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 in 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, they might have detected preterm contractions and stopped them.

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.

*This is an actual medical malpractice case that I was asked to review and given permission to discuss.