November 29, 2013

Justice for a Senseless Case of Untreated Jaundice

Although jaundice is not a welcome trait for a newborn, it’s not uncommon. About 6 in 10 U.S. newborns are at least mildly jaundiced — they have a tell-tale yellowish cast that signals elevated blood levels of bilirubin. It’s a naturally occurring reddish-yellow pigment in bile and blood, but if levels that are too high are left untreated, it can cause brain damage.

Usually, the danger is effectively neutralized with light therapy that turns toxic bilirubin into a water-soluble form the bodily easily eliminates. More difficult cases might need blood transfusions to rid the tiny body of its poison.

Six years ago, New York Methodist Hospital discharged a newborn without a proper exam despite his symptoms of jaundice. Even though his mother reported his yellowing skin, his doctor, Ioanis Atoynatan, did not follow up.

Six years later, Jaelin Sence, brain-damaged and permanently handicapped, received a $26 million judgment from a jury for the tragic case of malpractice.

“I don’t know if I’ve seen a more preventable case,” said his attorney, Thomas Moore, on the “It’s heartbreaking to see a child like this.”

Jaelin can’t use his arms and legs, and has never said “mama” or “dada.”

Fewer than 48 hours after he was born, Jaelin was sent home from Methodist Hospital despite rapidly yellowing eyes. Nurses apparently disregarded his mother’s concerns, and told her the problem would resolve on its own.

But Jaelin grew worse, and when he began vomiting, his parents rushed him to Kings County Hospital, where was diagnosed with hyperbilirubinemia (kernicterus) — the severe jaundice that causes brain damage and cerebral palsy.

Doctors performed two blood transfusions, but they couldn’t save Jaelin from the dire damage.

“They couldn’t save my son’s brain, but they saved his life,” Myrtho Sence told the Daily News.

The defense said it plans to appeal the jury’s award, but if it stands, it will allow the Sence family to provide 24-hour-a-day care for Jaelin.

All newborns are at risk for jaundice, but certain factors can predispose a baby toward it, including premature birth, incompatible mother-child blood groups and bruising.

To learn more about this kind of preventable brain injury, see our backgrounder.

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February 8, 2013

Electing Early Delivery Is Seldom Wise

It has been nearly 35 years since the American College of Obstetricians and Gynecologists (ACOG) recommended against delivering babies or inducing labor before 39 weeks of gestation, except when there are medical complications, such as the mother's high blood pressure (pre-eclampsia; see our recent blog on the Downton Abbey all-too-real plot line), diabetes or signs that the fetus may be in distress.

So why, then, are an estimated 10 to 15 out of 100 U.S. babies delivered early every year for no medical reason?

That reality is examined in a recent story by Kaiser Health News and the Washington Post. "After 37 weeks, patients really push for it because they are miserable and don't want to be pregnant anymore," Alfred Khoury, director of maternal-fetal medicine at Inova Fairfax Hospital, told KHN/Washington Post. "Or they say, 'My mother is here' or 'I have to be in a wedding.'"

Sometimes, it’s a matter of provider availability. Physicians who work alone or in rural areas might prefer to schedule deliveries before 39 weeks for time-management purposes. That’s a bad idea, but, said Helain J. Landy of the department of obstetrics and gynecology at MedStar Georgetown University Hospital, "The reality of caring for patients, or [doctors'] day-to-day needs, may sometimes interfere with following the guidelines."

In 2012, Patrick Malone represented a family in a medical malpractice lawsuit against a group of obstetricians for brain damage to a baby that resulted from misconceived plans for an early delivery. In that case, the doctor followed outdated medical literature that suggested babies of mothers with gestational diabetes should be delivered early even if monitoring shows the baby is doing fine. Mr. Malone's closing argument of the trial on behalf of both baby and mother can be read here.

Now, poor doctoring and patient ignorance are coming under the control of some government and private insurers, who are discouraging and sometimes penalizing doctors and hospitals for delivering babies early without cause.

