January 16, 2012
There are stories that make you cheer and Samantha Garvey’s is one of them. Her light is just beginning to shine but I’m certain in a few more years its intensity will become much brighter. She entered the world prematurely, raring to begin her human experience. At only 2 pounds and 14 ounces at birth, we might have easily have lost her. In her 17 brief years, she has had her share of adversity. Her mother’s automobile accident caused injuries that left her unemployed for almost 8 months. Her father’s income as a taxi driver was not enough to sustain them. The eviction from their rented home on New Year’s Eve came at the most inopportune time. Her father moved the family into a hotel temporarily but they eventually ended up in a homeless shelter, something that has happened more than once during Samantha’s childhood. Samantha immersed herself in school and for the past 2 years, was involved in a research project in marine biology. Ironically, her research project involved looking at the response of mussels when they are in the midst of adversity. What did Samantha discover? The greater the danger encountered by the mussels, the thicker their shells became. A lesson we can all apply to life.
Samantha submitted her research project to the national Intel science competition and made the competitive semi-finals. She is now one of 300 students nationwide who have a chance of winning the top prize of $100,000. And it gets even better. The county social service department found a home for Samantha’s family at a subsidized rent and a private corporation is donating furniture. Hopefully, she will also hear good news from Brown and Yale Universities where she has submitted her applications for freshman admission.
When Olga and Leo Garvey bought their 2 pound 14 ounce daughter into the world, they gave us a gift. Let Samantha’s resilience and determination be an inspiration to us all, especially to parents of premature babies. Somewhere on the other side of the rainbow, the angels are smiling, and we are too. Congratulations, Samantha. I’m sure we’ll hear about you again in the near future.
December 5, 2011
The umbilical cord of the fetus is the lifeline to its mother. Not only does it carry nutrients from the mother, but it also removes waste products from the fetus. The cord, as it is referred to, plays a very important role in obstetrics. At birth, a sample of blood from the cord is obtained and tested to identify its blood type and make certain the baby has enough oxygen. Traditionally, the cord is clamped immediately after birth or within the first 15 seconds of life to reduce the incidence of jaundice. However, this no longer holds true. A recent article in the New York Times discussed a Swedish medical study that demonstrated waiting 3 minutes or more before clamping the cord reduced the chances of getting iron deficiency in the newborn four months later. The blood of a newborn is unique because it is in its most primitive state and has stem cells. Stem cells are important because they have the potential to grow into many different cells in the body. When clamping of the cord is delayed, the baby essentially receives a blood transfusion of its own blood.
The practice of delayed clamping of the cord is not new but it is usually done after premature births to reduce complications. Delayed clamping of the cord of preemies by 30 to 120 seconds reduced the need for blood transfusions and reduced brain hemorrhages. These benefits were seen immediately. However, in the Swedish study, the benefits of delayed cord clamping were seen at a much later time interval of 4 months. This is was very significant and paves the way for further studies to determine if this benefit will still prevail months or even years later. Should all babies have delayed cord clamping? No not all. Newborns who had fetal distress during labor should not have delayed clamping because there is a greater transfer of blood from the placenta to the baby during this type of crisis. Also, babies who were growth restricted during pregnancy and babies of diabetic moms should not have delayed cord clamping as well.
Delayed cord clamping might play a significant role in the prevention of newborn and infant anemia. It certainly deserves a discussion with your healthcare provider at your next prenatal appointment.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
November 7, 2011
A recent article about the shameful infant mortality rate in the U.S. caught my attention. Certainly the statistics quoted are nothing new but still remains alarming. However, the Op Ed by CNN contributor Deborah Klein Walker gave the subject matter a new spin. Walker wrote “This is one of the greatest injustices in our country: that a baby’s chance of having a healthy life is largely dependent on where he or she is born. States and local communities vary widely in what care their leaders choose to provide to women and children.” If Dr. Walker were present, I’d give her a great big hug for her courage to say what no one else dared. A baby can die based on a hospital zip code.
Every pregnant mother needs to take a mini course in hospital politics because they are directly affected. A hospital is no longer a place of healing. It is a business and at times, ruthless. I have witnessed a colleague forced out of business because she said no when a hospital wanted to buy her practice so they withdrew her admitting privileges instead. I recall bitter battles with my former employer because I would not encourage my patients to deliver at a hospital that was notorious for being under staffed, overworked and a haven for medical errors, simply because of a business relationship that my employer had with thatehospital.
I commend our federal government for initiating programs such as Healthy Start and the new home visiting program, but dependence on government assistance alone cannot guarantee a healthy baby. A pregnant mom must do her due diligence. She must investigate the credentials of the provider and hospital where she intends to give birth. What should a pregnant mom do if she lives in a community or state that has a high infant mortality rate? Give birth at a teaching hospital that’s affiliated with a university or medical school. Most of these institutions receive federal and state financial support and are obligated to provide care to patients.
Can a baby die based on the zip code where it’s born? Unfortunately, yes unless the mother is willing to do her homework and take the necessary precautions to avoid that from happening. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
October 10, 2011
The story of Tanya* is compelling. She was 24 weeks pregnant with her third child and the hospital was threatening to send her home. Two years ago, she faced similar circumstances and delivered a baby at 23 weeks. Luckily, the baby is now two years old but the one before that was not so lucky. Tanya presented to a local hospital during her first pregnancy because of complaints of abdominal pain. She was sent home because her contractions “weren’t regular.” Ten hours later, Tanya returned to the hospital because of a “nagging feeling that something was wrong” although her contractions were still not regular. Unfortunately, her cervix was dilated and the contractions could not be stopped. Her son was born alive but died one hour later because the hospital was not equipped to deal with premature newborns. Tanya’s second pregnancy was similar to her first because she developed premature contractions again, at 23 weeks. As with the first pregnancy, her contractions were not strong and regular so she was discharged home from the hospital with a monitor that was supposed to help. It didn’t. Luckily, she had an appointment with her high risk physician the next day who informed her that she was dilated although she did not have regular contractions. Her preterm labor could not be stopped but this time, her baby did not die.
