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 11, 2011
At one time, a hospital would be called a 24-hour institution but now it’s a business. Within this business are shift workers that include nurses, technicians, clerical staff and even hospital employed doctors who are now called hospitalists. In a teaching hospital resident physicians also work in shifts so the responsibility of patient care is always being transferred from one group of healthcare providers to another. Do they always communicate effectively? Regrettably, “no.”
Sign-outs, handoffs, shift changes, nurses’ report. These are the multiple names for the process where a departing provider is responsible for letting the arriving provider know what’s going on with the patient. According to statistics, 80% of medical mistakes occur during shift changes and 50 to 60% of them are preventable. Listed below is an excerpt from The Smart Mother’s Guide to a Better Pregnancy that teaches pregnant moms what things should be known during a shift change.
“While in labor, there will most likely be a change of shift and a transfer of information should occur. However, it is not always successful. Information is sometimes lost, incomplete, misunderstood or inaccurate. Your doula or a family member should make a list of all tests that have been ordered since your admission. He or she should also know your most recent vital signs, including your blood pressure and whether your baby’s fetal tracing was reassuring. Other important include:
- The length of time since your membranes ruptured: the longer your membranes have been ruptured, the greater your chances of developing an infection in the amniotic sac around the baby called Chorioamnionitis
- A positive group B strep that must be treated with antibiotics to prevent your baby from contracting the infection
- The length of time you have been receiving Pitocin. The status of your fetal tracing should be noted to make certain that the baby can tolerate the contractions caused by Pitocin.
- Any other significant clinical issue that might have been discussed that could adversely affect your labor
Before the end of a shift, your family member or doula might ask the departing nurse or provider to review his or her notes regarding your care and ask “Is this correct?” When the new shift takes over, your doula or family member would show them the notes and ask whether they received the same information that was verified by the previous shift.
The path to a successful delivery becomes much straighter when everyone marches in the same direction. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
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.
March 30, 2011
I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will only receive a maximum of $250,000 in a medical malpractice lawsuit. This is definitely a “lose-lose” situation for patients.
Managed care is bad news for pregnant women. Extremely bad news. Every ultrasound, lab test and hospital admission that your physician or midwife orders on your behalf will have to be pre-approved by a gatekeeper who is on a mission to increase the profits of their company by reducing the amount of money that is spent on you. So you must therefore be on a mission to keep both you and your unborn baby out of harm’s way. How do you do that? Here are a few suggestions that are taken from The Smart Mothers Guide to a Better Pregnancy:
- Research your prospective healthcare provider through your State Board of Medicine’s licensing department to make certain they do not have any 7-figure malpractice suits settled or pending
- If you’ve had a previous high-risk pregnancy, request a referral to a Maternal Fetal Medicine high-risk specialist for your prenatal care
- If you delivered a preterm baby in the past, chances are likely you will do it again. Ask to have your cervix measured when you have an ultrasound and if it’s short , request a referral to a high-risk specialist
- If you have vaginal bleeding and are pregnant, do not leave a doctor’s office or an emergency room without someone doing an ultrasound to confirm that (a) the fetus is alive and (b) the pregnancy is not in the fallopian tubes (aka) ectopic pregnancy. An undiagnosed ectopic pregnancy could rupture and cause havoc.
- If you complain of a vaginal discharge, do not leave your healthcare provider until someone gives you a diagnosis and treatment. Untreated vaginal infections can lead to preterm labor. Bacteria is not your friend when you’re pregnant
- Back and lower abdominal pain should not be ignored, especially if you are less than 36 weeks. It could represent signs of premature labor
- Become familiar with fetal tracings. Flat lines and “u-shaped” curves during labor could mean your baby is in trouble and needs to be delivered quickly
- Try to deliver in a hospital that has a level 3 nursery and/or a NICU (neonatal intensive care unit)
- If a hospital mistreats you, contact its administrator. If you’re still not satisfied, file a complaint with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) http://www.jointcommission.org/
- Trust your instincts. I can’t emphasize this enough.