It’s a good idea from both a health and financial perspective.

Often, prematurely delivered babies develop problems ranging from breathing and heart disorders to anemia and bleeding in the brain that land them in the neonatal intensive care unit (NICU) where, according to KHN/Washington Post, the average charge is $76,000 per stay. (Learn about NICU injuries in our backgrounder.)

The folks who pay most of that tab also want to avoid subsequent medical costs to treat problems including jaundice, feeding difficulties and learning and developmental issues. Sometimes the health problems of preemies last their whole life.

As reported in the story, UnitedHealthcare, the nation's largest private health insurer, pays hospitals more if they take steps to limit early deliveries without medical cause and show a drop in their rates. And as of July, Medicare, which pays for disabled women to give birth, will require hospitals to report their rates of elective deliveries before 39 weeks. Hospitals might be penalized beginning in 2015 if their rates remain high.

Some insurers refuse to pay for unnecessary early deliveries at all. The South Carolina Medicaid program and BlueCross/BlueShield of South Carolina don’t reimburse providers for performing early deliveries without medical cause. Those two insurers cover more than 8 in 10 births in that state. Several other states either have or are considering such policies.

We’re reluctant to endorse such sweeping measures because individuals have different needs. But unnecessary early delivery is never a good idea.

Even without official prodding, some hospitals have taken steps to curtail elective early deliveries, and some simply won’t perform them. After St. Joseph Medical Center in Houston stopped performing them in 2011, NICU admission rates for babies born between 37 and 39 weeks dropped 25 percent in the first year.

Unfortunately, sometimes brawn works better than brain in encouraging practitioners to curb elective early births. One study mentioned by KHN/WP found that educating doctors about the risks was less effective in reducing rates of early deliveries than having medical staff simply prohibit the practice.

But some physician groups don’t like being told how to practice medicine.

"We oppose the legislative control of medicine," said Jeanne Conry, president-elect of ACOG told KHN/WP. Conry says her organization has developed its own "clear, effective guidelines" laying out clinical markers for determining when early delivery might be appropriate.

And as one obstetrician noted, when states or insurers get involved, doctors may hesitate to deliver early even when there are clinical reasons to do so. "Outcomes are best when there is a doctor-led process, rather than a legislative or payment mandate," he said.

Even the March of Dimes, that notable champion of safe birth practices, is wary of using financial rewards or penalties. "Payment is a really big hammer, and we want to have a comfort level with a policy so we don't cause unintended consequences [such as making doctors reluctant to perform early deliveries even when they are needed],” Cindy Pellegrini, a March of Dimes executive told KHN/WP.

Some doctors welcome the oversight, as one obstetrician said, to help "us all do the right thing" and make it easier to educate women.

But decades after the ACOG guidelines, only 1 in 3 hospitals reports rates of elective early deliveries at or below the goal of 5 in 100, according to the Leapfrog Group, an organization of businesses focused on patient safety. Many still have rates higher than 15 in 100.

Some of the resistance, unfortunately, might be because NICUs are profit centers for many hospitals.

The best way to address the wisdom of full gestation is to educate patients. There’s some work to do there—one survey from a couple years ago involving 650 women who had recently given birth found that half considered it safe to deliver before 37 weeks.

If you are expecting, or expecting to be expecting, make sure you and your obstetrician are on the same page regarding the optimum time for delivery. Do not accept any reason other than medical necessity for inducing labor before the due date, or otherwise delivering prematurely. It’s bad medicine with potentially lifelong consequences.

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August 21, 2011

Learning from Tragedy: The Faces of Children Hurt by Medical Error

The Empowered Patient Coalition has put together a moving short video of some of the many children killed from malpractice and other medical errors. Watch it here.

Then check out the Coalition's website for tools on how you can be a safer, smarter patient for yourself and your loved ones.

Helen Haskell and Dr. Julia Hallisy are mothers of children harmed by medical error who founded the Empowered Patient Coalition to try to make the medical system better and safer for future patients.

