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Transplant mixup sees lasting effects

Provoking debate on issues ranging from the prevalence of medical errors to the ethics of organ transplantation procedures, the treatment and death of Jesica SantillA¡n has made the 17-year-old girl a national symbol for a host of medical causes.

After receiving a heart and lungs of incompatible blood type Feb. 7 at Duke Hospital, Jesica struggled with declining health for about two weeks before finally dying shortly after a second transplant, also conducted at the Hospital.

As one prominent example of the aftereffects of her death, lobbying groups and federal lawmakers have used Jesica's example to argue against national efforts to cap malpractice awards. Kurt Dixon, the Santillan family's lawyer, recently testified before Congress about the issue.

Dr. Thomas Gallagher, an assistant professor of medicine at the University of Washington at Seattle and an expert on medical errors, said Jesica's case may help bring attention to the extensive problem of medical errors, which some studies suggest are responsible for between 50,000 to 100,000 deaths every year.

"When something like this happens at an institution as well-respected as Duke, it makes everyone think, 'This can happen to me,'" Gallagher said. He noted that three-fourths of the public say they worry about medical errors, adding, "Well-publicized cases like this heighten this concern.... It may provide the impetus for continuing discussions between patients and doctors for why errors occur in medicine."

Gallagher has investigated extensively into how the psychology of physicians and patients affects the way medical errors are dealt with, and said that Jesica's case illuminates many of the most salient issues. "[It's] a good example of how most medical errors are caused by defective systems of care rather than incomplete or inadequate effort on the part of health care providers," he said. He noted a growing movement among medical professionals seeking to emphasize how these systems affect the prevalence of errors above the common perception that all mistakes are the fault of incompetent doctors.

In addition, the case has helped elucidate the issue of disclosure, Gallagher explained. Physicians are often hesitant to admit error because they regard it as a sign of personal weakness or as a legal liability. "What physicians need to do is recognize that there is a basic set of information that patients want about errors," he said.

On the Hospital's part, Associate Professor of Surgery Dr. James Jaggers--the transplant surgeon for both of Jesica's operations--quickly admitted his error to the family, and the Hospital has repeatedly admitted its error to the public.

Criticisms of Duke's behavior have been continual and varied, wrote Health System Chief Executive Officer Dr. Ralph Snyderman in a March 11 statement. "Some have charged that Duke should have done more to save Jesica. And at the same time others have suggested that Duke did too much," he wrote.

Meanwhile, the situation forced the Hospital into difficult and uncertain terrain, Snyderman wrote.

"[Jesica's] case forced Duke to grapple with some of the most troubling questions that face today's hospitals and physicians: medical questions about mistakes in care and how to prevent them, ethical questions about organ transplantation and end-of-life issues and communications questions about balancing a patient's right to privacy, the needs of the family and the public's right to know," he wrote. "We are committed to learning from this event, improving the system and sharing that information with others."

Hospital spokesperson Richard Puff declined to comment on how the media scrutiny and criticism has affected the Hospital and its public image, but admitted the negative coverage reached a lot of ears. "If you look at the news coverage, it certainly was widely reported," he said.

Puff agreed with Snyderman that Jesica's case was an unusual and challenging one for the Hospital. "As everyone has said since the event occurred, nothing like this had happened before, so it's an extraordinarily rare situation," he said.

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