Evelyn Muhlhan's website - Page 3
Yes, this is what bugs me. I was a non-emergency transfer for a c-section from a birth center. From the time I arrived at the birth center until the time my daughter was born was 2 hours. This included checking me in, realizing my baby was breech, doing an ultrasound to confirm, crying and mourning my birth, talking with the midwives and my husband, transferring to the hospital, checking in, being prepped for surgery, being bumped because someone with an emergency needed the OR, getting into the OR, on the table, etc. To have Hopkins take a healthy mom and baby and just leave them there for 2 hours waiting until they were no longer a healthy mom and baby is criminal. Just to prove a point? Who knows. But whatever happened BEFORE they arrived is irrelevant.
The defense team solicted unbiased expert reviews when evaluating the case, and all consistently said that JHH did not committ malpractice in the case. I would assume that they are more quaified than you to render an opinion on what happened here. The jury admitted post-verdict that they disregarded all of the expert testimony in the case and rendered their decision based upon the fact that Hopkins is a great hospital and nothing bad should happen there. The cap will only cut out the bulk of the non-economic damages. They will end up paying around $29M on the caes. There dont appear to be any viable appeallate issues and Hopkis has high insurance limits. No one involved in this case supported tha actions of the NMW. There is no question that she committed malpractice.
Jreed, whoever you may be and whatever your interests are, you have yet to answer the question. Why did JH wait? All we can conclude is that either it was incompetence (they didn't have the organization to get a mother the care she needed) or it was malicious (punish the homebirther.)
Their actions seem by definition malpractice. JH was the last to act, had the time and ability to avoid harm, but did not do so. Good verdict.
Oh, did the defense get experts to say this was in the realm of the standard of care? What a shocker. JH paid those witnesses, and qualifying as a legal expert is not a difficult standard. I'm a defense lawyer. I hire experts. I could find people to say anything, although of course I have some ethical and frankly strategic problems with that. Here, the defense had no choice. They made the argument they had to make.
So yeah, our system puts these decisions in the hands of the jury. The public whom this hospital claims to serve. Baltimore City juries are notoriously Plaintiff friendly, but in this case, I can't see how they could have decided differently.
Yeah. Wonder why you're posting. In my quick review, that was a generally neutral article.
The question is why, at what should be one of the best hospitals in the US, a patient comes in with an emergency and has to wait hours for life-saving care. If JH was so busy, why not divert the ambulance to another hospital?
If the baby had died, you might be able to say it happened on the midwife's watch. A fetus does not lack for oxygen and survive for HOURS. That's a matter of minutes. Minutes that made up the end of the totally unacceptable wait caused by Johns Hopkins.
The anti-homebirth crowd can't have it both ways. They can't say in birth minutes count, and then let mothers in clear need wait. This was an ugly case where something terrible happened at the hospital. Clearly. And I don't see anyone taking responsibility for that.
At least we have the jury here to force hospital accountability, with a big enough number to make them rethink their policies. Maybe prompter attention next time? How about aiming for the standard - 30 minutes?
Really, why use this case to bring one of MD's last well respected midwives down? I don't know EM and have no opinion of her abilities. But she looks pretty innocent here? Yes, I've read the hospital's complaint. She cut an episiotomy, the horror! Also irrelevant. She looks like a scapegoat to me.
This case has confirmed for me something friends had told me about their transfer experiences. Homebirth in Maryland is more dangerous than I previously believed. Because hospitals punish homebirthing mothers on transfer. In that 7/14/12 Baltimore Sun article, the one new thing for me was that the hospital labeled the mother an "uncooperative patient." Oh the balls of the Dr or nurse that put that category down. Uncooperative? Make me wait when I know my baby and I are in need and see how "uncooperative" I could be. My husband would have been near violence. That poor family. Imagine how they felt after the first 20 minutes, hour, hour and a half.
The more I think about it, the more angry at our local medical birthing system I get. I'd like to believe this was an isolated situation, all the wrong things happened that night. But I suspect it's more endemic than that, and I personally know a woman made to wait 45 minutes for her "emergency" surgery on transfer. And I thought that was appalling.