Another touching video on turning medical tragedy into something positive was put together recently by Mary Ellen Mannix, a mom who lost a baby to medical mistakes in 2001. She went on to start James's Project, which focuses on patient safety to improve infant mortality and maternal health. Watch the video here.

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May 2, 2011

New York creates fund for babies with brain damage from malpractice errors

New York state has created a new fund to pay medical expenses for infants who are neurologically damaged as a result of malpractice and other medical mistakes, but opponents say it means families will have to fight with state authorities to obtain treatments as their children age.

The fund, which is due to go into effect on Oct. 1, 2011, allows medical costs to be provided on an annual basis to injured parties. Parents or guardians can still pursue medical malpractice actions on the basis of emotional distress and other losses.

Between 150 and 200 babies are expected to qualify annually for the new fund, according to Jason Helgerson, Gov. Andrew Cuomo's chief Medicaid reform adviser. Participation in the fund is mandatory for those seeking either Medicaid recompensation or filing medical malpractice suits.

Helgerson says the fund will offer a more accurate means of providing care for injured infants because it isn’t subject to inaccurate estimates made by judges and juries trying to arrive at an accurate figure for health-care costs under the current malpractice award system.

But opponents of the fund maintain that the system was championed by health-care providers and will subject the families of neurologically damaged infants to on-going battles with the state for treatments as their children age.

Under the new statute, the fund describes "birth-related neurological injuries" as "an injury to the brain or spinal cord of a live infant caused by the deprivation of oxygen or mechanical injury occurring in the course of labor, delivery or resuscitation or by other medical services provided or not provided during delivery admission that rendered the infant with a permanent and substantial motor impairment or with a developmental disability."

Medical care will be decided on a case-by-case basis. In the event the fund is reduced to 20 percent or less of its annual size, the law contains a default stipulation allowing suits to be brought for medical expenses.

The establishment of the fund was included in a host of recommendations by a Medicaid Redesign Team (MRT) appointed by Gov. Cuomo to halt escalating Medicaid costs. Another recommendation from the task force called for capping noneconomic damages in medical malpractice cases at $250,000. That proposal was fiercely opposed and eventually scrapped.

Source: New York Law Journal

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April 6, 2011

Which kids should get their tonsils removed? At long last, some guidance

Prompted by a lack of consensus on who should get their tonsils removed and how it should be done, the American Academy of Otolaryngology–Head and Neck Surgery has issued the first-ever clinical guidelines for tonsillectomy in children in the U.S.

Child safety advocates have argued for years that tonsillectomy is done way too often. This exposes kids to risks of an operation they may not need -- mainly from anesthesia and bleeding. Because the tonsils are situated at the junction of several blood vessels, the procedure carries a relatively high risk of hemorrhage.)

For example, it's been known for decades that children’s health in areas with high rates of tonsillectomy is no better than in areas in which fewer tonsillectomies are performed.

But the operation still gets done for preventive or “prophylactic” reasons. As a result, tonsillectomy currently is the third most common surgery in U.S. children younger than 15 years, with more than 530,000 performed annually, primarily for recurrent throat infections and sleep-disordered breathing, despite the risks.

The guidelines provide evidence-based guidance in identifying children who may benefit from tonsillectomy. They also offer recommendations intended to optimize the "perioperative" management of children undergoing the procedure and provide guidance on how to improve counseling and education of parents of children who may be candidates for tonsillectomy and suggests ways to reduce inappropriate or unnecessary variations in care.

According to the new guidelines, the need for a tonsillectomy is determined by the frequency of a child’s sore throats. Tonsillectomy should be considered when a child has (a) seven sore throats in a single year; (b) five sore throats for 2 years running; or (c) three sore throats for 3 years running. To count for this purpose, each sore throat must be accompanied by a fever of at least 38.3C (101F), swollen lymph nodes in the neck, pus or blood draining from the tonsils, or documented infection with a bacteria called hemolytic streptococcus.

