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Promethus
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Battle Creek, Michigan
Jan 2002
time: 00:26
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From The NYT 18Feb03
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Girl, 17, Fights for Life After Organ-Donor Error
By DENISE GRADY
A 17-year-old girl is in critical condition after mistakenly being given a heart and lung transplant from a donor with the wrong blood type at Duke University Hospital in Durham, N.C.
The patient, Jésica Santillán, has rejected the organs and is unconscious and on life support. Doctors say she is unlikely to survive more than a few days without another transplant. But she has little chance of getting one, because donors are scarce. In 2001, doctors performed only 27 heart-lung transplants in the United States.
Her family's last hope is that a dying patient who is a suitable Type O donor can be found, and that that person's family will make a "directed donation" to Ms. Santillán.
Duke issued a statement on Monday accepting responsibility for its part in the mistake, which happened on Feb. 7, but did not explain how it occurred.
The donor had Type A blood, and Ms. Santillán Type O. People with Type O blood can safely receive transfusions or organ transplants only from others who are also Type O; mismatches can be fatal.
Dr. William Fulkerson, the hospital's chief executive officer, said he could not discuss how the error was made until the hospital completed its own investigation, possibly within a few days.
"We've done thousands of transplants here over 30-plus years," Dr. Fulkerson said. "This has never happened. It's a unique tragedy for us."
He said that Duke had already changed its procedures to require that three members of the transplant team check the medical records of organ donors and recipients before surgery to make sure that they were compatible. Until now, he said, only the transplant surgeon was required to check.
Ms. Santillán's family moved from Mexico to North Carolina three years ago in hopes that she would be treated at Duke for a condition called restrictive cardiomyopathy, which caused an enlarged, weakened heart and damaged lungs. She had suffered from the problem for most of her life and was deteriorating.
By Feb. 7, when a heart and lungs became available, doctors estimated that Ms. Santillán would survive only about six months without a transplant.
Two groups involved in the transplant have provided clues to how the mistake may have occurred.
According to Carolina Donor Services, on Feb. 7, the New England Organ Bank said it had a heart and lungs from a Type A donor who, according to a national database, matched two Type A patients at Duke. The Carolina group notified Duke, but surgeons there declined the organs, because for reasons other than blood type they were not suitable for the two patients listed in the database. However, one of the Duke surgeons, whose name was not revealed by the Carolina group, requested the heart and lungs for a third patient.
The third patient was Ms. Santillán, who has Type O blood.
The New England Organ Bank issued a statement saying it had correctly identified the donor as Type A and had given the information to Duke twice, before the organs were removed from the donor and again when Duke surgeons arrived in New England to perform the surgery to remove them. The bank would not say where this surgery occurred.
As the surgeons flew back to North Carolina with the heart and lungs, Ms. Santillán's transplant surgeon began removing her organs. Time was short because heart-lung combinations deteriorate quickly, and doctors wanted to implant the new organs as soon as they arrived at Duke.
The operation went smoothly until routine tests performed near its completion revealed that Ms. Santillán and the organ donor did not have matching blood types and that Ms. Santillán was already beginning to reject the organs, Dr. Fulkerson said.
Mack Mahoney, a spokesman for Ms. Santillán's family, said that her surgeon, Dr. James Jaggers, told the family about the mistake immediately after the surgery, and listed Ms. Santillán for another transplant. He also said medicines might control the rejection, Mr. Mahoney said. They did not.
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Promethus
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Battle Creek, Michigan
Jan 2002
time: 00:26
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Girl, 17, Fights for Life After Organ-Donor Error
(Page 2 of 2)
Mr. Mahoney, a businessman who created a foundation to help pay for Ms. Santillán's treatment, also said that the surgeon told him and Ms. Santillán's parents that because he had removed Ms. Santillán's own heart and lungs shortly before the donor heart and lungs were brought to the hospital, he had no choice but to sew the donor organs into her.
Dr. Jaggers was not available for interviews, a Duke spokesman said.
Dr. Fulkerson said he could not discuss the details of Ms. Santillán's case, but he said that chest surgeons at Duke told him it was standard procedure to to take out the recipient's organs before the donor organs arrived, in order to save time — even if the organs were being brought in by helicopter or ambulance. Hearts and lungs are good only for about six hours, even on ice, and surgeons are racing against the clock.
Once the recipient's own organs come out, they cannot be put back in, Dr. Fulkerson said. For one thing, they are so damaged as to be almost useless, or the person would not need a transplant.
"It's not compatible with life to put organs like that back in," Dr. Fulkerson said.
Mr. Mahoney said: "The family is horrified, terrified, grieving. The mother has cried until she can't cry anymore. She's either at her daughter's bedside or in the chapel with the priest. She still holds out faith that somebody will help her, that somebody who loses a little one will give Jésica the gift of life and not bury the organs with the child."
Mr. Mahoney, who said he felt a heavy burden of responsibility for having helped arrange for the transplant, said he was devoting himself full-time to trying to find a family of a dying patient willing to donate organs for Jésica. She is petite and weighs only about 85 pounds, he said, so an organ donor for her would have to be a child or a very small adult.
