Octuplet mom fears hospital may not release babies

Date: 2/26/2009
By SHAYA TAYEFE MOHAJER
Associated Press Writer

LOS ANGELES (AP) — Nadya Suleman has voiced concern that the hospital where her octuplets are being cared for may prevent her from taking them home when they're healthy enough in coming weeks.

But in reality, hospitals don't prevent healthy children from going home — child protective services do.

And that's only if a complaint has been filed. Hospital employees are mandated to report to county authorities any concerns they have about unsuitable home environments, a mother's emotional or psychological instability, or any other situation that could result in harm to a child.

According to talk show host Dr. Phil McGraw, the 33-year-old unemployed mother called him Tuesday and said hospital officials were worried that her current living arrangement wouldn't be suitable.

Stu Riskin, a spokesman for Los Angeles County Department of Children and Family Services, said the agency cannot comment specifically on Suleman's situation and could not confirm whether a case had been opened on her family.

But in the event a child welfare complaint is made for a baby ready to leave the neo-natal intensive care unit, it's followed by interviews with family and doctors and in-home visits in an effort "to leave no stone unturned so that we can make the best possible assessment," Riskin said.

If a home is determined to be unsuitable, the county first looks to relatives willing to care for the children. If none is found, a foster home is sought, Riskin said.

Suleman gave birth to the octuplets at Kaiser Permanente Bellflower Medical Center on Jan. 26, when they were nine weeks premature. She has six other children, lives in her mother's three-bedroom home in Whittier and has relied on food stamps and disability income to provide for her family.

She expects the children to come home within the next two weeks, she told McGraw in a show that aired Wednesday. Part two of the interview is scheduled to air Thursday.

Kaiser Permanente spokesman Jim Anderson refused to provide details of Suleman's case, citing privacy concerns, and further refused to elaborate on the health provider's normal procedure for discharging neo-natal infants.

But according to experts and information published on the health provider's Web site, typical protocol for babies discharged from NICU is that the hospital's hired social workers and discharge planners work with parents to coordinate the child's return to the home.

"This discharge plan has to account for the fact that these children, because they're small, they might require special consideration," said Lizelda Lopez, spokeswoman for the state's Department of Social Services, which oversees the county-run child welfare programs. "The hospital has to plan for that and has to work with Ms. Suleman."

It is normal for hospitals to provide parents of premature babies with a host of services to prepare them to care for the babies at home, according to Vicki Bermudez, a neo-natal intensive care unit nurse at the Kaiser hospital in Roseville and a California Nurses Association regulatory policy specialist.

That includes environmental assessments and parenting instruction. Home consultations or home visits from nurses are not unusual, Bermudez said.

"This whole issue has been very emotional, and there have been many judgments made by the public. But nurses and doctors aren't there to make judgments," she said. "They just want to make sure the children and family are getting the services they're entitled to and what's in the best interest of those babies."

The babies must be medically stable before they can be released, which means they should be feeding well and able to breathe on their own, though they are sometimes sent home with oxygen or monitoring equipment, said California Nurses Association co-president Geri Jenkins, also a registered nurse.

"The bottom line is they won't be sent home until the medical team is sure — and they're evaluated to make sure — they're strong enough to eat and grow and thrive," Jenkins said.

In a video posted on the celebrity news Web site RadarOnline.com on Wednesday, cameras went from room to room at Suleman's home, showing cramped quarters and clutter.

In the video, Suleman says the home is "obviously too small" but has a large backyard where the children can play. She also says she's looking for a larger home to rent.

"I want the house to be ready, so my whole head is swimming with ideas," Suleman said in the video.

She has not responded to repeated interview requests from The Associated Press. Her phone has been disconnected and though she said on "Dr. Phil" that she has a publicist, the show only identifies him as "Victor" at his request. Efforts to reach him were unsuccessful.

Copyright 2009 The Associated Press.

Coroner criticizes doctors over girl who starved

Date: 2/16/2009


LONDON (AP) — An 8-year-old girl starved herself to death because of an extreme dental phobia that doctors failed to diagnose properly, a British coroner said Monday.

Coroner Emma Carlyon said staff did not realize the severity of the condition afflicting Sophie Waller, who died in December 2005. Carlyon said this prevented the girl "from receiving the medical support that could have prevented her death."

Witnesses at the inquest testified that Sophie had an extreme phobia of dentists and refused to eat, sleep or drink after her baby teeth became loose. Medical staff ultimately decided to pull out all her baby teeth under general anesthetic in November 2005.

She was sent home a few days later but would not eat and died three weeks after the operation.

Her parents said they contacted doctors and a psychologist but no one saw Sophie in person before she died.

The Royal Cornwall Hospital in Truro, 250 miles (400 kilometers) southwest of London, acknowledged there had been failures in Sophie's care, and said it had made changes.

