July 18, 2012
In Native American culture there is a premise that Nature thrives on order but it is man who creates the disorder. That thought came to mind last month when I presented yet another malpractice case for review with a panel of colleagues. A patient wanted to be induced at 39 weeks and inevitably had significant complications with a poor birth outcome. In my expert opinion, I suggested that the physician should have waited until the patient was 41 weeks before she attempted an induction and one of my colleagues thought that I was vehemently wrong. “She was full-term and entitled to an induction” he practically shouted in my ear. “That’s not the point,” I countered. There was no reason to do the induction except for physician and maternal convenience. I reminded him that most high-risks specialists will start fetal monitoring and nonstress tests (NSTs) at 40 weeks to document fetal well being and then induce labor at 41 weeks if it has not started spontaneously.
At 39 weeks, the cervix is usually thick which means it has to be softened with medication before Pitocin (the medicine that starts contractions) can be given. Anytime an induction goes beyond 48 hours, there is a strong possibility that it will end in a C-section. At 41 weeks, the cervix is usually soft and if an induction must be started, it has a much greater success rate for a vaginal delivery.
Very few physicians will allow a patient to deliver beyond 42 weeks because the baby gets too big and the placenta becomes old. An “old” placenta, aka “grade 3” means the baby could possibly receive inadequate oxygen and inevitably there will be meconium which is an internal bowel movement that sometimes indicates fetal distress.
According to the Bloomberg News, “Aetna has renegotiated maternity payments with 10 hospitals around the country so far, bringing rates for cesareans and vaginal births closer together.” This will inevitably decrease my colleagues’ checking accounts but please do not look for sympathy from me. The standards of medical care were written for a reason. Performing inductions of labor for the sake of “convenience” is certainly not one of them.
June 18, 2012
A few years ago, a 20-something year old pregnant woman presented to her physician with complaints of a skin bump that was red and painful. She was told it was a spider bit and given antibiotics. The patient ultimately went in labor but required an emergency cesarean which went well without any complications. Four days later she developed skin lesions and 3 months later she expired after a very stormy hospital course. What did she die of? MRSA, which stands for Methicillin Resistant Staph Aureus.
Staph Aureus (Staph) is a bacteria that can be found on the skin and doesn’t usually cause problems as long as there are no breaks or cuts in the skin. However, if there are cuts and Staph gains entry into the skin, an infection can develop that if often not serious. However, Staph has a very dangerous form that is resistant to the medications that will normally treat it. The resistant form of Staph can cause havoc if unrecognized which can lead to several complications including death. In fact, 20% of people who have (MRSA) dies from this infection because the diagnosis is made too late. One of the most common complaints patients have when there is a MRSA infection is a bump or red lesion on the skin that is misdiagnosed as a spider bite. How do you avoid the misdiagnosis? By knowing who is at risk and what to look for.
MRSA tends to be found in places where there are many people living close to each other such as nursing homes, but of late, several cases are also associated with
- People who are either in a prison or an athletic facility.
- Athletes who share towels or razors
People who either work in prisons or visit relatives or friends incarcerated should always wash their hands after a visit.
If you are given a diagnosis of a “spider bite,” request that it be cultured, meaning a Q-tip is used to take a sample from the bump. Sometimes people can have the infection without having any symptoms. This is known as being a “carrier.” Again, if you are given the diagnosis of having a spider bite, ask that a culture be obtained from inside of your nose to make certain you don’t have MRSA.
MRSA can be treated appropriately with the right antibiotics. Medicines that are associated with Penicillin such as Amoxicillin and cephaplosporins will not work.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
May 28, 2012
As a young girl growing up in a small Long Island town called Amityville, Memorial Day was a huge holiday filled with parades and barbeques. I would inevitably end up at my friend Diane’s backyard eating a hotdog along with the rest of the kids on our block. It was also a day when we made our annual trip to the cemetery to place American flags on the graves of veterans and flowers on the graves of the deceased. Well, today, in honor of both Memorial Day and Preeclampsia Awareness Week, I’d like to take time to remember all mothers and their babies who died during childbirth, especially from preeclampsia.
