Woman refuses CS, charged with murder

Jolie, BSN · Mar 16, 2004

It seems like there is much more to the story than is being told. This woman obviously did not have the real care or concern of the medical staff. The laws are quick now to interfere into peoples personal lives and if she has a history of mental illness, then she just does and she has special needs that need to be taken care of by her doctor and nurses and others involved in her care. It sounds like she was on the right foot to be involved with the father of the children. In a state like Utah, such persons who cohabitate may be unpopular with the status quo. So they would be more likely to be picked on and will stand out even more. She is not a good looking woman, which is all the more reason why she would be singled out.
People live with mental illness every day and raise children with the disease, like it or not and it's the reality and it's a high percentage now of our population. Mental illness strikes the ugly and the beautiful alike. I don't think that they should charge her with murder as this seems totally unfair. This talk of a scar does not make any sense to me. Maybe she was just fearful of another surgery and could not express herself in any other way to say that she didn't want to have a surgery here, so she made up this excuse involving the issue of the scar. That is quite possible as people often do not like to admit that they are afraid. Things are not always as they appear.
There are uncounted numbers of situations where C-sections were requested or required and were not done for one reason or another, only to find that the baby died or was still born. There are multiple cases where the doctor was busy with someone else. Doctors car broke down in traffic, doctor did not make it on time because of this or that, rounds took priority, or he was out shopping and didn't make it on time. Mother did not get to the hospital in time, mother was left alone at home, did not feel well and just thought to lay down for a little while, mother at the last minute changed her mind and opted for a lady partsl delivery against her doctors advice, etc. In the end, the story was the SAME, baby was stillborn.
In cases like this, do we prosecute everyone involved all the time? Our prison population will then sure grow fast. Are we becoming a police state and do we want to live in such a society that is policing people in their personal lives to such a hard core extent? Is it a situation that involves policing? She did not commit murder as she did not give this child pills or drugs to intentionally kill it. She may have been fogged from her mental illness and prehaps past experiences and needed extra time and concern from the medical staff plus maybe a psych referral or consult and maybe some spiritual care too and help with getting over her fears of having a C section.
She should have been dealt with more compassionately from the start to the finish and the situation might have not been so grievious. She is right now grieving for having lost her 2 children. She languishes in prison in a society that was unfair to her and in a system that did not have any real concern for her.

To Azdream'nRN,

I have to say that your post disturbs me. There is much about this story that is unknown to us, including whether or not the mother CHOSE to access prenatal care, yet you have decided that, "this woman obviously did not have the real care or concern of the medical staff." And that "the laws are quick now to interfere into people's personal lives..."

I'd like to know how you have reached these conclusions. Because with 11 years of OB and NICU experience, much of it high-risk, I have never encountered a situation that involved the lack of real care or concern for a patient, or a legal situation where a judge was quick to interfere into people's personal lives.

As I said, much of this discussion involves conjecture on our parts, since information has not been made available to the public. But I would be willing to bet the farm that this mother did not have regular prenatal care which would have enabled her to establish a trusting relationship with a provider such as an OB or CNM. Whether or not to access prenatal care is the mother's choice. No one goes out and rounds up pregnant ladies for their prenatal checkups. Having had at least 2 previous pregnancies, I'm sure she was aware of the importance of medical care, and had at least some inkling of how to go about getting it, but it appears that she chose not to do so. That she visited a number of different ER's in the final weeks of her pregnancy raises a huge red flag that she had no regular provider who could have helped her thru her mental health issues and the complications of her pregnancy that led to the demise of one twin. And not having a regular provider would have been her choice.

