Heart transplant kid: Does a bad end mean a bad call?

“About a month ago, Anthony Stokes was a 15-year-old who enjoyed playing basketball.”

That sentence, the first in a story we wrote in August 2013, might have added: “and, according to police, playing truant, burglarizing houses, possessing guns and setting fires.”

Given Stokes’ age, that information would likely have been shielded by police. But what would have happened if it had come out?

Would Stokes' mother have succeeded in using the media to portray him as a regular kid falsely maligned? Would she have succeeded in pressuring Children's Healthcare of Atlanta at Egleston into giving him a heart transplant after initially refusing?

More importantly, should Stokes have been passed over in favor of a more upstanding candidate?

Last week, Stokes died trying to elude Roswell police. The 17-year-old, whose rap sheet by then encompassed at least 11 arrests in DeKalb County alone, had allegedly forced his way into an elderly woman's home and shot at her. He then stole another woman's car and struck a pedestrian before crashing into a SunTrust bank sign, stilling his donated heart forever.

Since then, social media and comment boards have exploded with invective at the hospital, the family and the media, accusing them of squandering a heart on someone who wasted it.

Medical ethicists see the issues raised by Stokes’ life and death as complex, not given to clear lines and pat answers. Despite many people’s natural, visceral reaction that the hospital was goaded into a poor decision, ethicists say it’s not the job of doctors to separate the morally worthy from the unworthy — even if they could.

They say issues like whether a patient will take good care of a transplanted organ are a legitimate part of the equation. With most patients, the question may encompass nothing more than whether they’ll take their meds; with some, who exhibit a tendency to risky behaviors, the questions get thornier and the lines more blurred.

Mark Pastin, president of Health Ethics Trust, based in Alexandria , Va., said doctors try hard to stick to the medical side of things. But he said economic, social and lifestyle issues sometimes creep in, even subconsciously — and that makes him nervous.

“We probably don’t want hospitals to be sitting in moral judgment of people,” Pastin said. “They are supposed to treat what’s medically necessary.”

What Children’s did, in the face of mounting pressure, he said, “was a good decision that turned out wrong.”

Living in fear

Tell that to Pamela Wiggins.

The morning of Saturday, Nov. 8, 2014, was a cold one. Wiggins walked out of her Decatur home to warm up her blue Chevy Silverado. Before she could get back into her living room, she saw her truck going down the street.

She called police, who quickly stopped the truck. Inside they found Stokes, who had been in possession of his new heart for more than a year, with two guns.

When Wiggins arrived on the scene, she asked if she could speak to Stokes, who was in the back seat of a police car.

“I go over to talk to him, and all of a sudden he goes ballistic. He was in the back seat, kicking and screaming and yelling,” she said. “He said, ‘I am gonna (expletive) you up.’”

According to the police report, as Wiggins walked away, Stokes gestured as if he had a gun and made gun noises.

Wiggins got her car back and went and bought a gun.

“All this time, I have been waiting for him to come back,” Wiggins said. “My life has been living in fear. Walking around carrying my gun. Waking up in the middle of the night when I hear a noise in the house. Walking out of my own door, looking both ways to make sure he is not outside hiding.”

When she saw the news of his death on TV, she felt relief.

“I hate to say this, but I am glad his reign of terror is over with,” Wiggins said. “I am a sad about all of the lives that he has impacted.”

Evidence, intuition or bias?

When hospital officials rejected Stokes for a heart transplant in 2013, they sent a letter to his family saying the decisions was based on his “having a history of non-compliance.”

That term can cover a lot of ground. Experts say it often means the patient has not followed doctors’ orders in the past – skipping medications or missing appointments, for instance.

But what about someone who just generally colors outside the lines, and who doesn’t have a strong social system to check their excesses? Is it fair to conclude that they will take poor care of any organ they’re given?

When Stokes fell ill, his mother, Melencia Hamilton, was raising three boys on her own. She was unemployed and suffered from congestive heart failure. She was on Medicaid, and Stokes was on PeachCare for Kids.

Stokes was wearing an ankle monitor. Hamilton told reporters it was for fighting at school. More recently, Mack Major, one of the family’s advocates, said he was told it was for smoking pot.

The AJC attempted to locate Hamilton for this story. A woman who answered the phone number listed for Stokes on a November 2014 police report declined to comment and hung up.

Hospitals are especially leery of transplant candidates who use illicit drugs, said Arthur Caplan, head of medical ethics at New York University’s Medical School. And if a person can’t pay, many centers will reject them.

“Doctors do make social decisions,” Caplan said. “Sometimes they are based on evidence. Sometimes they are based on intuition, and sometimes it’s just bias.”

“They may look at a poor black kid with an ankle bracelet and just say no,” he said.

Or, they may look at Apple founder Steve Jobs and decide he needs to be moved to the head of the liver transplant queue.

A different face

Even Wiggins saw glimpses of a different Anthony Stokes.

A few weeks after he stole her car, she coincidentally rode in an elevator with him on the day of his court appearance. Again, she tried to talk to him. She asked if he was the boy who stole her truck.

“He was like, ‘Yes ma’am.’ He was very respectful,” Wiggins said. “I get the impression that he is two different people. When I watched (an interview with Stokes on Channel 2 Action News), I said, ‘That is the person I met in the elevator. The kid I met in the car was the wannabe stick-up kid.’”