What is preeclampsia and why is it so deadly? Preeclampsia is a condition of pregnancy in which there is high blood pressure; swelling of the ankles, feet, or face; protein in the urine; and abnormal kidney function. This condition requires the delivery of the baby in order to preserve the mother’s life and prevent seizures and strokes. The old fashioned term for preeclampsia was toxemia and it affects 1 out of 12 pregnancies each year. Approximately 76,000 women die annually from this disease and most people know of at least someone that it has affected during pregnancy.
When I think about preeclampsia, a woman name Dawn Fleming comes to mind. Dawn was 31 years old, a member of my sorority, Delta Sigma Theta and a popular radio personality in Orlando. Although I did not know her personally, she was from my former hometown of Queens. She was gregarious, a community activist who died unexpectedly from a preeclampsia related stroke. She had recently married and delivered a baby girl 6 days before her untimely birth. Her daughter is now approximately 8 years old and will never know her mother. When I attended Dawn’s wake, I was both angry and sad. I suspected someone had inevitably missed the diagnosis and by the time she was given treatment, it was too late. Such is the case of the vast majority of preeclampsia victims. By the time a diagnosis is made, the damage is already done. In her book, You Have No Idea, celebrity Vanessa Williams and her mother, Helen, discusses preeclampsia as the reason for her paternal grandmother’s death.
In my next blog, I will describe the signs, symptoms and treatment for preeclampsia that is also described in The Smart Mother’s Guide to a Better Pregnancy. But in the meantime, I urge all of us to take a few moments to remember all the moms and babies who are no longer with us and pray that a cure for preeclampsia will one day be found.
December 28, 2011
It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.
Snyder accompanied his wife to the hospital and witnessed the birth of his babies. Then Friedman began to bleed. And bleed. And bleed. At 9:30 p.m., she became yet another U.S. maternal mortality statistic.
At least 2 women die from complications of childbirth in the US daily. Some celebrities such as Christy Turlington Burns have become a Maternal Health Advocate as a result of first-hand experience. She had a near-miss childbirth experience but lived to tell the story. Many women, including Friedman, don’t. The American Congress and College of Obstetrician-Gynecologists (ACOG), will have both Burns and Tonya Lewis Lee, the wife of renowned director, Spike Lee as spokeswomen on the topic of maternal mortality at the 2012 Annual Conference in San Diego. However, we need much more. There are obstetricians who have worked on the front-lines managing high-risk patients for years who can’t get a seat on ACOG’s policy committees and it is frustrating. Here are a few questions that should be asked at the hospital where Friedman expired:
- She had a short stature with a uterus stretched to the max with two babies. Was the possibility of hemorrhage considered?
- When her blood pressure became elevated, was it controlled prior to doing the C. Section knowing the risk of possible HELPP Syndrome that is associated with pre-eclampsia?
- Was there an OB Rapid Response Team?
- Was a Bakri balloon used once the bleeding couldn’t be controlled with uterine massage or meds?
- Was the prospect of a problem anticipated BEFORE it occurred or was there chaos trying to find appropriate meds and equipment as the tragedy unfolded?
Pregnancy is not a benign act contrary to what most people believe. Things can and do happen, most often when the hospital staff is unprepared and ill-equipped to handle an emergency. My heart bleeds for Jay Snyder. He is 41 years old, a new father and now a widow who must take care of two beautiful children, who will never know their mother. With all due respect ACOG, talk is cheap. More action must be taken to stop this.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do…
December 26, 2011
Vernessa Richard is expecting her first child, but it will never meet its grandfather. On September 10, 2001, Lieutenant Vernon Richards was informed that he would be promoted to Captain of New York City Engine Company 16, Ladder Company 7 in New York City. Vernon had worked hard for that promotion and was delighted. It was an extraordinary feat for a Brooklyn native who had grown up in a New York City housing project. I should know. I grew up in that same housing project and defied all odds to become a physician. Vernon married his childhood sweetheart Dorothy, after he completed his military tour and from that union emerged Vernessa and Vernon Jr. On September 11, 2001, the world changed forever. Vernon and 10 firemen from his station entered the World Trade Center in New York City and never returned. Three months later, there was a memorial service in his honor and three years later an official funeral.