Prevention is the key to reducing medical injury, not taking away someone’s right to sue.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do. Check out the video below for my information and pick up a copy of The Smart Mother’s Guide
March 9, 2011
Did you ever love something or someone so much that you had to walk away because it hurt too much to stay? That’s how I feel about medicine. From the moment I saw my first delivery, I was hooked and there was no turning back. Perhaps I’m highly offended at our present state of affairs because I had to work so hard to gain acceptance into med school. I spent countless nights in the library at Columbia School of Physicians and Surgeons studying for the MCATs. Endured physiology, histology, biochemistry, gross anatomy (included the dreaded head and neck) and microbiology so that I could eventually diagnose clinical problems. I walked through the fire of residency training and came out whole on the other side. Yet, despite all of these humble achievements, I couldn’t see the destruction of healthcare coming. And neither did many of my colleagues. However, instead of banning together to save our profession, some of us allowed ourselves to be fiscally co-opted giving rise to the birth of “volume oriented medicine.”
Healthcare is now a business and quality of patient care has flown out the window. Billable procedures with diagnostic codes are the order of the day. “Productivity” is a buzz word, a euphemism for volume. The insurance companies are paying less, yet the healthcare providers are expected to do more. The number of patients on schedules increases and it has become “normal” for some of my colleagues to see 48 pregnant women in a day. A former medical director decided that he wanted to increase “productivity” even more so he paid physicians on a per-patient-basis and of course, his theory worked. When one of his cronies had 80 pregnant women scheduled in 5 minute intervals for one day, I had seen enough. I wrote a letter of complaint to the Florida Board of Medicine and was informed that there was no law that prohibited the number of patients a healthcare provider could see in a day. I then contacted the American College of Obstetrician-Gynecologists (ACOG) and they too, had no protocol or rule about volume. So, it was the wild, wild, west regarding patient care. No rules. No boundaries. And certainly no patient protection. Regime changes occurred, but the “numbers” game continued. I had had enough. So after 15 years of attempting to administer quality care in the midst of chaos and strife, I have tendered my resignation. There is nothing more that I can do except put it in the hands of God.
February 2, 2011
When our country starts closing obstetrical units in hospitals because they “cost too much” money to operate, pregnant women need to start running for cover and their babies are in serious trouble. Such was the case of the most recent casualty, South Seminole Hospital, a 200-bed hospital, that’s located within 30 minutes of my neighborhood.
More than 20,000 babies were born in South Seminole Hospital during the past 18 years and many of the babies were delivered by a local obstetrician who died approximately three years ago. I recall sitting in the emergency room of the hospital with a fractured ankle and listening to a chime that used to ring every time a baby was born. It was a soothing and humbling sound knowing that a new life was making its grand entrance each time that chime rang. Now, it will be replaced with silence.
Unfortunately, this phenomenon is not unique to Florida. In 1997 the closing of a North Philadelphia hospital (Northeastern) affected six additional hospitals in the community and their 23,570 annual births. In my hometown of Brooklyn, New York, Long Island Hospital had an annual delivery rate of 2,800 babies but still closed its doors to the community and sold the hospital as prime real estate to the highest bidder citing low reimbursement rates and high premiums for malpractice insurance as the culprit behind the decision. The Bedford Stuyvesant community of Brooklyn, New York lost St. Mary’s Hospital, a delivery center of thousands of babies in 2005.
Not only are hospital maternity units affected by money but by politics as well. How many times have I witnessed the closure of a hospital maternity unit because a “premier” ob-gyn group acted like spoiled brats when they didn’t get their proverbial way and took their patients en masse to a competitor hospital? A hospital might have hired a hospitalist group to deliver uninsured patients and the local ob-gyn physicians were annoyed because they weren’t “included in the decision-making process?” Or a popular ob-gyn physician is chastised by a head nurse for missing a delivery or having a preventable error and vows never to return to the hospital.
As pregnancy continues to be deemed a pre-existing condition with low reimbursement rates and high malpractice premiums, the disappearance of maternity wards will continue. If you live in a community where this phenomenon has occurred, I strongly encourage you to seek prenatal care at a teaching hospital where there are attending and resident physicians trained to manage low-risk and high-risk prenatal problems.
Remember a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
July 26, 2010
When you’re constantly fighting for people to do the right thing, something is terribly wrong. One of my best friends called the other day in a state of despondency. Her patients needed to have a C. Section and the anesthesiologist was acting like a jerk. The patient had two previous successful VBACs but this time had a placenta previa which meant the placenta was covering the opening to the womb . A vaginal delivery was impossible. The patient was 38 weeks and my friend instinctively felt that she needed to be delivered. Gratefully, she wasn’t bleeding.
