Former Ohio prison inmate thinks stillborn could have been prevented; Prison and hospital officials
In November 2006 a woman from Tipp City entered Ohio's prison system - she was about four months pregnant. By the end of February the eight month old fetus was dead. Hill alleges the prison system and hospital should have done more to try to save her unborn child. But officials say they took every necessary precaution. In the second part of a two-part series, WOSU asks the prison and hospital if inmates get top notch care.
Rebecca Hill was about four months pregnant when she entered the Ohio Department of Rehabilitation and Corrections in November 2006. She was there to serve less than a year for a felony theft conviction. Later that month Hill had a normal ultrasound. And by all accounts her fifth pregnancy was on the right track.
But all that changed in February. Hill says her fetus was not moving as much as it had been. And Hill, who has four other children, says this differed from her other pregnancies.
So Hill did was she could. She complained to corrections officers about the decreased fetal movements.
"And they just kept on telling him for me to do another fetal count, eat something to see if the baby would get active, or drink something, there was no improvement whatsoever," Hill said.
After complaining for a week Hill received a fetal non-stress test or NST. It's one of the first tests doctors perform when a pregnant mom reports decreased fetal movement. Doctors hope to see the fetus's heart rate increase and decrease normally. If so, most of the time, docs and moms can rest easy.
Hill received three of these non-stress tests on three consecutive days - two at the prison and one at the Ohio State University Medical Center. All three tests came back normal.
Despite reassurance from medical staff at the prison and hospital, Hill was convinced something was wrong. She said the fetus's movement was not improving.
Twelve days after she first started complaining about a decline in fetal movement, Hill delivered Elijah Paul Barnes about a month early. Elijah was stillborn.
Rebecca Hill is adamant she and Elijah did not receive all the medical care they should have because she was in prison.
So WOSU asked: could more have been done? And the answer we received was: yes.
Doctor Randy Fink is an obstetrician and gynecologist in Miami, Florida, and has served as an expert witness in medical court cases. While Fink did not review Hill's medical records, he questions the care she received.
"I think it certainly bears careful consideration as to whether the standard of care was met," Fink said.
Fink said had Hill been one of his patients with the same complaints he would have ordered something other than the non-stress test. He said he would have conducted a special ultrasound called a biophysical profile. It measures the amount of amniotic fluid, fetal movements and breathing.
"If a patient presented for a second time with decreased fetal movement there would not be an occasion when I would not have ordered a biophysical profile. A non-stress test doesn't tell you anything about, say for instance, the volume of the amniotic fluid, which can be an early indicator of fetal problems," Fink said.
WOSU sought another opinion. Carolyn Sufrin is an OB/GYN at the University of California at San Francisco. She reviewed Hill's medical records. When asked about biophysical profiles, Sufrin said they are often components of prenatal care, especially in high-risk pregnancies.
"But often times in a low risk pregnancy, which this pregnancy was, your first step is to do an NST. And if that's reassuring then most of the time you feel pretty reassured. However, you could say, you know, she consistently had decreased fetal movement. They could have looked into it and gotten a biophysical profile," Sufrin said.
John DesMarais is the prison system's medical director. He said he can not comment on the medical treatment Hill received in prison. But DesMaris said conducting a non-stress test in a case like Hill's is standard.
"In general the non-stress test is used as a screening tool in obstetrics to identify whether there is anything to worry about," DesMarais said.
The state department of corrections contracts out its medical care to Ohio State University Medical Center. DesMarais said the Ohio Department of Rehabilitation and Corrections does not dictate what kind of care or what tests its inmates receive. He said that's up to Ohio State.
"They are at liberty to use their best medical discretion," DesMarais said.
Mark Landon is the director of maternal fetal medicine at the OSU Medical Center. Landon said inmates receive the same level of care as any other patient.
"There is no second standard of care, if you will, for incarcerated women. And many of these women have high-risk pregnancies and receive all of the testing that goes with the management of their conditions," Landon said.
Dr. Sufrin was asked if she thought there was anything else that could have been done to save Hill's fetus.
"Maybe they should have thought about something over the weekend," Sufrin said.
But Sufrin said the answer is always easy in hindsight.
WOSU asked ODRC Medical Director DesMarais if inmates are given the benefit of the doubt.
"Are all their claims taken seriously? One of the things you'll notice during any interview that you have with me is that I'll refer to our inmates or offenders as patients, that's what they are to us. They have the right to life and we have a duty to perform the best medical services that we can," DesMarais said.
OSU Medical Center fetal medicine director Mark Landon said additional testing is not always the answer. Landon said hospital attorneys will not let him specifically speak about Hill's case. But he said when the non-stress test comes back normal or "reactive", no other tests are necessary.
"If the non-stress test is reactive then there is no need for a back up test since we know that the chance of something happening to the fetus in utero is very small in the face of a reactive non-stress test. So the back up test, such a as a biophysical profile is generally utilized when the non-stress test, also known as the primary test here, is non-reassuring," Landon said.
The autopsy indicated Elijah died from placental abruption. That's when the placenta separates from the uterine wall and deprives the fetus of oxygen. About one out of every 100 pregnancies will have a placental abruption. But only one in 800 abruptions results in the death of the fetus. Placental abruptions can have numerous symptoms like pain and bleeding or no symptoms at all. Hill never reported any symptoms.
Dr. Fink said the fact this was Hill's fifth pregnancy, was another red flag.
"I know that there is an increase in association of abruption in women with an increase number of pregnancies. So, I would raise my eyebrows. But a woman who comes in with decreased fetal movement, mom's subjective sense of the baby moving is one of the best indicators or is certainly a good indicator of fetal well-being," Fink said.
Both Sufrin and Fink said there is no particular test or series of tests that can identify when a woman will have a stillbirth. They said many times stillbirths happen very quickly and without warning.
Dr. Fink was asked if Hill's stillbirth could have been prevented.
"In the event that a biophysical profile had been performed that was, that was not completely normal, then, yes, a potential bad outcome could have been avoided," Fink said.
Prisons medical director John DesMarais would not second guess the decision-making.
"Is there a reason why you wouldn't want to do everything possible to reassure that absolutely nothing is wrong or could be wrong? I wish I could help you with that but honestly I am a board certified family practitioner not an obstetrician/gynecologist. I'm familiar with the initial events and some pre-natal care, but I'm not familiar with the absolute indications or contraindications to proceed in along those lines," DesMarais said.
Dr. Landon was asked if OSU patients like Hill are treated differently because of their inmate status.
"The obstetric care that incarcerated women receive through the obstetrics department is the same basic obstetrics care that all the women in our care and practices would receive," Landon said.
Of the 695 babies delivered in Ohio's prison system since 2002, Elijah Paul Barnes was the only stillborn baby. Rebecca Hill admits she's no angel. Hill's criminal record includes theft, drug possession and domestic violence.
Even so, Hill said her unsavory background should not have played a role in the type of health care she and Elijah received while she was in prison. But she thinks it did.
"Oh, well, send her back. She isn't worth it. She's not worthy enough. And, you know, maybe I'm not worthy enough, but my child was. You know, he was a pure innocent child," Hill said.