Thursday, May 15, 2008

My complaint against my former obgyn

My complaint against Dr. W is two-fold: first, he failed to properly treat my pre-eclampsia and second, he failed to diagnose that my son was suffering from a collection of congenital abnormalities, including the absence of thumbs, radius bones and a kidney, despite several ultrasounds during my pregnancy.

I was a 36 year old woman with a history of recurrent miscarriage before 8 weeks. I began treating with Dr. W in January 2005. At the time, I had had 2 miscarriages. After an additional miscarriage in May 2005, I became pregnant with our son, Brody, in January 2006. I delivered him at 33 weeks gestation, via c-section, on September 1, 2006 due to complications from pre-eclampsia.

I began seeing Dr. W after I transitioned from a reproductive endocrinologist at 12 weeks. Dr. W immediately informed me that I would be induced at around 38 weeks even though, at 12 weeks, there was no medical justification for doing so. In fact, Dr. W did not discuss with me his justification for induction at that time. I later learned from several other Dr. W patients (in the waiting room of his office and in our prenatal education classes) that he regularly schedules inductions regardless of medical necessity.

I began having high blood pressure early in my pregnancy. At around 20 weeks, Dr. W prescribed methyldopa. My pressures kept creeping up, however, even on the medication. Instead of prescribing bed rest, or additional or different medication, after getting a high reading during a visit, Dr. W would instruct me to lay on my left side. Then, while I was laying on my left side, he would take my blood pressure for a second time. The second reading would be within a normal range. However, at times, my blood pressure sitting up would be around 150/100.

Despite my high blood pressure, Dr. W still did not prescribe any additional medication, and he did not tell me to modify any behaviors such as work schedule. He suggested that I be on what he termed as “modified” bed rest which, he explained, would be 2 hours on my left side during the day, and 2 hours on my left side at night. Dr. W knew that I am an attorney and I was working full time in a fairly stressful job.

I had multiple ultrasounds during my pregnancy because of my history of miscarriage. In addition to the comprehensive ultrasound at 20 weeks, I had subsequent ultrasounds every couple of weeks in my second and third trimesters to check for growth and development. Although Dr. W did not attend any of my ultrasounds himself, he did review the results and photos with me during my visits. Dr. W routinely informed me that everything was fine. At no time did Dr. W express any concern regarding the bone or organ development of my baby nor did he recommend amniocentesis. I question now whether Dr. W even reviewed the photos of the ultrasounds.

In August 2006, at around 32 weeks of pregnancy, I went in for a scheduled appointment on a Monday. I had an ultrasound performed by Dr. W’s ultrasound technician. That same day, my blood pressure was 160/110. After the ultrasound, Dr. W indicated that my child had “fallen off the growth chart.” In particular, Dr. W said he was concerned that the baby’s head was measuring very small. He suggested I schedule an appointment with a perinatalogist. He casually mentioned that my fluid was low but did not prescribe any additional treatment or convey to me that there was any cause for concern. At no time prior to this appointment did Dr. W convey to me any cause to be concerned about the development of my baby.

Forty-eight hours later I was seen by a perinatalogist, Dr. S. Dr. S was not at all concerned about the size of my baby’s head, but was gravely concerned about my child’s well-being, my fluid level, and my blood pressure which remained at 160/110. She instructed her staff to bring in a wheelchair to the exam room, and one of her nurses immediately wheeled me into the adjacent Littleton Hospital for admission. Her staff indicated that my blood pressure was at the level at which people experience stroke and that my fluid level, which was presumably the same as it was 48 hours earlier, was dangerously low and was restricting the blood flow to my baby. She prescribed labetalol, which immediately lowered my blood pressure. At a minimum, I believe Dr. W should have more aggressively treated my pre-eclampsia and my high blood pressure or, if he was unable to do so, he should have referred me to someone else sooner. At no time prior to 32 weeks did Dr. W ever suggest I consult a perinatalogist for any reason. Moreover, clearly there are other medications used to treat high blood pressure during pregnancy, such as labetalol, that would have immediately lowered my blood pressure. Had Dr. W appropriately treated my high blood pressure, my fluid and my child’s growth would not have been so severely restricted.

During my hospitalization, Dr. W shifted my care to his partner, Dr. D due to Dr. W's vacation schedule. Although I was in the hospital for nine days before giving birth, Dr. W visited me only once on rounds.

On the 9th day of my hospital stay, in the evening of September 1, 2006, Dr. D delivered my son Brody via c-section. Although my fluid levels had been increasing since I was admitted, the c-section was necessary due to my pre-eclampsia. Brody was born at 3 lbs, 13 ozs and 17 inches long at 33 weeks.