The guidelines also recommend:

Watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years.

Assessing the child with recurrent throat infection who does not meet the criteria above for modifying factors that may nonetheless favor tonsillectomy, which may include multiple antibiotic allergy/intolerance, periodic fever, aphthous stomatitis, pharyngitis and adenitis, or history of peritonsillar abscess.

Asking caregivers of children with sleep-disordered breathing and tonsil enlargement about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis and behavioral problems.

Counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing.

Counseling caregivers that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management.

Advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain.

Self-monitoring by clinicians who perform tonsillectomy at least annually to determine their rate of primary and secondary posttonsillectomy hemorrhage.

Source: American Academy of Otolaryngology – Head and Neck Surgery

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March 30, 2011

Brain damaged boy’s family accepts $8.5M malpractice settlement

The family of a severely brain-damaged child in Bayonne, New Jersey will be paid $8.5 million to settle a medical malpractice lawsuit brought against the former owners of the Bayonne Medical Center and three medical workers. Attorneys representing the former owners of the hospital and the family settled the multimillion-dollar lawsuit after five days of testimony.

According to court records and trial testimony, Emily Ordonez, then 32, went to the hospital at 1:30 a.m. on Aug. 14, 2005 with labor pangs. All prenatal tests pointed to a normal healthy baby. But at 9:32 a.m., the heart monitor attached to her abdomen showed the baby's heart suddenly plunged from 140 beats per minute to the dangerously low level of 60 beats per minute.

Phone records show that the labor and delivery room nurse waited almost half an hour before calling the attending obstetrician and when he arrived from Staten Island 22 minutes later, he waited until 10:55 a.m. to start an emergency C-section.

The reason for the baby's low heart rate was that his umbilical chord was compressed and the fetus was starved for oxygen. The delays, therefore, left Jose Ordonez, now 5, with permanent brain damage and needing full-time care. The boy is prone to seizures, cannot see, walk, or hold his head up by himself, and he must be fed through a straw.

Besides the hospital, the parents sued the obstetrician, the delivery room nurse, and her supervisor.

Source: The Jersey Journal

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March 9, 2011

Preemies exposed to excessive radiation at Brooklyn hospital

Technicians at a Brooklyn, N.Y. hospital exposed premature babies to dangerous levels of radiation, according to a recently published report in the New York Times.

Technologists with the radiology department at the State University of New York (SUNY) Downstate Medical Center routinely gave premature infants whole-body X-rays when physicians ordered only a chest X-ray. They also failed to shield the infants’ reproductive organs as required by New York state health codes.

(The photo at the top of this blog entry shows a whole-body X-ray of a baby from a textbook, intended to show how to use X-rays to detect child abuse. This practice is now out of favor with up-to-date doctors due to the radiation risks, but as the article shows, medical practice is sometimes slow to catch up with knowledge.)

The errors were first discovered by the chairman of the SUNY Downstate Department of Radiology, Dr. Salvatore Sclafani. In a letter to colleagues, Sclafani wrote that he was “mortified” after finding the “full, unabashed total irradiation of a neonate” when examining the chart of a premature baby in his care. A pediatric radiologist Sclafani brought in to evaluate the hospital’s procedures found other “alarming” practices: In addition to frequently performing whole body X-rays, known as babygrams, technicians were performing CT scans on infants using the wrong settings, resulting in excessive radiation.

Although new, tighter procedures for radiological imaging of infants were instituted and babygrams were halted altogether, the hospital never reported the errors to N.Y. state officials as required by law. State officials now are investigating the claims in the New York Times article.

With technologists in many states either lightly regulated or unregulated, their own professional group is calling for greater oversight and standards. The American Society of Radiologic Technologists has been lobbying Congress for 12 years to pass a bill that would establish minimum educational and certification requirements for technologists, medical physicists and 10 other occupations in medical imaging and radiation therapy. However, Congress has yet to pass such a bill, leaving regulation up to individuals states. And in many states, radiation therapists (15 states), imaging technologists (11 states) and medical physicists (18 states) remain unregulated.