The staff members that evaluated her in each of those ER visits gave her consistent information regarding the risk of continuing her pregnancy and attempting a lady partsl delivery. She consistently refused their suggestions and left AMA each time. As much as it pains me to see the outcome of this case, I support her right to refuse a C-section. I don't know how you think the staff could have successfully gotten a judge to intervene and order a C-section. Have you ever been involved in obtaining court-ordered treatment for a patient? I have, and it is not easy. Judges do not take lightly (nor should they) the notion of over-riding a patient's stated wishes. The only cases I have seen in which judges issued orders for treatment involved minor children whose lives were in imminent risk without it, and whose parents refused consent. The rationale being that the children would want to live, if they were able to state their own wishes. I have never seen a case where a judge imposed an order for treatment against the wishes of an adult, especially when the life of the adult is not in danger. Even in cases of involuntary psychiatric treatment of the mentally ill, most states require that the patient pose an imminent risk to the safety of himself or another person before a judge can mandate treatment. Again, sadly, I have to agree that this case does not meet such a standard, as the rights of an unborn child do not outweigh the rights of the mother.

I agree that a charge of murder is not appropriate here. She did not take action to knowingly kill her baby. That she chose not to take action to save it is indeed sad, but not murderous.

You state, "She should have been dealt with more compassionately from the start to the finish and the situation might not have been so grevious." Please do not indict the medical professionals who tried to save her child. You have no idea what mental health interventions they attempted to make during her brief ER stays. So, the notion that more compassionate treatment by the doctors and nurses could have saved this baby's life is, frankly, offensive.

While I agree that this mother's choices do not make her a muderer, she is responsible for the outcome of this pregnancy.

kanai3 · Mar 16, 2004

Can anyone think of a more suitable punishment or charge than murder?(this is a question, I'm not saying murder is an apprpriate charge-so please don't misunderstand)

Hmm. I disagree with her being charged at all - since I don't think you can force people to have procedures, but if I had to charge her with something, I would charge her with criminal negligence for failing to use contraception, since people like that shouldn't be having children..

But I also wonder - if to give her the benefit of a doubt since all this reporting was A.) third hand - if maybe she was just scaried - maybe she needed some patient education - since she sounded pretty naive talking about the C-section, (what was that great quote they used - about having an incision from sternum from pubis..) I also question the veracity of some of the quotes.

kanai3 · Mar 16, 2004

Jolie -

I much agree with your reply but you stated it better than I could have. I became quite annoyed reading the post giving the same old "callous and cold-hearted "staff song and dance. It irritates me that her personal responsibility for her actions should be considered to be negated by "a lack of compassion" by medical and nursing staff. That just seems a conveinent way to shift blame.

While pondering her interior motivations is interesting, it doesn't absolve her of any responsibility for the ultimate outcome.

Recognizing this responsibility doesn't make us any less compassionate either. :)