For years the Richard family had attempted to commemorate Vernon’s accomplishments and achievements in the form of a permanent memorial but to no avail. People who they thought would be supportive weren’t. They put their dream on hold until a reunion of present and former residents resurrected it. “What if” conversations emerged. “What if there was a school in our neighborhood named after Vernon? The question ignited a passion and a movement was born. The children and young adults of our Brooklyn community deserve to be inspired by the late Captain Richard’s accomplishments. They need to know that a hero walked among us. A momentum has begun despite bureaucratic challenges. We must obtain the permission of several high level officials including the New York City Chancellor. We are also faced with a deadline of less than 2 weeks to demonstrate the need and desire for the school’s name change. We need your help and so does Vernon’s unborn grandchild. We would appreciate you signing and circulating a petition in support of the school’s name change. Here is the link: http://www.change.org/petitions/chancellor-d-walcott-school-name-change#comment-1670791
The Captain Vernon Richard Academy can become a reality with your help.
October 5, 2011
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession. Loni Hildebrandt was a 29 year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and her boyfriend saved their money and obtained fertility treatments. Her mother, Jo Novtny, a nurse of 30 years was ecstatic when she saw the ultrasound of her two grandbabies but her happiness was short-lived. One day after the procedure, Hildebrandt began to bleed so they went to Sarasota Memorial Hospital in Florida.
Sarasota Memorial Hospital has an excellent maternal fetal medicine (aka high-risk obstetrics) department but Hildebrandt never made it there. She got as far as the hospital’s emergency room where she was attended to by one of its physicians. Despite repeated requests to have her blood sugar checked, Hidebrandt had to wait six hours before it was done. An ultrasound at the hospital revealed a blood clot that was causing the contractions and the ER doctor told her that he could probably save one by “suctioning the clot so the labor would stop.” According to The Herald Tribune, the physician suctioned the clot and one of the twins as well. Hildebrandt allegedly began bleeding more, passing bright red blood clots. They called for help but no one came. According to the newspaper report, a nurse put the afterbirth in a bedpan and left it near Hildebrandt’s head where she was lying. Her mother moved it and placed it under her daughter’s bed. Novtny ultimately delivered the second twin because no one else was around. The ER doctor returned to the room saw the fetus in Novotny’s hand took it from her and put it in a bucket.
Novtny states her daughter did not receive proper treatment until her personal physician arrived and remained in a pool of blood for over 10 hours. Hildebrandt’s iron count was dangerously low because of the bleeding. Her mother’s request to speak with the hospital administrator was met with no response so she wrote a letter to the governor instead. An investigation was done, gross negligence was found, the ER doctor resigned and Hildenbrandt’s nurse was cited for “lack of critical thinking skills.” The hospital will now have unannounced federal inspections in order to keep their Medicare payments. The hospital administrator issued a public apology.
Perhaps one day hospitals will do the right thing, even when no one is watching. Hopefully, Hildebrandt will become pregnant again and have a better outcome.
September 26, 2011
Three young mothers under the age of 40 are dead because they wanted to be beautiful. Kellee Lee-Howard wanted a slimmer body. Ditto Maria Shortall and Rohie Kah-Orukatan. Shortall worked as a housekeeper; Lee-Howard was the mother of six kids and Kah-Orukotan died at the same place where she received manicures. What do these women have in common besides being minorities? They had liposuction procedures performed by men who offered a discounted price for an elective surgical procedure. These men professed to be competent in performing the procedures but never had accredited training.
I knew this day was coming. I saw the storm long before the clouds emerged. As the insurance payments for professional medical services decreased and declined, physicians began to look for alternative ways to earn money. But was it ethical? Gynecologists began to do liposuctions. General surgeons did breast augmentations. Some primary care physicians abandoned seeing patients altogether and opted to do chemical peels and weight loss treatments. Medical spas were added to traditional medical practices. Everyone wanted to cash in on a woman’s desire to be beautiful. Physicians were now business owners and entrepreneurs. However, could they attend a weekend seminar and returns to their offices on Monday ready to do the procedures? Were they really as competent as a plastic surgeon who had five years of training?
Jayne O’Donnell recently published an expose about these doctors in USA Today entitled Lack of Training in Cosmetic Surgery Can Be Deadly. It reads like a litany of horror. The physician who performed Kah-Orukotan’s liposuction was an Occupational Health physician. He didn’t have the proper equipment in his office nor was the procedure approved for office surgery. Shortall and Lee-Howard’s physician did an internship in pediatrics, another internship and residency in general surgery but never got board certified in the 27 years that he has practiced medicine. Had these ladies accessed the Florida Board of Medicine website and looked up their physician, they would have noted the $350,000 settlement in 2004. They would have also noted the absence of board certification, the absence of plastic surgical training and the absence of privileges to admit to a hospital.
