Incident Report sent to Patient Advocate

I was visiting Dr Vimi Bajaj regularly for my prenatal care and follow-up and ever so more regularly during my last 8 weeks of pregnancy. At none of the appointments she failed to diagnose that I had low amniotic fluid. Not one NST was performed during my entire pregnancy well being aware of the family history of neonatal deaths nor was the fundal height measured or recorded correctly. This was after I was assured that post 32 weeks we would be doing weekly NSTs. My concerns about baby movements being slow and irregular were dismissed as being said that baby has outgrown space to grow. On a routine appointment at 38 weeks after being dismissed from her office saying that there is no dilation and baby won’t be born for 5 days. However I returned back and on my insistence an NST and Ultrasound was performed which showed that baby was measuring 2 weeks small and fluid levels were 4. This was not detected or monitored during any of my prenatal visits. And I had to undergo an emergency c section the same day because baby was more than stressed at this point. The baby who was measuring exactly on target at 30 weeks was measuring two weeks small for his gestational age. Had my gynecologist had been able to determine my fluid and baby’s growth restrictions by measuring fundal heights correctly; I wouldn’t have been robbed out of the experience of delivering even with laboring. I was very fortunate that I insisted on NST because else the baby might not have able to make it.

Due to being anxious, tired and dehydrated based on my very negative birth experience and possibly as a reaction to anesthesia, I developed tachycardia .The next day, Dr Bajaj orders a cardiac consult for tachycardia. TSH, ECG, EKG were all normal so a CTA was ordered to rule out PE. I refused CTA telling that I am fine. However I was forced to get the CT Scan by the doctors. The CTA was severely degraded by respiratory motion and inconclusive in its findings. At that point, based on equivocal report and in absence of any symptoms, heparin was started being fully aware that the patient has just had a recent abdominal surgery.. In the CCU, my HR stabilized during the night. Dr. Bajaj arrives next morning and instead of ordering definitive diagnostic tests, took the decision to start me on Coumadin and anticoagulation for a year and 5 days on heparin moving me to the heart hospital. Dr Bajaj also asks me not to breastfeed and says she will give me injections tomorrow to dry out my breast milk. This was after that fact that I denied all symptoms and insisted I was feeling fine. I was also not told that CTA was inconclusive and I was not allowed to see the report in the hospital and all requests for confirmation CTA were denied for 5 days. I was also not made aware of the possibility of bleeding on anticoagulants.

On Post Op Day 3, there was significant bleeding from the incision site and wound was opened with 4 staples. There was copious amount of serum and blood drainage (almost to soak fifteen to twenty ABD Pads and bed sheet completely) However still no definitive studies were carried and anticoagulation was continued. Also Dr Bajaj tells me that I should never have any more kids because of the severe PE I had. On Post-Op day 5 the entire wound opened up, again large amount of serum and bloody fluid was extracted from the abdomen. Again fifteen – twenty ABD pads and the entire bed sheets were soaked with blood. And anemia kept on getting worst in spite of oral Iron medication thrice a day. WBC count keeps on rising daily in spite of intravenous antibiotics for past 5 days. The wound which was superficial is now almost a centimeter deep. Still heparin and Coumadin are continued in spite of recurrent bleeding and repeated absence of any symptoms (chest pain, shortness of breath, leg pain, swelling etc ). I am also discontinued from telemetry saying that my tachycardia is due to anxiety and anemia. At that point I again requested them that since I am having no symptoms and I am bleeding and telemetry is being discontinued saying tachycardia is due to anemia and anxiety (And since tachycardia was only indication of cardiac consult) why don’t we order another CTA and see where we are at clots. But they dismiss me. On day 5 nights, I start running a fever due to loss of blood and weakness. However still heparin is continued. On Post op day 6 finally wound erupts and massive hemorrhage occurs. There was enormous oozing through gauze despite significant amount of pressure. I was on vitals every 4 hours and when nurse came to check vitals she saw me covered with clotted blood and gradually diminishing blood pressure. Since I was not on monitor even my falling vital signs were not detected. At that point five days late Doctor Bajaj finally orders a second CT scan, VQ Scan, and Venus Doppler study all of which rule out DVT and PE. At the end of 6 days finally she refers me to pulmonary doctor who rules out PE and DVT. On Day 6, Dr Bajaj tells me that we need to do a CTA to drain fluid from the abdomen and also because first was inconclusive so let’s now order a CT scan again and see if clots actually exist. It was determined that there was no PE or DVT and there was no evidence of PE or DVT ever, I was never required to be on anticoagulants.