southRNflchick · Mar 16, 2004

To Azdream'nRN,
I have to say that your post disturbs me. There is much about this story that is unknown to us, including whether or not the mother CHOSE to access prenatal care, yet you have decided that, "this woman obviously did not have the real care or concern of the medical staff." And that "the laws are quick now to interfere into people's personal lives..."
I'd like to know how you have reached these conclusions. Because with 11 years of OB and NICU experience, much of it high-risk, I have never encountered a situation that involved the lack of real care or concern for a patient, or a legal situation where a judge was quick to interfere into people's personal lives.
As I said, much of this discussion involves conjecture on our parts, since information has not been made available to the public. But I would be willing to bet the farm that this mother did not have regular prenatal care which would have enabled her to establish a trusting relationship with a provider such as an OB or CNM. Whether or not to access prenatal care is the mother's choice. No one goes out and rounds up pregnant ladies for their prenatal checkups. Having had at least 2 previous pregnancies, I'm sure she was aware of the importance of medical care, and had at least some inkling of how to go about getting it, but it appears that she chose not to do so. That she visited a number of different ER's in the final weeks of her pregnancy raises a huge red flag that she had no regular provider who could have helped her thru her mental health issues and the complications of her pregnancy that led to the demise of one twin. And not having a regular provider would have been her choice.
The staff members that evaluated her in each of those ER visits gave her consistent information regarding the risk of continuing her pregnancy and attempting a lady partsl delivery. She consistently refused their suggestions and left AMA each time. As much as it pains me to see the outcome of this case, I support her right to refuse a C-section. I don't know how you think the staff could have successfully gotten a judge to intervene and order a C-section. Have you ever been involved in obtaining court-ordered treatment for a patient? I have, and it is not easy. Judges do not take lightly (nor should they) the notion of over-riding a patient's stated wishes. The only cases I have seen in which judges issued orders for treatment involved minor children whose lives were in imminent risk without it, and whose parents refused consent. The rationale being that the children would want to live, if they were able to state their own wishes. I have never seen a case where a judge imposed an order for treatment against the wishes of an adult, especially when the life of the adult is not in danger. Even in cases of involuntary psychiatric treatment of the mentally ill, most states require that the patient pose an imminent risk to the safety of himself or another person before a judge can mandate treatment. Again, sadly, I have to agree that this case does not meet such a standard, as the rights of an unborn child do not outweigh the rights of the mother.
I agree that a charge of murder is not appropriate here. She did not take action to knowingly kill her baby. That she chose not to take action to save it is indeed sad, but not murderous.
You state, "She should have been dealt with more compassionately from the start to the finish and the situation might not have been so grevious." Please do not indict the medical professionals who tried to save her child. You have no idea what mental health interventions they attempted to make during her brief ER stays. So, the notion that more compassionate treatment by the doctors and nurses could have saved this baby's life is, frankly, offensive.
While I agree that this mother's choices do not make her a muderer, she is responsible for the outcome of this pregnancy.

I completely agree with your statement, Azdream'n....everything you said was right on....

The only thing that I haven't read in a single one of these posts is this:

if the patient was truly suffering from a mental illness,and wasn't of sound mind...why didn't someone step in (anyone, a doctor, a family member) and have a stat psych consult done on her, and BAKER ACT the woman? If you are a threat to yourself or others (in this case, the babies) and do not act rationally...this is always an option. She could have at least been monitored, possibly developed a "rapport" with a medical professional (for those of you that assumed no medical staff was caring or kind to this woman) and the whole outcome could have changed. I've seen pregnant patients Baker Acted before, so I know it can be done!!! Hindsight really IS 20/20.

:uhoh3:

ktwlpn, LPN · Mar 16, 2004

http://dsdsdemo2.ap.org/aponline/us_stories/122_ds_3568026.html Here is another stiory that sheds some insight into this woman'a psych history-and she certainly looks like she has decompensated...

CoffeeRTC, BSN, RN · Mar 18, 2004

I'm not an OB nurse, but have read a few of the posts... Question..could they have just tried to induce her for a lady partsl birth and try to deliver the babies that way? I know C section would be safest, but wonder if this could have been an option??

Jolie, BSN · Mar 18, 2004

I'm not an OB nurse, but have read a few of the posts... Question..could they have just tried to induce her for a lady partsl birth and try to deliver the babies that way? I know C section would be safest, but wonder if this could have been an option??

That thought has crossed my mind too, but it is hard to say with the scanty details we have available.

The reason I've seen given for the recommendation of a C-section is that the twins' heart rates were slowing. No further details as to whether mom had a NST, a CST, or a biophysical profile, any of which would be helpful in determining the babies' ability to tolerate labor. I've also not heard that mom had any clear-cut contra-indications to labor such as a placenta previa or partial abruption. Another consideration would be the position of the twins. If they were vertex-vertex, perhaps an induction could have been attempted, but breech or transverse presentations would have made this too risky.

For argument's sake, let's say that the twins were vertex-vertex, and mom had no clear-cut contra-indications to labor. Because of the slowing heart rates, a C-section was advised, but mom refused. Whileinduction is not the optimal standard of care here, it is probably preferable to continuing the pregnancy indefinitely. If you were the OB, would you offer the option of an induction to this patient?