Once Brody was delivered, however, it was immediately apparent that something was seriously wrong. His arms were short and his hands were bent 180 degrees backward. It looked like his palms were glued to the underside of his wrists. I heard the anesthesiologist murmur “Is that because of the low fluid?” to Dr. D, who did not answer. My husband Jeremy, who was holding my hand, began to shake uncontrollably in the OR. The NICU nurses wrapped Brody up, and took him to the NICU.

That night and the next few days, which should have been the happiest in our lives, were among the worst and most terrifying. Our family and friends at the hospital have told me that after Brody was born, my husband fell to the floor in the hallway, sobbing. The neonatalogist informed us that Brody did not have thumbs and was missing the radius bone in both arms. That night in the hospital room, my husband and I wept for hours, not knowing if our son would survive. I had never seen my husband cry before.

The next morning we were told that Brody had tracheo-esophageal fistula, meaning that his esophagus did not connect to his stomach. He had to be transferred to Presbyterian St Luke’s in Denver for emergency surgery. I remained at Littleton until September 4, when I could finally join my husband at my son’s side.

Over the coming days and weeks we learned that in addition to missing radius bones in both arms, missing thumbs, and TE fistula, Brody had only one kidney, and had a fused metopic suture in his skull. His lone kidney is misshapen, and he has a level 4-5 reflux, meaning that not all the urine drains from his bladder. To date, he has had 3 surgeries, and will require several more. Officially, Brody’s diagnosis is Vater, or Vacterl, association.

I’m filing this complaint not because I blame Dr. W for Brody’s congenital issues, but because he failed to diagnose any of them. In fact, Dr. W kept telling me I was measuring perfectly, and that the baby was growing. At no time prior to 32 weeks of pregnancy did Dr. W mention to me that any of the ultrasounds revealed concerns with the development of my baby. And yet, Brody has no thumbs, no radius bones, a missing kidney, a fused skull bone and only a partially grown esophagus. To this day, I cannot understand how Dr. W failed to notice these abnormalities.

Had we known of even some of Brody’s conditions, we would have immediately had an amniocentesis done to confirm that it was not genetic in nature. Instead, we waited agonizing week after agonizing week for the results of the genetic testing to tell us if our son had Fanconi’s anemia, a catastrophic diagnosis that would likely mean mental deficiencies, and increased likelihood of several forms of cancer and a greatly shortened lifespan. Every day I spent the majority of the day in absolute terror that our son had it, as it is also characterized by arm malformations.

Had we known of Brody’s condition, he would have been born at PS/L where they have a more advanced NICU, more experienced surgeons, and doctors who are familiar with Vater/Vacterl association. Instead, my son had to be transferred to PS/L while I was still in Littleton. Instead of being by my newborn son’s side, I was stuck in a hospital 45 minutes away, unable to see him before his surgery, unable to be with my husband and our family during that surgery, and unable to hold my son after his surgery.

I realize that the news of our son’s congenital issues would have been devastating to hear at any point during my pregnancy. But if we had known before the birth, we would have been prepared, emotionally and medically, to handle it and give the best care possible to Brody. We would have had a more positive birth experience, instead of living the nightmare of that weekend and the tortuous uncertainty of the weeks that followed. Even now, 7 months later, and even though I love my son more than anything in this world, the memory of my son’s birth is a heartrending and traumatic memory that has given me countless nightmares and sleepless nights.

Because of Dr. W's abject failure to properly treat my pre-eclampsia and utter failure to detect even the most basic of prenatal abnormalities, the absence of organs and digits, my life was put at risk and more importantly, my child’s life was put at risk. I write this complaint hoping to prevent this situation from occurring to anyone else.

5 comments:

SaRaH said...

You very eloquently told your story. It makes me hate your doctor and love Brody even more.

Robyn said...

Wow. I'm SO sorry you had to go through that.

Jess said...

Wow. I'm dumbfounded at how your doctor could be so ignorant. I'm amazed at realizing how little I know about your birth story and how much you and your family have been through. Your family is in my thoughts and prayers even though you have proven that having strength is not an issue.
Brody is an amazing child, you and your husband are amazing parents. I am at awe at how much you have been through already and how much you have still yet to face. Give Brody a hug for me. I love him so much and hope he lives an amazingly full life. <3

whefah said...

I can't begin to imagine what that must have been like for you, and just trying to imagine it brings me to tears. I know I've said it before, but you and Brody are absolutely AMAZING.

Brittany said...

Man.. This takes me back.. When I was pregnant with Olivia, my husband and I had the exact opposite experience.. We knew from 12 WEEKS that there was something wrong.. So every other week I had to travel the 140 mile round trip to have the doctors tell me that "there was no way that my child would make it through this pregnancy" and "if IT did it would only be moments until IT passed." We spent time with social workers planning for my unborn child's funeral instead of being excited and setting things up for her arrival.. Either way the experience is traumatic and life changing. We are just lucky that the doctors were absolutely wrong and we can hold and love our beautiful, amazing little girl every day!