All three women died from complications of anesthesia. They had received too much lidocaine which is a numbing medicine given by injection prior to a surgical procedure. Too much lidocaine can also stop the heart. These deaths should have never happened.
In Part 2 of this blog, you will learn what can be done to avoid becoming a victim of a preventable medical mistake. The life you save could be your own.
May 9, 2011
There are two types of physicians who practice medicine: those who choose medicine as a career and those who medicine chooses to serve. When you are called to serve, your relationship with patients extends beyond a 15 minute boundary. Such was the case of my relationship with my patient, Adriana Echeverri Tucker.
Adriana was 38 years old when she first entered my office both happy and anxious about her first pregnancy. If Adriana had medical insurance, I might not have met her. She was married to a U.S. citizen but had to wait the prescriptive time period for her green card so she was not eligible for state-funded insurance and her husband was self-employed.
Adriana was a dog trainer by trade and originally from Colombia, South America. Her ambition and entrepreneurial spirit was contagious and admirable. She was also a perfectionist and because we shared the same birth month, I intuitively understood her fears and concerns about this first pregnancy. I would see Adriana even without an appointment on days when her anxiety got the best of her. She was an older woman who had conceived without the benefit of In Vitro Fertilization and I, who was childless at that time, knew her pregnancy was a precious gift. She ultimately delivered a beautiful baby boy, who she named Martin. When she brought Martin to Colombia to see her family, she brought me back a gift that remained on my desk for years.
I eventually lost contact with Adriana until this past Friday night when I flipped through my local newspaper and saw her name in the obituary section. At first I wasn’t sure if it was the same person until I read the part about her being a dog trainer. A was a memorial service scheduled for the next day.
The parking lot was completely filled and there must have been over 100 people in attendance. When the pastor asked if anyone else wanted to make a comment, I was given a microphone and tearfully stated how fitting that her memorial service was held on the day before Mother’s Day because she was such a proud mother. Through the testimonies I learned that Adriana was a volunteer COP in her community. She organized a movie night once a month in her church. She became a U.S. in 2009 and her 7-year-old son, Martin, was thriving. I also learned that Adriana had late-stage cancer that was only recently diagnosed 2 months prior to her untimely death that occurred in Colombia, one day after she returned to the country of her birth.
Her service ended by the release of purple balloons in the parking lot symbolically returning her spirit back to God. Her life was abbreviated but purposeful. I am proud to have been her physician and equally proud to call her my friend.
January 11, 2010
Just when I think that I’ve seen and heard it all, I read yet another bizarre story that proves me wrong. Last month CNN reported a story about a woman who had attempted to end her rival’s pregnancy Woman Tried to End Rival’s Pregnancy, Prosecutor Say in a most deceptive way.
Kisha Jones was arrested for allegedly tricking Monique Hunter, her husband’s pregnant lover into taking an abortion-inducing drug. Jones allegedly forged a physician’s prescription and prescribed a medication that would induce early labor. She told the pharmacist that the medicine was for “a procedure.” She then called Hunter and convinced her that her physician had prescribed an important medication and she should pick it up and take immediately. Hunter complied. Shortly thereafter, she was soon rushed to the hospital and delivered a premature baby boy two months early.
While Hunter’s baby was still in the intensive care unit, an unknown man brought what he claimed to be breast milk for the baby and it was later determined to be poison. The hospital staff called the police and Jones was arrested on a host of charges including criminal impersonation. The facts of this case suggest that either Jones was familiar with labor inducing medications or knew someone who was. The “abortion-inducing drug” referred to by CNN was probably Mifepristone.
Mifepristone is a medication that’s used for early first-trimester abortions and to induce labor with fetal demises. Since its inception back in the late ‘80’s, I have disagreed with it being prescribed as an outpatient medication. Any medicine that causes bleeding and the evacuation of the uterus should be done in a controlled environment under the supervision of medical staff to avoid complications. Unfortunately, the FDA has reported several deaths of women who had taken this medication at home.
While this story has all of the makings of daytime drama, the bigger tragedy is that an innocent newborn was almost killed. I think the FDA should reexamine its policy regarding Mifepristone. People like Kisha Jones should never be allowed to strike again.