The anesthesiologist refused to give the patient an epidural, citing her “high-risk” status and was also rude in the process. He felt the main hospital operating room was a more appropriate arena for the delivery as opposed to the labor and delivery suite. My friend had had problems with this physician before. He would play the “dumping” game using any excuse to postpone performing a case until the next shift took over. My friend was not about to play Russian-Roulette with the patient’s baby and refused to send her home. “What should I do?” she asked in frustration. “I’m trying not to lose my composure and I’m not in the mood to fight.”
My friend needed encouragement. I reminded her that she was a brilliant physician whose calling was to heal women and save babies. I suggested that she get the hospital’s administrator and ob-gyn chairman involved to deal with the anesthesiologist directly and document on the patient’s chart why she was unable to deliver the baby. Above all, she must trust her instincts.
The high-risk specialist agreed with my friend’s assessment and wrote a note on the chart as well. My friend shared her dilemma with the nurse-in-charge who then took control of the situation and forced the hand of the anesthesiologist.
The baby was ultimately delivered and had a low APGAR score at one minute although there was nothing on the fetal tracing to suggest why. Had my friend not intervened, the baby could have possibly died.
My friend scored a moral victory with this delivery. But what will happen the next time?
October 14, 2009
Stephanie Saul’s New York Times’ article, The Gift of Life, and Its Price, affected me on a personal level. As an obstetrician and a victim of infertility, I am well versed with the inherent risks of IVF. Saul describes the exorbitant costs of fertility treatments and the increased complications of multiple births. We are still recovering from the aftermath of Nayda Suleman’s controversial delivery. It’s miraculous that neither Suleman nor her eight babies died.
In Saul’s article, we follow the Mastera family who conceived twins through in Vitro Fertilization after four failed attempts using artificial insemination. The twins subsequently delivered prematurely at 32 weeks and were in the neonatal intensive care unit for approximately 51 days at a cost of $1.2 million dollars. The average cost of an IVF cycle ranges from $12,000 to $25,000. Is there any wonder why there is a low compliance to follow the prescribed guidelines and attempt conception with just one embryo when the chances of a live birth are improved with two? Unfortunately, the greater the number of embryos, the greater the risk of preterm deliveries, therefore having a twin pregnancy is not a benign act. Even WITHOUT the benefit of IVF, a twin pregnancy is a high risk condition.
Twins are notorious for delivering prematurely, have an increased risk of the placenta separating too soon, increase the mother’s chances of developing hypertension and 30% end up in the NICU. Twin pregnancies should be managed by high-risk obstetricians (aka maternal fetal specialists), yet I am amazed at how many of my OB colleagues attempt to manage these pregnancies alone.
Coping with infertility is an emotional roller coaster, a ride I know all too well. In the end, my husband and I chose adoption and are the proud parents of two rambunctious little boys.
For those who are considering IVF, less is sometimes better than more. Should you opt to use more than one embryo and successfully conceive, PLEASE place your pregnancy in the hands of a skilled maternal fetal medicine specialist. I promise you won’t regret it.
August 18, 2009
Yesterday was my birthday, but I wasn’t in the mood to celebrate. The deeper I get into the fifth decade of my life, the more reflective I become.
My cousin, Pearl (“Paulie”) Ford Colon left us on August 8th and to say that I’m devastated is an understatement. She was not only my cousin, but one of my dearest friends.
Paulie and I were considered the “good” daughters in our extended family. The daughters who never gave their parents grief; that played by the rules even when others didn’t; who finished college got the “good” job and was the family support (both financially and emotionally) in the midst of a crisis. We both walked the perennial tight-rope in corporate America while maintaining our family culture and traditions. Paulie was my greatest cheerleader and “in-house” comedian. How I lived for her e-mails that made me howl!
We were scheduled to meet in New York this week so that she could finally meet my children. We both held the undesired distinction of being childless until the adoption of my sons last year. Paulie was previously married and had miscarriages. If only I had been in practice during the time of her pregnancies.
Paulie briefly mentioned that she was having foot surgery but I never gave it a second thought. In retrospect, I wish I had. She ultimately had two foot surgeries within a two-week period although the first surgery allegedly had not healed.
The smell of smoke alerted her neighbors who called NYPD on that fateful night. Upon forced entry, a frying pan burning on the stove was discovered along with her lifeless body. The cause of death was a blood clot to the lungs and I have a million unanswered questions for her podiatrist. Did he obtain medical clearance from her family physician? Did he prescribed anticoagulants (blood thinners) upon her discharge and did he have to do the second surgery so soon?
The “business” of healthcare has claimed yet another victim. When is it going to stop?