“It’s amazing to us, knowing the complexity of medical imaging, that there are states that require massage therapists and hairdressers to be licensed, but they have no standards in place for exposing patients to ionizing radiation,” said Christine Lung, the technologist association’s vice president of government relations.

Source: The New York Times

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February 8, 2011

Caps threaten $19.2 million jury award to family of preemie who received overdose

A jury recently awarded $19.2 million to a Florida couple whose premature infant daughter received a massive overdose of nutrients at a Fort Myers hospital, but the family may never see most of it due to a cap on liability. The little girl is in a wheelchair for life and nearly blind due to the negligence of the hospital staff.

The cap, which is based on the concept of “sovereign immunity,” applies to public institutions, including public healthcare systems. (HealthPark Medical Center, where the event occurred, is part of the Lee Memorial Health System, a public health care system created by a special act of the Florida Legislature.) Sovereign immunity means that an employee, officer, or agent of the state and local governments is not held personally liable for negligence committed during the scope of his or her employment or function, unless the employee acts in bad faith or with malicious purpose. Instead, the state takes the place of the employee and defends the claim.

In Florida, sovereign immunity also limits the amount of recovery in any claim against the state to $100,000 per person and $200,000 per incident. (Effective Oct. 1, 2011, the limits will rise to $200,000 per person and $300,000 per incident.)

The verdict came after a two-week trial for medical negligence brought against the Lee Memorial Health System by the parents of Kiarra Summer Smith, who was born in 2007 weighing 1.5 pounds and 3 months premature. Kiarra was give a formula of neonatal nutrition including amino acids and carbohydrates as well as vitamins and trace minerals based upon her body weight. When she was 15 days old, the pharmacy misread an updated physician order sheet and calculated the dosage of trace elements as if it were for a person weighing about 160 pounds. As a result, Kiarra received a dose of trace elements, including zinc, copper, manganese and others, about 100 times larger than she should have.

The lawsuit states Kiarra’s body fluids became highly acidic and she went into cardiac arrest, requiring cardiopulmonary resuscitation and transfusion of all the blood in her body. She also suffered a brain hemmorhage. The long-term result is Kiarra has permanent neurological damage, a type of cerebral palsy where all four extremities are spastic, and is nearly blind. She also is completely disabled and in a wheelchair.

Lee Memorial admitted negligence but denied the overdose caused damage. “Although Lee Memorial Health System accepts responsibility for this unfortunate event, we believe the verdict is excessive and against the greater weight of the evidence,” a Lee spokeswoman said after the trial. “We admitted error in administrating nutrition but we believe strongly that this was not the cause of the child’s condition.”

To overcome Lee Memorial’s sovereign immunity protection, a specific bill would have to be passed by the Florida Legislature, which could only happen after all appeals had been exhausted, which could take years.

Source: Fort Myers News-Press

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August 28, 2010

Pediatricians repeating medical myths endanger child safety

Parents who turn to their child’s pediatrician for health and safety advice may end up hearing recycled parenting myths, a new study reports.

“In some cases, a child’s well-being may be seriously compromised if parents are given misinformation by a pediatrician based on these misconceptions and old wives’ tales,” said Andrew Adesman, M.D., lead investigator of the study and chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children’s Medical Center of New York.

The study was based on a questionnaire sent to a national sample of board-certified primary-care pediatricians and included a mix of 34 myths and 14 true statements. Analysis of more than 1,000 responses indicated that the majority of pediatricians (76 percent) mistakenly endorsed one or more of the parenting myths as being true, and 13 percent got three or more wrong.

Although most of the myths are benign old wives’ tales, Adesman said, there were a “dangerous dozen” health beliefs that reflected outdated parenting beliefs that could pose a risk to a child’s safety or well-being. For example:

• 33 percent said a burn can be treated with an application of ice. Risk: Ice can also cause injury to the skin.

