EXCLUSIVE: A USA TODAY investigation shows that rising childbirth complications can't be explained by demographics alone. Data, medical records and lawsuits suggest a complicated mix of misdiagnoses, delayed care and a failure to follow safety measures.
“We all think we’re giving great care and we are treating everybody equally,” said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative. “The data doesn’t support that.” , Main said, too often respond defensively instead of using the data to evaluate their care practices.
The analysis tallied complications at 1,027 hospitals using a formula developed by the federal Centers for Disease Control and Prevention – the same one used for years by academics, big insurance companies, hospitals and others to track and study women harmed from childbirth. Touro participates in two programs that calculate rates this way, one run by Blue Cross Blue Shield, another by the state of Louisiana.
But the list also includes community hospitals in cities, suburbs and small towns where many routine births typically occur. “It’s a valid point, but it’s not a point that hospitals can use to simply not do better,” said Elizabeth Dawes Gay, a founding co-director of the Black Mamas Matter Alliance, which advocates for racial justice in women's health. “They also have to be willing to change, to look at their practices, their policies, their providers and ask: Where are we failing women?”
Touro’s rate was 2.8 percent, or about 360 of more than 13,000 women who delivered there from 2014 to 2017. The next highest rates in the city were Ochsner Baptist Medical Center and Tulane Lakeside Hospital – two other hospitals that also take on risky births. Touro Infirmary is known to many in New Orleans by its longtime slogan that it’s the place “Where babies come from.” It is among hospitals where USA TODAY found women are suffering severe childbirth complications at twice the rate of other hospitals.A short walk from the historic St. Charles Streetcar Line, Touro Infirmary has been a cornerstone of health care in New Orleans for more than 165 years. It has long marketed itself as the place “Where babies come from.
During her stay at Touro, West developed a complex set of symptoms. Along with the seizure, odd blood test results and problems with her kidneys led a doctor to diagnose a rare blood disorder. The nurse ran through five doctors before she found someone who would address West’s blood pressure: a doctor learning internal medicine skills through one of Touro’s training programs. Even when told the latest reading was 175/94, the resident didn’t react as if West’s blood pressure was an emergency. Renata McClendon is tortured by thoughts that she somehow didn’t do more to ensure better care for her sister Felicia West. “I feel like,...
“It was almost like she was having an out-of-body experience,” McClendon said. “She would look at us, turn away, look at us, turn away.” That was the last time McClendon would see her sister alive. Jenny Nedopak, who suffered a ruptured uterus and dangerous hemorrhaging, has has filed a lawsuit accusing trainee doctors of failing to call their professors for help until 20 minutes after her baby was delivered.
All three of the doctors in the operating room were trainees in Touro’s medical education program, run by the Louisiana State University Health Sciences Center, according to the family’s lawsuit. Two were residents, newly graduated from medical school and still learning to be obstetricians. The third had recently completed her residency but was a fellow, not yet board-certified as an obstetrician.
Jessiffi Francois died from blood clots in her lungs in 2014 after a trainee doctor failed to send her home with clot-reducing drugs after delivery, her family says in a lawsuit filed in December. Francois had a family history of blood clots. She had been on such medications during her pregnancy and while hospitalized after the delivery, records say.
After delivery, the OB/GYN fellow discovered Jenny Nedopak’s uterus had ruptured, court records say. Bleeding from ruptures can be fatal. Only then, the family’s lawsuit alleges, did the trainee doctors call their LSU professors to help perform a hysterectomy to stop the bleeding. There is no national requirement that a professor be in the room when OB/GYN residents and fellows treat patients or do surgery. Faculty only must be “immediately available.” Jamal Wright said excitement turned to horror in the hours after his then-girlfriend Nicole Phillips gave birth. “I expected her to get the best care...
Nicole Phillips died in 2016 after being in a coma for 19 months following the birth of her daughter. She had worked in a school cafeteria and had recently completed training that she hoped would land her a job doing medical coding, her family said.Asked about the 2018 warning, LSU spokeswoman Leslie Capo said only that it “had nothing to do with patient care” and was addressed. She wouldn’t say whether resident supervision was an issue.
About 30 miles outside New York City, Westchester Medical Center has a complication rate double its state median and three times the median of all hospitals examined by USA TODAY. Like Touro, it is a primary teaching site for new doctors learning to become obstetricians. In Texas, officials at University Hospital in San Antonio explained its complication rate of 6.9 percent – more than four times the median – by saying its patients are uniquely complex.
Among the hospitals where most maternity patients are black, just over half had complication rates twice the norm, meaning nearly half had lower rates. “We too have a similar issue with a lot of patients coming in late to care, or with no prenatal care, and substance use disorders becoming a real problem,” said Dr. Robert Atlas, chairman of Mercy’s OB/GYN department. He said very low-risk patients are uncommon at the hospital.
Shantel Smith developed a pelvic infection and gangrene after the delivery of her stillborn son in 2011. She had to learn how to walk, drive and do basic tasks like making dinner for her family after she needed amputations to her hands and legs to save her life.As policymakers and health care providers search for solutions to the nation’s maternal health crisis, the human toll is enormous – and growing.
Lawsuits still are pending over the care received by Nedopak and Francois. The suit over Phillips’ care is pending against Touro, but was dismissed against her LSU doctors because they weren’t properly notified of the lawsuit. A confidential financial settlement in the lawsuit over West’s death exhausted Louisiana’s $500,000 malpractice payment cap, according to court records. Because most of the records are sealed, it is unclear which healthcare providers were involved in that settlement.
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