A Day at the Circus

When a gravelly-voiced North Carolina politico in a Panama hat named Mack Mahoney began complaining that Duke University Hospital was covering up a potentially fatal medical mistake, the media was enthralled. Starting with local press--WRAL-TV ran a sketchy account Feb. 12--and diffusing outward, when ABC radio sent the story nation-wide the following day, the story exploded.

Shocking accusations of threats and false information on the part of the Hospital began to emanate from Mahoney, speaking for the family of Jésica Santillán, a 17-year-old girl who had received a heart-lung transplant of the wrong blood type. He would later candidly admit that he was partly trying to drum up popular support for Jésica, in hopes of getting a second transplant. The accusations were nevertheless faithfully disseminated--including in my articles, as I covered the story for The Chronicle and followed the national journalists' lead.

I was surprised all along that the story was getting so much attention, although Duke's early silence certainly aroused suspicion. Was this so much different from the 80,000 other fatal medical errors one study claimed occur every year in the United States? Perhaps not, but it was a compelling story and it sold newspapers.

Late in the afternoon of the day Jésica received her second transplant, Duke held a press conference in a room packed with cameras and wiry journalists. Hospital reps paced about, handing out press releases and information on Duke's transplant programs. I sat in the back and waited. Mahoney and the Santilláns entered to a buzz and sat to my right. Medical Center news office head Jeff Molter introduced the keynote speakers, Hospital CEO Dr. William Fulkerson and surgeon Dr. Duane Davis, who stood at a well-lit podium with a royal blue DukeHealth backdrop.

Davis updated Jésica's condition: "As critical as a person can be." Fulkerson followed with the Hospital's then-fullest explanation of the tragedy, outlining what, to my knowledge, is still Duke's official story.

But before delving into Duke's explanation, we need to look at the normal procedures for a transplant match, and to examine the events of the night of Feb. 6--the details of which only became clear later.

All potential transplants first run through the United Network of Organ Sharing, the national database that matches available organs to possible recipients, tracking priority and ensuring compatibility of blood type. Late in the evening of Feb. 6, Duke's local transplant office, Carolina Donor Services, was alerted by UNOS to two potential matches at Duke for a newly available heart-lung set. Neither match was Jésica Santillán.

They contacted Duke with the offer, and were connected to transplant surgeon Dr. James Jaggers for the first possibility. He rejected the offer because the patient was not ready, but then, in the words of a Medical Center press release, "inquired as to whether the heart and lungs might be available for Jésica Santillán, specifying the patient by name."

CDS responded that it would check and call back. After a rejection for UNOS' second match, CDS offered the organs for Jésica. Jaggers confirmed a match for size, but incorrectly assumed that CDS must have ensured a blood match. Duke surgeons flew to Boston to procure the organs, returned and the heart and lungs were sewn into Jésica's body, eventually costing the girl her life.

During the press conference, Fulkerson pointed to two major errors made by Jaggers surrounding the Feb. 7 transplant: One was assuming a blood type match had been made when CDS offered the organs to him based on his request, and the other lay in failing to verbally confirm the blood type after procurement.

This account was commonly accepted and printed in almost every major news outlet. It also formed the basis for the explanation Duke gave to UNOS and other regulatory bodies, as well as for the Hospital's subsequent reform of its transplant procedures. Yet this explanation is logically flawed and entirely insufficient. Fulkerson was acknowledging two errors that stemmed from failing to check for a previous error, without admitting the existence of that previous error. Questionable, but the crowd bought it.

So what was the initial error? And why did Jaggers assume that a blood match had been made? The likely answer to the latter question is simple: Jaggers was presumably used to getting match offers that had been cleared through UNOS, whic takes care of blood type matches. But, as UNOS later confirmed, Jésica was never matched to the incompatible organs in their database--it was arranged solely between Jaggers and CDS.

As a UNOS spokesperson told me, this arrangement--the request to CDS and their complicity--represented a "significant error" on Jaggers' and CDS' part. It was one example, in her view, of the too-common practice of "organ shopping," in which surgeons and transplant offices go around UNOS for organ matches.

So according to the national organ database, it was Jaggers' inquiry to CDS for a possible transplant to Jésica that set the whole episode in motion. When CDS gave Jaggers the okay and he accepted, he assumed the blood type had been checked, because that was the usual procedure--but the case was not a usual one because of his initial violation.