• 33 percent said it is safe to put a baby to sleep on his or her side. Risk: Crib death -- also known as sudden infant death syndrome. (All babies need to sleep on their backs.)

• 5 percent said children can be given an ice bath to treat a fever. Risk: Hypothermia.

• 5 percent said children over age 6 can be given aspirin for a fever. Risk: Reye’s syndrome.

• 5 percent said it’s OK to place a soft object in a child’s mouth during a seizure. Risk: Dental injury to the child, hand injury to the adult.

• 3 percent said babies younger than six months can be given honey. Risk: Botulism poisoning.

Many pediatricians also endorsed less dangerous myths.. For example:

• 15 percent said children should not swim until 30 minutes after eating.

• 17 percent said vitamin C helps ward off colds.

• 16 percent said eating carrots improves a child’s vision.

• 8 percent said eating chocolate causes acne.

• 11 percent said listening to Mozart makes a baby smarter.

• 7 percent said reading in the dark causes visual problems.

• 11 percent said sugar causes hyperactivity.

• 7 percent said sitting too close to the TV damages vision.

• 9 percent said sleeping with a nightlight causes nearsightedness.

Source: Los Altos Town Crier
You can view the complete study here.

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August 1, 2010

Protecting Babies from Hospital Malpractice in Labor and Delivery Units

Who's at fault for the high rate of Cesarean sections in the United States? If you listen to the obstetricians, it's all about lawsuits -- they are at risk of being sued for "anything short of a perfect outcome," as two doctors wrote last week in a letter to the editor in the New York Times.

But maybe the real issue is basic patient safety, and the failure of hospitals and doctors to have the right staffing necessary to make vaginal childbirth safe after a previous C-section.

If you listen to the euphemisms from the medical industry, "less than perfect outcome" sounds like parents suing over a small blemish or other trivial injury. What is really at stake, however, is permanent devastating brain injury caused by a hospital not having the resources to deliver a baby quickly enough when the vaginal birth attempt has gone south.

Three in ten American women now deliver their babies by Cesarean section, which seems like a lot. And many of those are repeat Cesareans which only happen because of the prior Cesarean, even if it might be safe to at least try normal labor and see if the baby can be delivered safely. Recent headlines suggested that hospitals were refusing to even let women try a course of normal labor after a prior Cesarean. They couldn't afford the lawsuits, it was suggested.

But here's the problem with VBAC -- vaginal birth after Cesarean. In one in 100 to one in 200 VBAC attempts, the uterus ruptures. This cuts off the baby's lifeline. The best studies show that brain damage begins in around 17 to 18 minutes, and worsens dramatically every minute after that the baby remains undelivered. After 30 minutes, most babies in ruptured uteruses are dead if not delivered.

New guidelines from the American College of Obstetricians and Gynecologists (ACOG) for VBAC have stuck to the group's 1999 recommendation that a surgical team has to be "immediately available" to deliver the baby by C-section in the event of a rupture. Immediate means right there in the hospital, ready to operate.

Hospitals don't like the "immediately available" standard, and prefer the old, looser guideline of "readily available," whatever that means. After the 1999 guidance of "immediately available" was issued, a number of hospitals, rather than having the right staffing level to ensure baby safety, simply banned VBAC procedures and said any pregnant woman with a prior C-section had to have another C-section in their hospital. This conjures up an image of tying women to hospital beds and hovering over them with scalpels, so that doesn't sound right either.

In March 2010, the National Institutes of Health convened a panel of experts who took a step backward by asking the obstetricians to consider softening the guidance back to the old "readily available" or some other mushy language.

Thankfully, ACOG didn't do that. But -- and this is a big but -- the obstetricians are now talking about pushing the risk of brain damage back onto the parents -- without giving them the full picture to make an intelligent decision.