Until I hear something from the hospital or Maryland medical community saying something went wrong here, rather than point fingers at the midwife who got a mother in need to the place for care in ample time to keep the baby alive (if not well), I have to assume this problem is system wide, and would happen again and again.
Edited by Gena 22 - 7/18/12 at 8:24am
Unbiased experts who reviewed the case in the case evaluation stage concluded 2 things. First that JHH committed no violations of the standard of care (based on all the circumstances) and that the damage had been done during the labor at home. Earlier delivery would not have made any difference once the child had arrived at the hospital. They can determine this trough analysis of the blood gasses, fetal monitoring strips and imaging studies. The amount that will be collectible after application of the state cap will be $29M. This amount will be paid, unless plntf elects to accept less to avoid potential appeals on legal issues. There do not appear to be any significant appelllate issues. You make many assumptions in your posts that are not supported by the facts.
Jreed - again, sources, please! A Baltimore jury found Hopkins guilty based on evidence that our legal system deemed admissible. They have the right to appeal but, for now, they have been found responsible. The burden is on you to provide resources to back up your claims that our legal system is wrong and/or the jury made an error in judgement. What are your sources?
Not saying anything for or against this case, but I just wanted to point out a baby can survive for hours (yes, hours) while becoming acidemic in utero. Although outcomes have not been shown to improve with continuous EFM we know that the "type" of strip we are looking at can be indicative of fetal acidemia in utero...in layman's terms, the strip can look crappy and be a cause for immediate delivery (i.e. c-section). We don't have a strip to review in this case since they don't do EFM at home. What if when she got to the hospital the strip looked "okay"...not saying there's an excuse for why mom was forced to wait two hours for a c-section (it should have been immediate IMO), but it could explain why JHH waited two hours. Another tool we have to assess fetal status are cord blood gases. In the case of baby Martinez, the gases upon delivery were not good but not terrible and possibly not what you'd expect with a baby diagnosed with HIE (cord/lnitial blood gas was ph 7.1; pC02 63; p02 10; BE -13). That being said, it's hard to identify a cause for the severe CP...there's really no way to tell if it happened at home or at JHH.
JHH did not stand a chance in winning. Most women nowadays have had at least one friend/family member who have had an emergency c-section (the how's and why's of whether it was truly emergent is another convo entirely). That being said, how many emergency surgeries take one or two hours to initiate? I wasn't at the hospital so I don't know what happened or why it took so long, but I don't think any jury would have voted in favor of JHH regardless of what happened at home. Do I think a jury should have heard what happened at home? Absolutely. Let's see the entire picture of what went wrong, because based on practice standards (which OBs and CNMs alike choose to follow when getting board-certified) things seemed to go wrong on both ends. Do I think it would have mattered in the verdict? Probably not...again, if things got bad at home why wait to do a c-section?
Let this sad case be a reminder that collaboration on both ends is key. You can't be anti-hospital and physician and expect there to be a seamless transfer system in place from home to hospital. Similarly, docs can't be anti midwife and homebirth and expect for hbing families to just go away or be swept under the rug. Hb will continue...heck, women will free birth if need be...and doctors and midwives will need to find a way to co-exist. More work is needed on the physician end since our mw's have a hard time finding collaborating MDs to begin with, Still, this case will only scare more MDs into not working with our mw's...remember that obstetrics in this country is rooted in the practice of defensive medicine. Sad, but true.
Edited by baltimoremomtobe - 7/22/12 at 3:50am
Thank you, Baltimoremom. That was a thoughtful post, and I didn't know or understand some of the details you mention.
Wish you first sentence above wasn't true, but I know it is. What an ugly cycle we're in. Defensive medicine. Bad for everyone.
I don't know EM, and for all I know, maybe she is a incompetent midwife. Not saying she is, only that of course it's possible. I only got involved with this thread because of my shock and disgust over the treatment of the home birth transfer in the Johns Hopkins case. From what I've heard, although EM doesn't sound like a midwife I would have hired (too hands on), the case against her looks an awful lot like a witch hunt. Which breaks my heart, because Maryland was under served by good midwives when I gave birth 5 years ago, and the situation is so much worse now.
