Nearly two weeks after Jesica Santillan's death, internal and external investigations of Duke University Hospital continue to search for answers.
Santillan attracted international attention following a Feb. 7 transplant of a heart and lungs of incorrect blood type into the girl at the Hospital. She died Feb. 22, following a second transplant.
Kurt Dixon, the Santillan family's lawyer, told the press that the family is contemplating a lawsuit against the Hospital, but will likely wait as many as six to eight weeks until the publication of results from Santillan's autopsy.
Hospital spokesperson Richard Puff said the Hospital has not begun preparing a defense or formulating responses to core legal questions.
"I'm not aware of any lawsuit that has been filed," he said.
One uncertainty is whether the family signed an arbitration form that could shield the Hospital from a lawsuit - something Dixon has said he needs to determine. Puff said he had no knowledge about the form and referred the question to the family.
Another legal uncertainty is whether responsibility for the error leading to Santillan's death lies with the Hospital or Associate Professor of Surgery Dr. James Jaggers, the surgeon who conducted both heart-lung transplants.
"I have recalled [Hospital Chief Executive Officer] Dr. William Fulkerson taking responsibility for this," Puff said. "Whether he meant one individual or Duke as a whole, you'd have to ask him."
Fulkerson was unavailable for comment on legal responsibility, but an initial press release from him did indicate an admittance to error by more than just Jaggers.
"In our efforts to identify organs for this desperately ill patient, regrettably, a mistake occurred," Fulkerson said in the statement. "This was a tragic error, and we accept responsibility for our part."
Investigations of the Hospital by the state Division of Facility Services; the North Carolina Medical Board, which oversees doctors; the national accrediting body for hospitals; and the United Network for Organ Sharing - the national database that matches organ donations to recipients - are ongoing, in addition to probes by the Hospital into both the processes leading to the error and the conduct of Jaggers.
UNOS's investigation is looking at Duke Hospital's compliance with its guidelines, said UNOS spokesperson Anne Paschke. Among the possible ramifications, UNOS could publicly declare the Hospital to not be in "good standing" following the investigation.
"We have a team looking at all the circumstances surrounding the case," Paschke said. "The process is built to bring people into compliance with policy."
Despite press reports to the contrary, including a recent article in USA Today, Duke Hospital did not break UNOS policy by transplanting organs to an illegal immigrant, Paschke said.
"We don't collect whether the citizen is here legally or illegally," Paschke said. The only guideline is that a hospital can offer only 5 percent of transplants to non-residents, making illegality irrelevant, she said.
Paschke reiterated that the practice of "shopping" for organs - in which regional transplant offices offer hospitals organs not according to UNOS match results - does not agree with UNOS policy. Unless the organs are a direct donation, no organs should be transplanted without a UNOS match.
"The policy is that you go according to the match run," Paschke said. "By policy, the match run is to be followed."
Duke Hospital officials have admitted that the organs initially transplanted to SantillA¡n were only offered to her based on a specific request to the regional transplant office by the transplant surgeon, not based on a UNOS match.
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