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A Day at the Circus

(07/23/03 4:00am)

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.

Colleagues commend CEO's tenure

(03/05/03 5:00am)

Outgoing Chancellor for Health Affairs Dr. Ralph Snyderman taught Dr. Sandy Williams more than just the complexities of medical leadership--he also taught the medical school dean how to fish. Williams reminisced about a trip to Canada last summer in which the pair fished for Northern pike, demonstrating the personal side to his 30-year relationship with Snyderman, Duke's health care impresario who will leave his position in June 2004.

Santillán's condition still critical

(02/20/03 5:00am)

ONLINE UPDATE (4:30 p.m.): Following a second heart-lung transplant performed early Thursday at Duke Hospital, 17-year-old Jésica Santillán is off life support and being given a fighting chance. Although doctors said it is too soon to fully judge Jésica's condition, the operation went smoothly and her heart and lungs are functioning on their own. This most recent surgery became necessary after Duke surgeons completed an initial transplant Feb. 7 with organs of the wrong blood type--an error the Hospital is acknowledging. ONLINE UPDATE (9 a.m.): Jésica Santillán is in surgery and will likely be out between 10:30-11 a.m. Dr. James Jaggers is performing the surgery. More information will be posted as it is known. Jésica Santillán remained in critical condition late Wednesday, as further details surfaced surrounding Duke University Hospital's mistaken Feb. 7 transplant of a heart and lungs of the incorrect blood type into the 17-year-old girl. In rapidly declining health and suffering from failing kidneys, Jésica - who had waited three years for the needed organs - is not expected to live more than a few days, unless a new set of donated organs can be found in time. Associate Professor of Surgery Dr. James Jaggers, who performed the operation on Jésica, said Wednesday he mistakenly assumed a blood-type match had been completed. "I am heartbroken about what happened to Jésica.... Early in the morning of Feb. 7, I received a call from Carolina Donor Services and was informed of available organs," Jaggers said in a Wednesday statement. "I assumed that after providing Jésica's name to the organ procurement organization and after the organs were released to me for Jésica, that the organs were compatible.... "I continue to oversee Jésica's care and have been devastated by this tragic event," Jaggers continued in the release. "I informed Jésica's parents immediately after the operation that an error had been made and that the organs were blood type-A and Jésica was blood type-O and that this was an incompatible transplant." The Santillán family and family friend Mack Mahoney, who paid for the operation, have made the tragedy national news in hopes of attracting a "direct donation" to Jésica of a suitable heart and lungs. Meanwhile, Duke has 45 days to submit a thorough review of its transplantation procedures and an analysis of how the mistake occurred to the Joint Commission on Accreditation of Healthcare Organizations, the national evaluation and accreditation association for health care institutions. "We classify [the blood-type mismatch] as a 'sentinel event,'" said JCAHO spokesperson Mark Forstneger, which he defined as an unexpected occurrence involving death or serious injury. "Any time a sentinel event occurs at a JCAHO organization, the organization is required to conduct a thorough 'root cause analysis.' They have to look at the roots of their system, where the system failed and determine what changes need to be made." Since the mistake, the Hospital has reconfigured some of its transplantation procedures by mandating multiple confirmations of blood-type matching by the patient care team, instead of a single confirmation by the surgeon performing the operation. "As a result of this tragic event, it is clear to us at Duke that we need to have more robust processes internally and a better understanding of the responsibilities of all partners involved in the organ procurement process," Hospital Chief Executive Officer Dr. William Fulkerson said in the Wednesday statement. Mahoney, who has medical power of attorney for the girl because her parents do not speak English, has accused Duke officials of trying to stop the family from speaking to the press about the incident and of attempting to limit Mahoney's access to Jésica, against the wishes of her parents. The pressure stopped when Sen. Elizabeth Dole, Woman's College '57, offered assistance to Mahoney, he says. Since then, Mahoney and the family have hired a Greenville, N.C., lawyer. Hospital representatives are not responding to the charges. Officials at the United Network for Organ Sharing said the botched transplant was only the second such error in the last 15 years in addition to one other non-matching organ that was delivered but not transplanted. Pointing fault for the error solely at Duke, both the New England Organ Bank, the source of the donated organs, and Carolina Donor Services, the regional transplant office that notified Duke of the organs' availability, are insisting the mistake did not originate with them. NEOB originally notified CDS that the type-A organs were potential matches for two Duke Hospital patients, who were both rejected as recipients for reasons other than blood type. According to a CDS statement, a Duke surgeon then requested to use the organs for a third patient - Jésica Santillán, who has O-positive blood type. "Carolina Donor Services was informed that Duke suspected an incompatible blood match only after the transplant took place," the statement reads. The Duke surgeons who flew into Boston to remove the heart and lungs from the donor were told of the organs' blood type twice, once when Duke made the request for the organs, and again before the surgery removing them, the NEOB said. Fulkerson publicly admitted the Hospital erred in a Monday press release. "This was a tragic error, and we accept responsibility for our part," Fulkerson said in the release. "This is an especially sad situation since we intended this operation to save the life of a girl whose prognosis was grave." Hospital administrators declined to elaborate further on how the multiple errors occurred until an internal investigation is completed. Fulkerson has indicated Duke has no intention of stopping its transplant programs, many of which are among the largest in the country.