to exist in such an impossible environment.

The original letter was a combined Spanish-English language that I have spent time editing, hopefully without the loss of René’s intended message. I understand this letter was written and left next to him when he committed suicide by shooting himself. The letter follows.

A LETTER FROM DR. RENÉ FAVALORO

 If you had read my letter of resignation to the Cleveland Clinic, it is clear that my return to Argentina (after reaching an important role in cardiovascular surgery) was due to my eternal commitment to my country. I never lost my roots. I returned to work in teaching, research and medical care.

The first stage in the Guemes Sanatorium showed that we immediately organize residents in cardiology and cardiovascular surgery, as well as graduate courses at all levels. We gave importance also to research involving most members of our group. In assistance-care we demanded hospital beds for the homeless. Thus, hundreds of patients were operated free of charge. Most of our patients came with “socialized medical insurance.” The Favaloro Hospital had a contract with the most important social insurance provider at that time. The working relationship with the hospital was very clear: the fees came, they were for the patient’s therapy and care, then the hospital was paid (undoubtedly the biggest slice). We paid the earned fees to the residents and secretaries and our incomes were distributed proportionately among physicians.

We were never allowed to touch a single penny of what we did not share. Although managers claimed that there was “no returns [of profit],” I knew that they had profited. From time to time, at the request of its union manager, we greeted the syndicalist [unionizer] union organizer of the day, and they appreciated our work. This was our only contact with the labor unions and insurance providers.

In the mid-70’s, we began to organize the Favaloro Foundation. First with the help of the Sedra, we created the basic research department which has given us much satisfaction, then the construction of the Institute of Cardiology and Cardiovascular Surgery.

When it started, I wrote the “10 commandments,” to be held to the letter, based on the ethical guidelines that have always been with me.

The quality of our work, based on the technology incorporated and the work of selected professionals, resulted in that no work was missed, but we had to continually struggle with rampant corruption in medicine; part of the massive corruption that has polluted our country at all levels of any kind. We have consistently refused to break ethical guidelines, therefore, never took a single dollar in return.

Thus, major “social insurance” providers did not send, nor do they now send their patients to the Institute. Oh, what I could tell about the countless interviews with syndicalists [unionizers]! They are corrupt men living at the expense of workers and receiving kickbacks, mainly with money from the social programs that correspond to medical care!

The same applies to the PAMI. This can be certified by physicians in my country who, for survival, must accept part of the system implemented throughout the entire country. As a single example: the PAMI has an old debt to us (I think since ’94 or ’95) of 1 900 000 pesos.

If we had accepted the conditions prevailing in the corruption of the system (which has been increasing in recent years) we should have 100 more beds. We would not agree to meet the demand. Whoever wants to deny that this is true, then accept that the fundamental principle of freedom of choice of doctors governs in Argentina, which would end the health-care corruption.

The same applies to private hospitals, including those of private health insurance plans. The doctor who sends patients to the famous “ana-ana” knows, and expects to receive a hefty share from the surgeon.

Since many years ago I have heard that Favaloro no longer makes surgeries! Where does this fib come from? It is very simple if the patient is studied. Conclusion is made that the patient’s cardiologist said that the patient should be operated upon. The patient accepts and expresses their wish that Favaloro operates on him. “But how, you do not know Favaloro does not operate, since long ago?” the cardiologist says. “I am going to recommend a surgeon of real value, do not worry.” The surgeon “of real value,” in addition to their professional capacity, will return to the cardiologist 50% of the client’s fees!

Many of these cardiologists are of national and international prestige. They attend the Congress of the American College or the American Heart Association and then yes, there they will provide me with all sorts of praise and hugs every time I present a “lecture” of significance. This happened with my Paul D. White lecture in Dallas, where dozens of Argentinean cardiologists embraced me, some with tears in their eyes. But here, again they have to fit into the “system” and money is what most interests them. Corruption has reached levels I never thought I would ever witness in my country.

Prestigious institutions such as the Institute Cardiovascular Buenos Aires, with excellent medical professionals, send well-trained employees visiting cardiologists in their offices. There, they explain in detail the mechanisms and rates of return that will not only be for surgery, but also for noninvasive diagnostic methods (Holter, Echo, Gamma Camera, etc.) catheters, angioplasty, etc.

Physicians of our Foundation had shown me writings that they leave for the patients, all very well explained. Once the patient is operated upon, the same trained staff will visit back with the cardiologist, who will explain in detail “the economic” and deliver the corresponding “envelope!” The current fiscal situation of the Foundation is hopeless, since millions of dollars of work done need to be collected, including high-risk patients we cannot refuse. It’s easier to say “no beds available.”

Our medical oath prevent[s] us from that. These patients require a high cost rarely acknowledged by social insurance. To that, it should be added debts everywhere, which corresponds to the construction and equipping of ICYCC, suppliers, the DGI, banks, physicians with delays of several months. All our projects are staggering and everything is becoming increasingly complicated. In the U.S., major medical institutions can perform their task of care, teaching and research for the donations they receive. The five most momentous medical schools receive more than $100 million each!