Maryland hospitals are dangerous places for some moms - like me. I was a healthy primipara carrying di-di twins, both head down. No birth center would take me - rules are rules. AAMC's 80% twin c/s rate would mean surgery and drugs I didn't need. I ended up with a midwife from Pennsylvania, a smooth home birth, and a healthy family. My good delivery wasn't a fluke, it was the result of good prenatal care (in parallel with OBs) but more importantly an experienced and skilled midwife, well provided with oxygen, IV, and IM pit (to help with 3rd stage).
Maryland is a wonderful state, but the attitude against midwives and home birth transfers hurts us all. Maybe it's best that EM loses her license. I doubt it, but anything's possible. From what info I've read about her case, it's not warranted, will definitely have a chilling effect on future midwives, and is making Maryland a more, not less, dangerous place to birth in.
Edited by Gena 22 - 8/1/12 at 8:06am
Gena...sounds like you had the perfect birth - good for you! I wrestled with a hb for my didi twins and ran into problems finding a good provider (actually, I felt I needed two providers - one for each baby and myself). The difficulty in finding the right "team" and the out of pocket costs would have been too difficult this time around. If I have another baby, I'd def like to hb. I opted for a hospital birth and don't regret it even if it I didn't have the "natural birth" I desired. In our case, my son's head became stuck in the birth canal - his sister arrived vertex and he (having extra fluid) turned footling breech for his delivery. I fully believe the positive outcome we had was because I chose an experienced provider (one who was skilled in twins and breech delivery) to catch my babies. Too many people get stuck on OOH or hospital birth and don't know the skill set of who will catch their babies. Not all hb midwives are skilled in breech or twin delivery...similar for hospital-based providers. Too many woman don't know who will be at their delivery. This is a problem. If you are seeing a hb midwife who has another client in labor when you are ready to deliver and she sends an assistant or her backup mw to your birth but those folks don't have enough experience with breech presentation then I view that as an unsafe situation. Similar to going to an OB practice and only one or two providers know how to catch breech babies and you go into labor when Dr so-and-so is on and you get an automatic c-section b/c baby #2 is breech. Both situations are bad and bring unnecessary risks to mom and baby. The only answer is to have more providers available for the services that we (consumers) want. The change must come from the consumer base because our mws are too overextended as-is trying to juggle the heavy client load. We have to contact our representatives and let them know what options we want! Too many are interested in going with the status quo and that's what fuels our poor maternity care system. We preggos have an equal responsibility to fight for change we believe in. Okay...off my soapbox for the day :-)
You have no idea what you are talking about.
This case is one of the reasons that Evelyn lost her license.
Here are at least 4 ways that Evelyn committed malpractice in this case:
I.Utilizing Intramuscular Oxytocin to stimulate labor in a term pregnancy;
II. Using fundal pressure in the second stage of labor to attempt to cause descent ofthe fetus;
III. Using vaginal chlorhexadrine, rather than intravenous penicillin, in labor to treata known group B beta hemolytic strep vaginal carrier to prevent early onset GBS neonatal sepsis;
IV. Misdiagnosing fetal station resulting in an unnecessary episiotomy. The physical exam on admission to Hospital B was a fetus impacted in the vagina at + 1 station which was incompatible with the report that the fetus had been crowning when the episiotomy was performed...
In addition to the above, Evelyn let the mother labor for 20 hours prior to calling an ambulance.
Finally, the assertion that the damage was done in the last 18 minutes is patently false. That was just the plaintiff's allegation. The science said otherwise, but the jury disregardrd the evidence.
I. emergency. pulling out all the stops because baby was struggling.
II. Fundal pressure is used in emergencies in many industrialized countries with better fetal outcomes than the US.
III. She lets the PATIENT decide what course of action to take and gives risks and benefits of each
IV. No misdiagnosid necessary. Stress can and does cause reverse stationing. I have personal knowledge of such an occurrence that also resulted in immediate cesarean.
Oh wait, this one didn't result in immediate cesarean... because JHU didn't trust the perfectly qualified professional who was telling them what was needed... because of their own prejudice against homebirth. And THAT is why the jury found negligence on JHU and NO charges were filed against Evelyn, neither by the family NOR the hospital.