A coroner's inquest is required in Britain to establish the facts when someone dies unexpectedly, violently or of unknown causes, but has no power to punish anyone.

Carlyon gave a narrative verdict, in which a coroner simply outlines the circumstances that led to the death or deaths.

She said the immediate cause of Sophie's death was kidney failure due to dehydration and starvation.

Copyright 2009 The Associated Press.

Don't just talk to your toddler — gesture, too.

Date: 2/13/2009

By LAURAN NEERGAARD
AP Medical Writer

WASHINGTON (AP) — Don't just talk to your toddler — gesture, too. Pointing, waving bye-bye and other natural gestures seem to boost a budding vocabulary.

Scientists found those tots who could convey more meaning with gestures at age 14 months went on to have a richer vocabulary as they prepared to start kindergarten. And intriguingly, whether a family is poor or middle class plays a role, the researchers report Friday.

Anyone who's ever watched a tot perform the arms-raised "pick me up now" demand knows that youngsters figure out how to communicate well before they can talk. Gesturing also seems to be an important precursor to forming sentences, as children start combining one word plus a gesture for a second word.

University of Chicago researchers wondered if gesturing also played a role in a serious problem: Children from low-income families start school with smaller vocabularies than their better-off classmates. It's a gap that tends to persist as the students age. In fact, kindergarten vocabulary is a predictor of how well youngsters ultimately fare in school.

One big key to a child's vocabulary is how their parents talked to them from babyhood on. Previous research has shown that higher-income, better-educated parents tend to talk and read more to small children, and to use more varied vocabulary and complex syntax.

Do those parents also gesture more as they talk with and teach their children?

To see, university psychology researchers Susan Goldin-Meadow and Meredith Rowe visited the homes of 50 Chicago-area families of varying socioeconomic status who had 14-month-olds. They videotaped for 90 minutes to count both parents' and children's words and gestures. Quantity aside, they also counted whether children made gestures with specific meanings.

This is not baby sign-language; parents weren't formally training their tots. Instead, they used everyday gestures to point something out or illustrate a concept. A child points to a dog and mom says, "Yes, that's a dog." Or dad flaps his arms to mimic flying. Or pointing illustrates less concrete concepts like "up" or "down" or "big."

The researchers found an income gap with gesturing even in toddlerhood, when children speak few words.

Higher-income parents did gesture more and, more importantly, their children on average produced 25 meanings in gesture during that 90-minute session, compared with an average of 13 among poorer children, they reported in the journal Science.

Then the researchers returned to test vocabulary comprehension at age 4½. The poorer children scored worse, by about 24 points. Researchers blamed mostly socioeconomic status and parents' speech, but said gesturing contributed, too.

It's not just that richer parents gesture more, stressed Peggy McCardle of the National Institute of Child Health and Human Development, which funded the work.

"It's that there's a greater variety of types of gesture that would signal different types of meaning," McCardle said. "It sure looks like the kids are learning that and it's given them kind of a leg-up."

The study doesn't prove gesturing leads to better word-learning, but it's a strong hint. Now scientists wonder if encouraging low-income parents to gesture more could translate to toddlers who do, too, and in turn improve school readiness.

"It wouldn't hurt to encourage parents to talk more and gesture more," Rowe said.

Copyright 2009 The Associated Press.

Medical society looking into octuplets' conception

Date: 2/10/2009

LOS ANGELES (AP) — The American Society for Reproductive Medicine says it's investigating whether fertility treatment guidelines were broken in the case of a Southern California woman who gave birth to octuplets last month.

The society said in a statement issued Monday that it asked Nadya Suleman and the doctor for more details about her latest pregnancy. Suleman's six other children were conceived through in vitro procedures.

The voluntary, nonprofit organization has guidelines for the number of embryos that should be implanted to prevent multiple births. But the group can't stop doctors from practicing.

"It seems that the guidelines may not have been followed in Ms. Suleman's case," Dr. R. Dale McClure, president of the American Society for Reproductive Medicine, said in a statement.

In an interview broadcast Monday on NBC's "Today," Suleman said she underwent in vitro fertilization at a Beverly Hills fertility clinic run by Dr. Michael Kamrava.

The birth of the octuplets has raised questions over the ethics of implanting numerous embryos in a woman who already had six children.

Without identifying the doctor, the Medical Board of California said last week it was looking into the Suleman case to see if there was a "violation of the standard of care." The board said it has not taken any disciplinary action against Kamrava in the past.

Kamrava, 57, would not comment on the issue.

In the NBC interview, Suleman did not identify her doctor by name, but said that she went to the West Coast IVF Clinic in Beverly Hills — of which Kamrava is director — and that all 14 of her children were conceived with help from the same doctor. In 2006, Los Angeles TV station KTLA ran a story on infertility that showed Kamrava treating Suleman and discussing embryo implantation.

Suleman said she had six embryos implanted for each of her pregnancies. The octuplets were a surprise result of her last set of six embryos, she said, explaining she had expected twins at most. Two of the embryos evidently divided in the womb.