Had Heparin been started as a preventive dose, Coumadin and anticoagulation for a year should have been decided only after a definite diagnosis was made. Coumadin was started on 01\12 very well being aware that patient feels fine, CTA is inconclusive and recent abdominal surgery. Bleeding on 01\13 did not force them to take any necessary action till 01\16.Even on 01\15 when incision was draining serous material and patient developed a fever of 101.1 , heparin was continued. Pulmonary consultation, repeat CTA, Venus Doppler, VQ Scan should have been carried out much earlier instead of on 01\16. The patient had started bleeding on 01\13. In light of the inconclusive reports, repeat CTA or VQ should have been carried out before jumping on decisions for IVC Filter or Coumadin.

All during the course, I was kept in bed with a Foley catherator and asked to lie absolutely still without moving my legs. Once it was determined that no PE or DVT exists, I was to be transferred to the OB floor on morning of Jan 17. The baby was discharged on Jan 17 mornings and it would have been easier for us to keep the baby on OB floor. However she does not visits me till late in the afternoon on Jan 17. At around 3.30 p.m. She arrives, removes the Foley and asks me to go home without checking if I am able to ambulate or urinate. I was only allowed to get out of bed once during these 7 days to bedside. When I expressed my hesitation and discomfort on ambulation, she leaves me in the heart hospital room and we had to make the baby sleep in the hospital bed with us because there was no bassinet available on the floor. I was discharged with continuous bleeding and indurations from the incision site and only hours after I was allowed to ambulate after 7 days in bed. She does not even visit me on the day of discharge (Jan 18). After that I had to visit her continuously for 14 weeks for wound care and treatment. Wound drained purulent thick bloody serous material for 6 weeks enough to soak 8 ABD pads per day and there was a big clot over the right hand corner of the corner of the wound. After 6 weeks the drainage changed to yellowish and continued for another 6 weeks. The wound was 13 cm long and an inch deep. I faced great difficulties in walking and urinating during weeks after discharge. Even today there is a 0.5 cm gap from where the incision closes to the point where it meets the rest of the skin.

There was no home health care barring once a week and my husband had to dress and pack the wound twice daily for 14 weeks apart from taking care of my infant son. He had to suffer severe strain because of this. Also because of mother baby separation and anemia during the first week of his life, my baby lost on a lot of precious breast milk. Entire trauma all caused loss of bonding and breast milk for my baby.

All during the hospital stay my baby was kept away from me in the hospital nursery and allowed only 2-3 hours per day for the first week of his life. Moreover he was discharged a day earlier and we had to make him sleep with us in the heart hospital room before I was allowed to go home. Any planning for baby no 2 definitely needs to wait a great amount of time due to the ongoing physical and emotional trauma

Her carelessness is evident from the numerous mistakes in the hospital discharge summary:-
1. The wound has been mentioned to open superficially in the hospital records. The patient wound was 13 cms long and at its peak 2.4 cms deep and has taken 14 weeks to close. The patient had to undergo severe mental and physical trauma during this period.
2. The PT\INR was not therapeutic on Coumadin during the hospital stay
3. Coumadin was started on Post Operative day 2 i.e. January 12, 2006 and not Day 4 as mentioned in the records on being ok by Dr Bajaj.
4. Hypercoagulable workup was ordered due to clots and not due to lipids.
5. Heparin was discontinued only for an hour on Jan 16 due to super therapeutic levels and was to be restarted after an hour.
All during the hospitalization, I ask Dr Bajaj that I feel fine and I have no symptoms. I want to know how big the clots are. But all I am told by her is that I should be grateful to her for saving my life. I feel no symptoms and I would have never known about her PE and died had she not been proactive in saving her life. How lucky for me that she treated me although there were no symptoms. A girl like me who is generally logical, confident and smart is exploited in most vulnerable way. My coherent confident self turned nervous, anxious and scared as I was told that I am unable to feel symptoms of what is going wrong with my body.