As quoted in the New York Times, the new ACOG guideline adds the recommendation that if an immediate Caesarean is not available, it should be explained to the patient, and she should be "allowed to accept increased levels of risk." And Dr. Richard Waldman, president of the obstetricians' group, said: "What I'm hoping is that everybody will get together and do the right thing. That includes patients. If they take the risk, they have a certain responsibility not to sue the physician if there's a bad outcome, knowing that they took the risk."

You can search ACOG's statement about its new guidelines high and low, and you will never find the key facts spelled out about what this risk really means -- a child who can never walk, talk or have normal development.

ACOG and the hospitals seem more focused on the risk of lawsuits than the risk of catastrophically injured babies. It would be like talking about the danger of oil spills from deepwater drilling based on how many lawsuits would happen, not on how much damage to the environment would result.

Let's make sure our communications are very clear. We're talking about delivering babies safely. The lawsuit buzz is just a convenient whipping boy for those who want to avoid tough questions about why they're not investing in safe childbirth facilities for mothers and families.

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March 26, 2010

C-Section versus Vaginal Births: What Is the Safest?

The rate of C-section births in the United States has been increasing every year since 1996 for women of all ages and racial and ethnic groups, and now the procedure is the most common operation in the country. In 2007 alone, 1.4 million Caesareans were performed, representing 32 percent of all births. However, although C-sections can be life-saving in some instances, experts are concerned with the ever-increasing number of the procedures, reports Denise Grady of the New York Times.

Joining other critics, Dr. George Macones, spokesman for the American College of Obstetricians and Gynecologists, is worried that the rise in number of C-sections “is not going to be good for anybody.” The procedure, a costly major surgery, poses health risks to the mother as well as the baby:

Risks to the mother increase with each subsequent Caesarean, because the surgery raises the odds that the uterus will rupture in the next pregnancy, an event that can be life-threatening for both the mother and the baby. Caesareans also increase the risk of dangerous abnormalities in the placenta during later pregnancies, which can cause hemorrhaging and lead to a hysterectomy. Repeated Caesareans can make it risky or even impossible to have a large family.

The new report notes that Caesareans also pose a risk of surgical complications and are more likely than normal births to cause problems that put the mother back in the hospital and the infant in an intensive-care unit.

According to Grady, the reason for the rising popularity of the procedure is manifold: doctors fearful of malpractice liability should babies be born injured with vaginal delivery; women requesting the procedure even when it’s not medically warranted, not understanding its risks; increased tendency to induce labor for reasons of convenience. Also, many hospitals have banned vaginal births for women who have had Caesareans, adhering to the obstetricians’ college’s guidelines.

In light of the many risks of Caesareans, expecting mothers should educate themselves about their delivery options and consult their doctors to decide whether the procedure is medically necessary.

The bottom line is to find the best way to ensure the baby's health. Sometimes that is with vaginal delivery, but sometimes not. In our law firm's practice, for example, we have represented several families whose children suffered terrible injuries because the mother's uterus ruptured during a VBAC delivery (Vaginal Birth After Caesarean), and all of those mothers would have skipped the effort at vaginal birth if they had known the risk of catastrophe. Our firm's website has extensive information about birth injuries here and here.