I would not, and this is my reason: It is simply too risky legally for me. This mom has clearly stated that she will not, in any circumstances, submit to a C-section. So, if the induction goes badly, I would have no means of saving the babies, and hence have no legal protection. And I'm quite sure that this patient would sue me for all I'm worth if something does go wrong.

I have, on occasion, seen OBs offer a trial of labor to patients in whom it was not really indicated, because the patients had a strong desire to attempt a lady partsl birth, and a clear willingness to RUN to the OR should anything go awry. This has happened when the patients had good, long-standing, and trusting relationships with their doctors, which was clearly not the case with this patient.

Sadly, it was not in the OBs best interests here to deviate from the accepted standard of care because of the potential that they could lose their practices for the sake of a non-compliant mom.

jnrsmommy · Mar 18, 2004

This is an all around sad situation. What truly scares me is the steps that the healthcare system can now take for or against you. Here's my point, does anyone remember the case several months ago (I believe it may have been on the east coast, but I could be wrong) about the lady who was told at two different hospitals that she needed to have a c-section. I'm not clear on all the details, but what was said was that she was scared of them because she had known someone that had died either during or as a result. She left both hospitals AMA, and proceeded to a third. During this time, the second hospital was able to obtain a court order for her to have the c-section. They weren't able to serve her due to her going to the third hospital, where she delivered a healthy baby lady partslly.

I understand that in this day and age fetuses have rights, but where does theirs begin and ours end?

upallnight · Mar 18, 2004

Whatever her reasons for refusing a c-section should have been addressed by the medical staff. If just for vanity, then teaching should have been done. If she is mentally ill, then she should have been seen by a psych doctor and green warrented into a mental health facility. If this woman is mentally ill, then only she knows what was going on inside her head. She had probably convinced herself of all kinds of crazy things! She could not think rationally. I choose to believe she is mentally ill because I am appalled that someone would risk a dead baby to avoid a scar. I have taken care of all kinds of weird women in labor who have all kinds of crazy things written on their birth plans. Through teaching a rational person will make an informed decision to ensure her baby's health, and the goal here is to have a healthy happy outcome - a good baby and a good mom who had a good labor experience.

I'm afraid that charging a woman with murder will lead other women with uneducated ideas about hospital births to avoid doctors and hospitals in the future - leading to even more bad outcomes!

newgrad2004 · Mar 18, 2004

I'm Sorry I just dont get it. I would take a bullet for my kids, would step infront of an oncoming car to save them. Never even considering what it would do to me. Scar my face, scar my body, I do not care. I would choose my childrens lives before anything, even vanity. I have had one child I lost prematurely. I would have taken any scar to have him alive. I did have an emergency C/S, and have had 2 more since. (although, when I got cancer of the cervix I was vain but in the end chose to have the new scar to LIVE for my kids.) Would she not breast feed because her breasts might get smaller? Would she not worry about getting hemmroids, episiotomy, or having stretch marks?

I'm sick about her decision. This is not the same as abortion, this appears to have been a child who could have been born alive, and had a chance at life. And her selfishness/vanity cost him his life. Sorry but she should not be a mother.

What if her child falls into a pool and she just had her hair done, will she leave him fighting for life to go get someone else to rescue him/her?

BabyRN2Be · Mar 18, 2004

I don't know if this has been updated, but I had heard the other night on national news that this woman had tried to sell the surviving twin to a relative for bond money. I tried to find a link to this story, but I've been unsucessful.

There's another link I've found that give more details surrounding this story. When she did eventually deliver, she was positive for alcohol and cocaine. This link goes a little more indepth to the story.

http://www.sltrib.com/2004/Mar/03122004/utah/147031.asp

It's amazing that she's doing so much talking from prison. I hope that her attorney is talking to her about how much she's saying to the press.

Katherine

newgrad2004 · Mar 18, 2004

Oh god, I just saw her picture. And she was vain? I think she was affraid of being tested for drugs, and going to jail any way.

Im surprised she didn't just squat in some alley to have her kids.