The Johnson family was up before dawn on March 28, 2011. It was a momentous day.
Terrence Johnson was to receive a kidney from his wife, Gwendolyn, in a living donor transplant. She had passed all the rigorous medical tests, proving compatibility.
"He was so excited. He was jumping up and down," Gwendolyn Johnson, 46, said, describing her husband's jubilance about undergoing the operation at North Shore University Hospital in Manhasset, the same institution that rescued one of their daughters from a severe asthma attack years earlier. The Johnsons were convinced the transplant would add decades to Terrence Johnson's life.
Yet, as she spoke of her husband's joy, tears streamed down his face. He said their lives transformed irrevocably that morning.
The Johnsons, who live in Queens Village, say an unidentified fluid dripped from the operating room ceiling into the receptacle containing her freshly harvested kidney, an event that set off a flurry of recovery efforts. It is a charge vigorously denied by the hospital but corroborated by a surgeon's discharge report.
The hospital never reported a leak or drip to state health authorities. Public health law requires reports of therapeutic misadventures to be on file with the state Health Department. North Shore insists nothing happened.
But a leak did occur, according to the surgeon's report, over the so-called "back table," a standard prep space in transplant operations, and the organ was exposed in the basin where the fluid dripped.
The Johnsons contend the fluid contaminated the kidney, and efforts to rescue it delayed the transplant. North Shore was negligent, the Johnsons are arguing in a lawsuit filed in January, because the second-floor operating room was faulty. The hospital should foot the cost of all medical bills, they contend, and address their pain, suffering and lost wages.
Above all, they want to learn what type of contaminant could so easily damage an organ deemed robust by multiple physicians.
"We have no idea what the contaminant was, whether it was a chemical, sewage or some form of bacteria," Stephen Civardi, the Johnsons' Freeport lawyer said, noting the kidney was washed, flushed with antibiotics and studied microscopically, a grueling process that consumed hours.
As the hurried organ-rescue efforts were underway, the couple lay anesthetized in separate operating rooms, he said, oblivious to the activity spinning around them.
By the time Johnson received the kidney, it barely functioned. He not only remains in kidney failure, his wife now has just one kidney, Civardi said, and Johnson needs another transplant.
"The outcome has cast a pall over Mrs. Johnson's remarkable gift to her husband," Civardi added, "and frustrated all these tremendous forces of [surgical] talent and the ability of the transplant team to pull off a perfect result."
Hospital denies allegationNorth Shore executives are adamant that nothing untoward happened that morning. The condition of the ceilings in the hospital's surgical suites is sound, they say.
"In the six-year history of the hospital's Kidney Transplant Center, and continuing to the present, there has never been any incident of environmental contamination from any foreign liquid or material as is being alleged in this lawsuit," Terry Lynam, a North Shore vice president, said in a statement.
Yet, Dr. Ernesto Molmenti, director of North Shore University Hospital's kidney transplant program, stated in his discharge report that "a drop of fluid fell from the light on the ceiling of the operating room onto a basin where we were preparing the kidney."
He reported the kidney had to be "emergently" removed.
Despite his reference to the dripped fluid, Molmenti does not report its size, color or consistency and does not speculate on what it might be.
He has not returned Newsday's inquiries, requesting details about his report dictated on April 15, 2011.
Terrence Johnson, 45, said Molmenti and members of the transplant team told him about the fluid and the heroic efforts to save the kidney. The languid organ, once transplanted, led to an imbalance in his body's chemistry, forcing his admission to a critical care unit where he was immediately put on kidney dialysis, Johnson and his lawyer said.
"The transplant staff came in and said, 'Oh, we heard what happened and we're so sorry,' " Johnson said, who was confined to the unit for two weeks. "They said something fell on the kidney. My first question was: 'What do you mean, something fell on the kidney?' "
An incident report was not filed with the state Health Department, according to Lynam, because North Shore's environmental experts found no evidence supporting a leak. He noted that as part of an ongoing focus on patient safety, hospital personnel continually monitor the surgical suites.
"North Shore University Hospital assesses the environmental conditions in its operating rooms throughout the day," Lynam said. "In this case, an immediate inspection of the operating room revealed no evidence of water, condensation or other form of contamination.
"In all surgical procedures, including each of the approximately 150 transplants that have been performed at the hospital, all appropriate steps are taken to ensure the safety of all of our patients."
For the Johnsons, the possibilities initially promised by the transplant have devolved into an uncertain future.
"I call Terry my best friend and I told him, if I could do anything to keep him here, I would. I felt it was my duty to do it. I don't know what's going to happen now. I don't have another kidney to give," Gwendolyn Johnson said.
The Johnsons are fully insured through her administrative position at the Department of Justice in Manhattan. Terrence Johnson, formerly employed by the New York City subway system, has been unable to work for years. He thought the transplant would help provide his re-entry into the job force.
Married nearly 25 years, the couple met at church in Brooklyn 40 years ago as children. They have two daughters in their early 20s, and a son, 10.
"At first I didn't want her to do it," Johnson said, noting he feared for his wife's safety. But when doctors assured them of the double surgery's success rate, they decided to proceed.
"The bottom line," he said, "is that we really love each other."
Johnson was diagnosed with type 2 diabetes in 1998 but by 2010 was found to have end-stage kidney disease. He also has hypertension. Both conditions can irreparably damage the kidneys.
Experts: Transplant woes rareExperts in live-donor kidney transplants say problems are rare, but the risk for mistakes is not zero.
Advocacy organizations, such as the National Kidney Foundation, support live donations whenever possible because these kidneys tend to function more efficiently than those from a cadaver.
Moreover, patients who have a willing donor can sidestep the cadaver-kidney waiting list. The average time on the list in New York is five to seven years, which means many in the queue die waiting.
Johnson was never on the list because Gwendolyn agreed to be his donor.
Dr. Christie Thomas, who chairs the living donor committee for the United Network for Organ Sharing -- UNOS -- said steps in a living donor transplant are similar nationwide. UNOS is the nonprofit contracted by the federal government to oversee organ procurement and transplants nationwide.
The key emphasis in back-table procedures, said Thomas, a kidney transplant surgeon at the University of Iowa, is the expeditious preparation of the organ.
"Once the donor kidney is removed, typically, the recipient surgeon comes into the room and accepts the kidney; then there is some prep time in the donor's [operating] room to get the kidney ready for the recipient.
"The back-table operation is standard," Thomas added. "This is a little table on the side where the recipient surgeon sits and trims excess fat and flushes it with a solution and then walks it over to the recipient's [operating] room."
Despite standardized steps, mistakes can occur during a living donor transplant.
In Ohio, the kidney transplant program at the University of Toledo Medical Center was temporarily suspended for a while last year.
A healthy kidney in a live donor transplant was trashed by a nurse who mistook it for medical waste.
The problem occurred when nurses switched shifts shortly after the kidney was harvested. The incoming nurse didn't recognize the organ and flushed it down a "hopper."
The organ was being donated by Paul Fudacz, 21, to his sister, Sarah, 25.
The Fudacz family is suing the University of Toledo Medical Center, which is denying negligence.
Civardi, meanwhile, credits Johnson's surgeon for his honesty. "Had Mr. Johnson's surgeon not had the integrity to tell them what had happened, the truth never would have been known," Civardi said.
At the very least, he added, North Shore should pay for the couple's medical care, especially Terrence Johnson's because he is still under North Shore's care.