Tanya contacted her Bedrest Coach, DarlineTurner-Lee, owner of Mamas On Bedrest that provides support to high risk pregnant moms and Lee contacted me. She asked for advice regarding Tanya who was 24 weeks and about to be inappropriately discharged home from a specialized teaching hospital. I offered strategies on Tanya’s behalf but there weren’t necessary. One of the physicians at the hospital convinced the staff to allow Tanya to remain in the hospital until 28 weeks. There are lessons to be learned from her case
- Trust your instincts. Tanya was correct in not wanting to be discharged home because of her previous history. Women who delivery preterm babies (especially at 23 weeks) are bound to do it again. The chances of survival are far greater at 28 weeks than at 24 weeks
- She obtained an advocate and sought a second opinion. 2 heads are always better than 1 especially when there is doubt about a diagnosis or treatment
- If you have a high risk problem, always attempt to be admitted to a Level 3 hospital where they have specialized care for newborns
Tanya expressed her gratitude by saying “. . . I thank God for people like you and the staff who fight for our little miracles.”
1 out of 8 pregnant women will deliver a premature baby in the US each year. Hopefully, this time, Tanya will not be one of them.
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.
September 5, 2011
It seems that Matthew Scheidt, had a summer job working part-time for a surgical supply company. He allegedly went to the Human Resources Department of the Osceola Regional Medical Center (ORMC) and convinced them that he was a Physician Assistant student at Nova Southeastern University and lost his identification badge. This is the hospital where many of my former patients were forced to go for medical care because they were either uninsured or received Medicaid. My former employer had a fiscal relationship with them. The use of the word “forced” is quite appropriate because my uninsured patients had no options. When those who had Medicaid requested to deliver at a women’s hospital in another county they were discouraged to do so by the powers that be. I recall with great pain the memos, reprimands and threats I received from my former employer because I wanted to give my patients the freedom of choice. Oh, the stories I could tell about the numerous altercations I had with certain staff members regarding patient management issues. So the fact that this hospital is now on local and national radar screen does not surprise me at all. The hospital was formerly owned by the organization that Florida’s incumbent governor once worked for and eventually paid fines because of fiscal improprieties. The hospital’s long-standing former administrator resigned once the governor ran for office. Yes, politics indeed can affect patient management. But let us return to the story of Scheidt.
Scheidt allegedly performed CPR, changed IVs, cleaned wounds, performed interviews and physical exams on male patients who were disrobed. He was also in the operating room. He only got caught when he asked permission to go to “restrictive areas” of the hospital and I pray it wasn’t the labor and delivery suite. How did this happen? Because our healthcare system is presently on automatic pilot. There are no checks and balances. No accountability. A 17 year old can show up in the human resources department of the hospital and no one does a background check to verify his credentials. Pity the poor patients. This is one of many reasons why The Smart Mother’s Guide to a Better Pregnancy (TSMG) was written. Patients need to be protected.
Could this happen to you? In a heartbeat if you’re not astute and aware. There is a chapter in TSMG, called Investigating the Places Where You Will Receive Care. I strongly encourage everyone to read it.
June 8, 2011
She was well past age 35 when she showed up in the emergency room inebriated, confused and complaining of a swollen stomach. One might ask shouldn’t she be able to tell whether she was pregnant after giving birth to so many children? Perhaps she was in denial because pregnancy had not served her well. Each child she brought into the world eventually became the ward of social service.
An ultrasound was done and the baby was in plain view. There could be no more denial. It was a third trimester pregnancy. An emergency room physician listened to the fetal heart rate and declared it normal. She requested that social service be contacted as the alcohol began to wear off. Perhaps she was mandated to do so if she ever became pregnant again. When social service was contacted they advised the hospital staff to call the police who in turn, deemed she should go to jail because of an outstanding warrant.
It was not known how long the fetus had been exposed to alcohol but no one bothered to contact an obstetrician. Or place her on a fetal monitor. Instead, the ER doc wrote on her discharge summary to contact an obstetrician in the event that she was incarcerated for more than three days. She refused to allow the ER doc to do a pelvic exam but the nurse did one instead. However, the pelvic exam was not documented on her chart.
It’s not clear what happen when she arrived at the jail. There were no patient records available for review and an obstetrician was not consulted or called. 48 hours after her hospital discharge, while sitting in her cell, she felt like she had to move her bowels, screamed for help and then pushed as hard as she could, and her baby landed into the toilet like a projectile. Its umbilical cord was severed from the traumatic birth and it nearly bled to death. By the time the ambulance arrived, the baby was lifeless but CPR brought it back to life. If only this story had a happy ending. The baby has severe brain damage and required life-saving surgery on its heart because it was born with an anomaly. Had the hospital kept the patient or obtained an OB consult prior to her discharge, the results of her delivery might have been more favorable.
Did she need to wear a neon sign to alert the hospital staff that she was a high-risk patient? No prenatal care. Alcohol abuse. Advanced maternal age. Need I go on?
Life should not begin in a toilet bowl. Its effects can be indelible, far-reaching and devastating.
[i] This is an actual medical malpractice case that I was asked to review and given permission to discuss.
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.
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