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January 19, 2010

Stroke in Kids: It Does Happen

Stroke, an injury to the brain usually caused by a clot of blood that blocks delivery of oxygen to a portion of the brain, is thought of as an adults-only disease. It does happen in children, though, and it's worthwhile for parents to know about it, because the symptoms are frequently misdiagnosed. A father's account in the New York Times tells the story of his son Jared, who had a stroke at age seven. Now, two years later, his brain has mostly recovered, a testament to the remarkable power of children's brains to "rewire" themselves, especially when damage is limited to a discrete area. The most common signs of stroke in children or teenagers include the sudden appearance of:
  • Weakness of the face, arm or leg, usually on one side of the body
  • Trouble walking due to weakness or trouble moving one side of the body
  • Problems speaking or understanding language, including slurred speech, trouble trying to speak, inability to speak at all, or difficulty in understanding simple directions
  • Severe headache, especially with vomiting, sleepiness, or double vision
  • Trouble seeing clearly in one or both eyes
  • Severe dizziness or unsteadiness that may lead to losing balance or falling
  • New appearance of seizures, especially affecting one side of the body and followed by paralysis on the side of the seizure activity.
This list comes from Children's Hospital of Philadelphia (CHOP), which has the first pediatric stroke center in the country. In babies and newborns, the signs of stroke can be more subtle, but include seizures and extreme sleepiness, or unusual favoring of one side of the body. Parents who see sudden onset of these signs in their child should call 911 or get the child to an emergency room with expertise in stroke, and should consider a consult by telephone with the experts at CHOP. The stroke experts say that recognition of stroke is often delayed or even missed in most children. Many kids with stroke syndromes are misdiagnosed with more common conditions that mimic stroke, such as migraines, epilepsy or viral illnesses. But the key message is that early recognition and treatment during the first hours and days after a stroke is critical in optimizing long-term functional outcomes and minimizing the risk of a repeat stroke.

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September 15, 2009

A Little Girl Is Saved Because Her Mom Refuses to Take Her Home from the ER

A riveting story in the Washington Post tells how a Washington area woman's advocacy in the emergency room likely saved her sick daughter from harm.

Sandra Boodman's article interviews Patricia Dawn about her 4-year-old daughter Brooke's illness, that was eventually discovered to be Kawasaki disease, an unusual heart condition. Brooke got the right treatment in time, but only because of her mother's persistence. Mrs. Dawn refused the recommendation of the emergency room doctors to take her daughter home at 2 a.m. when she wasn't feeling any better but they had run out of things to do. At her insistence, her daughter was hospitalized, and an infectious disease specialist eventually figured out that the red lips, red eyes, fever longer than five days, and swollen lymph node in the neck all were signs of Kawasaki, which affects about 2,000 American children a year.

It was also at the family's suggestion that the infectious disease doctor was brought in who made the correct diagnosis.

The story underlines the importance of having a good advocate present at all times with a patient in the hospital. Even a lay advocate can see when symptoms aren't improving and can insist on action.

I discuss this subject in depth in Chapter 12 of my book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst."

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January 16, 2008

Virginia State Medical Board Reprimands Two Doctors

The Virginia State medical board has reprimanded two obstetricians for how they handled the births of infants that were severely and permanently injured during delivery.

The doctors in question are immune from lawsuit because of a 20-year-old no-fault Virginia program that provides medical care to injured children without requiring a trial while protecting obstetricians from legal action. A consequence of this program was that birth-injury cases would often go unscrutinized and negligent obstetricians could go unnoticed and without reprimand. That is why this an unusual event and the first of its kind in twenty years.

The reprimands do not impose monetary sanction on the doctors, nor do they limit the doctors' ability to practice.

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August 25, 2007

Child Victim of Negligence Awarded $9 Million for Brain Damage and Other Injuries

Tripler Army Medical Center must, thanks to the order of U.S. District Judge David Ezra, pay $9 million to the family of Parker Kohl. Parker is a 3-year-old who suffered severe brain damage while being treated at Tipler; he now has an IQ of less than 30, must be fed through a tube, is blind and cannot walk. Judge Ezra found that the hospital was negligent in its treatment of Parker.

This resolution is the best news the family could have hoped for, as they now have the resources to care for Parker's needs.

What happened to injure this child so grievously? Parker was diagnosed with a heart defect shortly after he was born and later developed a respiratory infection that led to hospitalization--except that his condition worsened while he was in the hospital's care, leading to cardiorespiratory arrest and subsequent brain damage. According to Judge Ezra, the hospital staff's failure to monitor Parker and prevent this incident was negligent. This is an example of the importance of attentive hospital care and the disastrous consequences of a lack of such care. What can you do to prevent this kind of thing from happening to you or your child? Only one thing has a real chance of helping, and that is asking questions and speaking out if you notice anything in your care that looks improper or inadequate.

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