Wiggins wasn’t alone in her take on Stokes. Several people who dealt with him said he was able to “code switch” around adults and authority figures, presenting a persona they would find palatable.

Or maybe he had a sincere desire to become the person Wiggins saw in the elevator. Perhaps he had some sense of the end that awaited the blunt-smoking, gun-toting, pants-sagging gangsta portrayed in the numerous selfies he posted on Facebook over the past year.

Jonae Tate, who had known Stokes since their days at McNair Middle School, reconnected with him via social media after he was in the news. They dated for about four months.

“When I used to date Anthony, he wasn’t out stealing cars and breaking in houses. Or at least I didn’t know about it,” Tate said. “When I finally saw his pictures on Facebook, I was shocked. He never smoked weed around me. He never showed me a gun.”

Now, she is filled with sorrow and remorse. “Did he waste the heart? Yeah, I think he did.”

No questions asked

Sam Mosteller fought for Stokes to get the transplant.

“(The hospital) gave him a death sentence,” said Mosteller, who was then the state president of the Southern Christian Leadership Conference. “At the age of 14, I knew he needed a chance at life. If I had to do it all over again — knowing what I know now — I would do it again.”

What he knows now is very different from what he knew, or asked, then. He said that aside from hospital officials’ contention that Stokes would not be a suitable patient because they feared he would be “non-compliant,” the SCLC never delved into any of his problems.

“We didn’t have any idea of that at all. It wasn’t part of what (the family) asked us to do,” Mosteller said.

Mark Bell, head of the New Order Human Rights Organization, also came to the family’s aid without inquiring about Stokes’ history. “My mission was to save a life,” Bell said. “Everybody has a past. I did not want to jump in and be judgmental.”

In the cold light of present knowledge, Mosteller reaches this conclusion: “He may have been in too deep by the time we got to him.”

Seeking, rejecting help

In 2011, Stokes’ mother walked into Mack Major’s office and begged for help. Since 2006, Major, a Vietnam veteran, had run a mentoring program called Operation No Target for Police to Shoot.

“She signed the papers, but I didn’t see them anymore,” Major said.

Then, in 2013, with Stokes’ health deteriorating, Hamilton called again. Major visited Stokes several times at the hospital and several more at the Ronald McDonald House after his surgery.

Major said Stokes’ demeanor was generally respectful, although he had “to check him a few times.”

“I could work with him,” Major said. “But he had no positive influences in his life. No older males that could check him. All he really knew were the streets, rapping, video games, guns, gold around his neck and misery.”

Their relationship ended abruptly in November 2013, when Hamilton called to say that she wanted everybody to get out of her family’s life.

“I was shocked and hurt,” Major said, adding that Hamilton sent him a text more than a year later to apologize. But she never explained what happened and refused to invite him back.

Major didn’t know Stokes was dead until called by a reporter. After that call, he took a look at Stokes’ Facebook page.

“Words could not describe what I felt,” Major said. “Holding guns, and weed in his mouth. I felt so outdone … at 15 years old, he said he wanted to go to Yale, Purdue or Duke. I was impressed by him.”

A PR disaster

The institution at the center of the controversy has the least to say about it.

“We cannot provide any additional information about this tragic situation. We are deeply saddened by this loss,” Children’s Healthcare of Atlanta said Thursday in a prepared statement.

No one is likely to get a detailed explanation of why the hospital initially denied the transplant, or whether decision makers there knew why Stokes was wearing the ankle monitor.

What’s easier to surmise is why Children’s reversed course: It faced day-after-day news coverage in which civil rights advocates impugned it as racist.

“It’s a public relations disaster,” said Marian Meyers, a professor of communications at Georgia State University. “The media picks up on it, and then it gets to social media. So there’s an echo chamber. It’s the kind of a situation that no company, no hospital, wants to deal with.”

The quickest way to make the PR problem go away, Meyers said, was to give Stokes a new heart, which the hospital did within roughly two weeks. The average wait time is nine to 10 months.

Similarly, Pastin’s guess is that social factors — Stokes’ brushes with the law, the stresses on his family — were part of Children’s calculus. And when the case blew up in the media, those elements acquired a questionable smell.

If Stokes’ criminal record had become public at the time, Meyers said, the story might well have played out differently.

“It probably would have made a difference in how it was covered, and how people reacted to that coverage,” she said.

On the other hand, she said, news organizations might have hesitated to publish the information, for fear of seeming to embrace racist stereotypes.

Nothing good to say

All human decisions are based on expectations of how they will play out in the future. We make them based on past experience as well as the beliefs we hold, which may be either exalted or base. Few of our choices turn out exactly as we envision.

Similarly, in deciding who gets on transplant lists, doctors weigh current choices in the light of past experience. Some of their personal biases may creep in. In some cases, the outcome isn’t what they would have hoped.

Most people seem to feel that the doctors who treated Anthony Stokes made a bad call in response to public pressure. Pastin, of Health Ethics Trust, said those people have an advantage the doctors lacked: hindsight.

“You can’t look into a crystal ball when deciding to treat him,” he said.

Now, amid all the raging opinions, one thing is certain, he said: “There’s nothing good to say about a case that turns out this way.”