This aspect of the Santillán case was almost universally downplayed. For example, in 60 Minutes' online transcription of its extensive coverage of the case, this central error is not mentioned until the 24th paragraph, and the only acknowledgment of it comes from CDS. Also, the Hospital's admissions imply a reluctance to reveal any occurrences of organ shopping. It's possible the Hospital's official explanation was designed to intentionally hide a practice it wished to continue. Although UNOS issued strongly-worded statements decrying organ shopping in February, it has recently revised that stance and is seeking to formulate guidelines for when it might be appropriate--an odd reaction.

The excited reporters certainly missed all this during the press conference's question-and-answer session. In fact, I was absolutely shocked by the questions from the press, all either grasping for scandals or reiterating details. One reporter guardedly suggested Duke must have rigged the transplant rolls to get the second organ set to Jésica, and then repeated the question three times, not liking any of the answers.

The scene turned grotesque once the Hospital brass were gone. Mahoney left the building, but the press wanted more. A frantic reporter ran up behind Mahoney and dragged him back, pushing him through a waiting group of reporters, each of whom joined the parade back to the cameras.

The swarm bottlenecked in front of the door leading to the big room, the mass halted suddenly by the reappearance of Molter, thrusting his arms forward like an overwhelmed traffic cop.

"I'm afraid you can't use this room, but you're free to conduct this interview elsewhere," Molter demurred. The growing mass of 60 or so was now chirping excitedly.

"They said we could use this room," one of the Oxford shirts lied.

"Who said that?"

"She did," the reporter said, pointing to no one in particular.

Still barring the door, but now looking confused, Molter whispered to one of his assistants and turned back. "Okay, let us take down the Duke background and I'll let you in." The horde let out a roar of approval and shuffled into the room.

Mahoney quickly let fly at the podium, again accusing Duke of trying to cover up the tragedy. "You can't hide behind a corporate veil when children's lives are at stake, and that's what happened here," he said in a croaking voice. Later I learned this was a remarkable departure from the conciliatory tone of the press conference he held that morning shortly after he learned of the second transplant.

Clearly displeased, Molter abruptly stepped in front of Mahoney a few minutes into the rant. "Okay, I think that's about enough for now..."

Ready to riot, the reporters began to yell like school children. "Hey, that little girl's just standing there. Why don't you let her talk?" cried a female reporter, pointing to Jésica's 12-year-old best friend.

"Yes, that's perfectly fine," Molter said, retreating.

The girl stepped to the podium and immediately began sobbing, as the press slowly lobbed up inane questions like, "How long did you know Jésica?" and "What did you like to shop for at the mall?" She kept crying and they kept asking questions, none of which had any connection to real news. The girl's mother was standing behind her, hands clasped at her stomach, smiling like her daughter was playing the tuba poorly. Molter slinked away, and I did too.

Jésica died shortly thereafter. Some newspapers began printing rumors that the Santillán family declined to allow Jésica's organs to be donated, eliciting indignant rage in various corners; meanwhile, others reported the family had been told by Hospital surgeons that Jésica's organs were useless because of her ordeal.

For two long weeks in mid-February, I had the illuminating experience of covering the case of Jésica Santillán, whose mismatched heart-lung transplant prompted a national press circus. I learned, to mild surprise, that journalists bear no resemblance to ashen-faced scholars straining for truth; they are chatterers and schmoozers. They flick cigarettes and create scenes.

The failures and biases of the national media have brought forth a great deal of well-deserved bile in recent years, but I think the most common complaint is off base. The media isn't biased toward liberalism; it's biased toward entertainment. We get more hurricanes, celebrities and hurricanes named after celebrities; exaggerated crime reports even as the crime rate plunges; exploding seatbelts and thrilling bombing campaigns; and political news increasingly centered on power and away from policy. Complexity is discarded in favor of anything that can compete with whatever's on the next station, accuracy be damned.

So for two weeks the national media descended on my town, on my beat, and I watched them spin a complex tragedy into the movie of the week. And frankly, I didn't do much better.

Mike Miller, Trinity '03, is a former health & science editor for The Chronicle.


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