Here, we cannot even begin dreaming of receiving this funding. I made arrangements at the BID who helped us in the initial stage and then they advertised our Foundation in several of its publications as one of their accomplishments!

I sent four letters to Enrique Iglesias the famous singer, asking for help; so much money thrown overboard in this America! I am still awaiting a response. He handles billions of dollars, but for an institution that has trained hundreds of physicians scattered throughout our country and throughout Latin America, there is no response.

How can we measure the social value of our educational task? Undoubtedly, to be honest in a corrupt society, there is a price. In the short or the long run, you do pay. Most of the time I feel alone in my efforts. In that letter of resignation to the Cleveland Clinic, I told Dr. Donald B. Effler that I knew in advance that I would have to fight and I reminded him that Don Quixote was Spanish!

Undoubtedly, the struggle has been very uneven. The Foundation project falters and begins to crack. We had several meetings with my closest colleagues, and some comrades from our National Association of La Plata advised me that in order to save the foundation we must be incorporated into the “system.” Yes to the returns, yes to “ana-ana.” They advised, “We will organize people.” There are “experts” who know how. “You have to step aside. We will clarify that you know nothing, you’re not aware. You must understand if you want to save the Foundation.”

Who will believe that I am not aware! At this point and at this age, to finish with the ethical principles that I received from my parents and my teachers is extremely difficult for me. I cannot change, I’d rather disappear. Joaquín V. Gonzalez wrote the lesson of: “I have not been beaten by anyone.” I cannot say the same. I have been defeated by a corrupt society that controls everything. I’m tired of receiving honors and accolades at international levels. A few days ago I was included in the select group of “Legends of the millennium” in cardiovascular surgery. Last year I had to participate in various countries, from Sweden to India, listening to the same thing. “The legend, the legend!”

Perhaps the cardinal sin I have committed, here in my country, was always to express loudly my feelings, my criticisms, again, in this society of privilege, where a few have abundance, while the majority live in misery and despair. All of this cannot be forgiven, however it must be punished.

It comforts me to know that I have served my patients without distinction of any kind. My colleagues know of my penchant for the poor, that comes from my distant years in Jacinto Arauz. I’m tired of fighting and fighting, galloping against the wind as Don Ata. I cannot change. It was not an easy decision but thoughtful. No talk of weakness or lack of courage.

The surgeon lives with death, it is his inseparable companion. I leave taking her hand. I just hope this does not become a comedy act. To the Journalism I ask you a little pity. I am calm. Once, in an academic ceremony in the U.S. I was presented as a good man who is still a rural doctor. Pardon me, but I think it is true. I hope you remember me like this.

These days I sent desperate letters to national and provincial politicians, and businessmen, with no response. In the Foundation, a crisis committee has begun to take action with external expertise. Yesterday the first layoffs began to occur. Some have been loyal and dedicated staff.

On Monday, I could not face all of you.

To my family, especially my dear nephews, my colleagues, my friends, remember that I reached the age 77, you are required to keep fighting at least until reaching the same age.

Again I reiterate the obligation of cremation immediately, without wasting time and please throw my ashes in the mountains near Jacinto Arauz, back in La Pampa, although it is strictly prohibited in religious or civil ceremonies.

A hug to everyone,

René Favaloro, July 29, 2000, 14:30 hours

BIOSKETCH

Don B. Olsen, D.V.M., decided to pursue a research career at the University of Nevada’s Desert Research Institute in Reno, Nevada. More opportunities opened through his association with Dr. Willem J. Kolff, being offered a position in Kolff’s Artificial Heart Research Laboratory (AHRL) in the Institute for Biomedical Engineering (IBE) at the University of Utah, developing and researching artificial hearts and assist devices. He became Director of the AHRL, later Director of the IBE. In 1982, the first FDA-approved permanent implantation of the Utah total artificial heart was done in a clinical patient, Dr. Barney Clark. The surgical team included Drs. William DeVries, Lyle Joyce, and Don Olsen.

Dr. Olsen traveled throughout the world, training TAH implantation techniques, including work with Dr. Michael DeBakey. He received numerous international and national awards and accolades (some recent include: Living Legend Award, 16th World Congress of the World Society of Cardio-Thoracic Surgeons, Ottawa, 2006; First Kolff Prize, Kolff Memorial Symposium, University Medical Center Groningen, The Netherlands, 2009; Deseret Foundation 2010 Legacy of Life Award in Cardiovascular Mechanical Support, Salt Lake City, UT, 2010).

He was in the 95th percentile of NIH research funding as reported in May 2005. He acquired donation of the off-campus building where the lab’s research has been performed since 1973. He established scholarships for graduate and undergraduate students at four universities. He has created and chaired multiple private companies. One currently has implanted over 900 total artificial hearts throughout the world, based on the Utah-developed TAH design. Dr. Olsen is also founding member of International Faculty for Artificial Organs, American Institute for Medical and Biological Engineering, International Society for Rotary Blood Pumps and International Academy of Artificial Organ Pioneers, and the Barney Clark Award. He is married, with five children.