People who know of a potential donor can get in touch through a Web site, www.4jhc.org.
According to the United Network for Organ Sharing, which keeps the national database and coordinates transplants, there are only two cases on record in which patients received mismatched organs. One patient died, and the other survived.
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DinoDoc
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AECCP loves Democracy
Sep 1999
time: 23:26
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Doctors left scrambling for insurance
by Emery Carrington
DM City News Editor
February 17, 2003
Problems arising from medical malpractice suits have tightened their grips on Baptist Memorial Hospital-North Mississippi, and they have not let go yet.
As insurance companies pull out of Mississippi, doctors are left without insurance. They are unable to treat their patients for fear of a malpractice suit.
Fourteen doctors in three areas of BMH-NM were forced to curtail their practices last week, not admitting any more patients, until a solution is found.
"It has the potential of being very, very serious," said Jim VanderSteeg, administrator/CEO of BMH-NM. "We are working on several things that could be a quick solution. We are going to take care of patients."
VanderSteeg and other doctors conducted discussions over the weekend, meeting with local state Representative Jay Eads, hoping for an answer.
If the answer does not come for this problem not, only plaguing the state but the nation, these physicians will have no other choice but to leave the state and leave their patients behind.
"I don't know of anybody who wants to leave," said pulmonologist Dr. Keith Mansel with Oxford Lung Physicians, which had to send some of their patients to other facilities in Tupelo or Memphis. "I'm 50 years old, this is my home, I grew up here. I feel very much a part of the community, and I do not want to leave."
Mayor Richard Howorth said he does not want physicians to leave, either.
"I can't think about it because the doctors we're talking about are from Oxford, they went to Ole Miss," Howorth said. "They are just a really essential fabric of the community. I can't foresee a successful community without these particular doctors."
As much as Mansel said the doctors do not want to leave the area, if the situation worsens, they might not have another choice.
"We'd have to leave the state," Mansel said. "By the end of the week, if we don't have any insurance, we have no other choice but to look at opportunities out of state. You have to have insurance to practice."
Along with flight of doctors from the area, recruiting efforts and local economy will also be affected, VanderSteeg said.
"This is definitely not good for recruiting (specialists)," VanderSteeg said. "The medical engine is very significant to the economy here."
For the past 10 to 12 years, Mansel said specialists and hospital administrators have consciously worked to strengthen the hospital's reputation, but in the worse case scenario, that reputation could be crushed, Mansel said.
"Once you loose that, it will be very difficult to build it back," Mansel said. "It takes a lot of people working together to do that. Once you leave, the chance of you coming back is probably slim."
Mansel along with BMH-NM officials and other physicians are scrambling to find a company who will cover their practice. He will travel to Houston, Texas, today in hopes of saving the practice.
"There is nobody writing insurance in the state of Mississippi," Mansel said. "It's not that we can't afford it, it's just not available. We have some hope that this (Houston underwriter) might bridge us over, hopefully, until we could get standard insurance. We don't really know until we hear the details, though."
BMH-NM officials continue to search for multiple alternatives, however.
"Right now, I don't know what the best option is," VanderSteeg said. "You don't want to put all of your eggs in one basket because if that option doesn't work, then you are in trouble."
Even though tort reform has been put into place, it has not eased insurance company's minds or financial burdens. Doctors Insurance Reciprocal, the company covering Oxford's 14 physicians affected, was deemed financially unstable and began informing doctors that they must hire their own attorneys in the event of a malpractice suit.
"We have been advised by various legal council that said we don't have insurance, we just have to quit," Mansel said. "For really about a month, we have known things weren't favorable and we have engaged brokers around the country."
The effects of last week's events have already spread through the hospital, with approximately 180 patients being cut down to 100 in a day, Mansel said - a 44 percent drop.
The three physicians in Oxford Lung Physicians generally see a combined 40 to 50 patients, Mansel said. On Sunday, Mansel said he only saw six.
Current patients are being consolidated into one area, being moved from partially full floors.
The emergency room remains open, but if a patient comes in that needs a specialist in an area hit, such as the Oxford Lung Physicians, they will be transported to another facility, VanderSteeg said.
Even these other facilities, especially Tupelo, aren't safe from insurance companies pulling out.
"In Tupelo, there are 120-something physicians with Reciprocal (DIR's sister company)," Mansel said. "It's potentially moving very quickly over there, too. They might not have insurance soon."
A heart surgery was canceled Friday, and Mansel said he anticipates more major surgeries being canceled because the physicians "depend so heavily on each other" and cannot do the surgery if even one specialist is unavailable.
Local orthopedic surgeon Dr. Wayne T. Lamar said he will continue serving his patients.
"I'm going on with business as usual," Lamar said.
"I haven't been notified that I don't have insurance, and I'm paid up through August. My due date is in August, and if something happens, then I'll have to act accordingly. We live every day by the sword, though."
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19-02-2003 11:40
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