Medical ethicists have criticized the implanting of so many embryos. National guidelines put the norm at two to three embryos for a woman of Suleman's age, except in extraordinary circumstances.

Kamrava's clinic performed 52 in vitro procedures in 2006, according to the most recent national report compiled by the Centers for Disease Control and Prevention. Of those, five resulted in pregnancies and two in births. One of the births were Suleman's twins.

Kamrava's pregnancy rate that year was one of the lowest in the country. Experts say many factors affect a clinic's success rate including a patient's health and types of procedures done.

The average number of embryos Kamrava transferred per procedure for women under 35 was 3.5, compared with 2.3 nationally the report said. Fertility doctors often implant more than one embryo to increase the chances that one will take hold.

Suleman's octuplets were delivered nine weeks premature but doctors have said they appear relatively healthy.

Copyright 2009 The Associated Press.

Fla. lawsuit claims 3 kids died from hospital mold

Date: 2/4/2009

By CHRISTINE ARMARIO
Associated Press Writer

TAMPA, Fla. (AP) — The families of three pediatric cancer patients sued a Florida hospital this week, claiming their children died after contracting fungal infections from renovations being performed at the facility.

The lawsuit filed by parents against St. Joseph's Hospital Inc. in Tampa on Tuesday claims the children were exposed to pathogenic fungi because the hospital failed to properly seal off an area under renovation.

Each of the children — ages 2, 5, and 9 — had been previously diagnosed with acute lymphoblastic leukemia, a cancer of white blood cells. Two had recently gone into remission, and a third was still battling the disease.

Attorney Steven Yerrid, who is representing the families, said they believe dust containing the fungus became airborne and invaded the patients' rooms, "where all these children then were forced to engage in yet another battle."

"And this one was unnecessary, and could and should have been prevented," he said.

In a statement, the hospital said patient safety is its top priority, and that they take necessary measures to reduce infections. Those include using barriers around construction areas, filtering the air and monitoring ventilation systems.

All those measures were in place when the infections occurred, spokeswoman Lisa Patterson said. The hospital is part of the BayCare Health System, a network of not-for-profit hospitals in the Tampa Bay region.

"Cancer kills more children than any other disease," the hospital statement read. "Sometimes, despite all the measures we have in place, all the medical expertise we provide, and all the personal care we deliver, patients do not survive."

The lawsuit offers the following patient accounts:

Matthew J. Gliddon was first diagnosed with leukemia in 2005. After being treated with chemotherapy, he went into remission. But two and a half years later, his cancer returned. From November of 2007 through February 2008, he spent most of his time as a patient at St. Joseph's Hospital receiving treatment.

The 5-year-old's white blood cell count dropped very low, and he was at risk for bacterial and fungal infections.

According to the lawsuit, physicians discovered a spot on his nose, which grew and began destroying tissue. A nose biopsy later determined that he was suffering from a nasal mold infection.

As a result of the infection, Gliddon underwent surgery that removed most of his septum. Still suffering from cancer, and now in the presence of a mold infection, he was not a candidate for a bone marrow transplant. Gliddon died in April.

Around that same time, 2-year-old Kaylie Gunn-Rimes was also taken to St. Joseph's.

She had been diagnosed with leukemia when she was less than a year old. Last January, the toddler had an allergic reaction to one of her medications and was admitted to the hospital. Though she was cancer-free at the time, she was staying in the pediatric cancer floor and developed a fungal infection in her lungs. She spent 76 days on a ventilator before dying.

The third patient was a 9-year-old girl named Sierra Kesler.

Her leukemia had been in remission, but in March 2008 she went to the hospital and physicians discovered it had returned. She was given chemotherapy and went into remission again. The lawsuit says Sierra returned to the hospital a week later with a fever and coughing. She eventually had to be intubated and died in May.

In each case, tests confirmed the presence of a pathogenic fungi.

The lawsuit says patient rooms were located right above the construction activity, where renovation work would have created a moderate to high level of dust. The air condition systems would have brought air from the outside into patient rooms, it claims.

Sometimes, the patients had to be transported right through the construction area. The parents claim the hospital failed to take common precautions, including sealing the area under construction from non-work areas.

At least one of the parents had raised concerns about the air ventilation in their child's room, Yerrid said.

The hospital said that aside from using barriers around construction areas, it also conducts regular preventative maintenance rounds throughout the hospital; infection control, nursing, and other departments work together to provide a clean environment; and they educate families about the importance of infection control measures.

Yerrid said the parents are filing the lawsuit in hopes of helping other cancer patients. The parents themselves did not wish to speak publicly, he said. "Every precaution that needs to be taken, should be taken, from the welfare of our most vulnerable, these young weakened children," he said.

___

BayCare Health System: http://www.baycare.org/

Copyright 2009 The Associated Press.
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