Medical Power Over the Innocent Part 2

Yesterday, we left off with Sara and her daughter, Crystal, chasing after the Family Service workers who had taken custody of Sara's baby to bring it back to hospital.

My friend who had been witness to this entire episode was so upset she was not able to drive for ½ an hour or more. She was sure that when she was able to drive back to the hospital, she would see Sara's car crashed by the side of the road but luckily, Sara kept her head enough to get back safely.

When she arrived at the hospital, she was told that her baby was upstairs in the ward with 7 other babies and that she could stay there for the night but her other daughter, Crystal, couldn’t and if she couldn’t find somewhere for Crystal to stay, she would be put into foster care.

Luckily, one of the sympathetic nursing staff agreed to take Crystal home with her while this is going on.

The doctor examined the baby and said that she needed to be back on IV antibiotics. This was despite the fact that she had no temperature nor any signs of illness.

When I spoke with Sara, she said that they tried 5 times to get the cannula into the baby’s hand but were unable to insert it so they had to give her a short break and try again. In all, it took 7 attempts before the cannula was able to be inserted and the antibiotics started.

The baby was screaming and screaming from the pain of all those needle sticks and one has to wonder about the risk of infection just from having all those needles shoved into her arm.

Again, there is no evidence of an infection, but the doctors said the IV antibiotics were simply a ‘precautionary’ measure.

The choice of antibiotics seemed interesting. Both times baby was given antibiotics, it was not just one but two. And not your normal, average, run of the mill antibiotics. She was given two very powerful drugs - Vancomycin and Gentamicin.

Vancomycin's prescribing information states:

To reduce the development of drug-resistant bacteria and maintain the effectiveness of vancomycin and other antibacterial drugs, vancomycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.

In addition, Vancomycin is generally reserved for treating hospital-borne infections and yet, this baby was given this drug as soon as her mother was brought in the first time when she had never been in a hospital.

Below is the list of known side-effects from Vancomycin - as you will see, this is not a benign drug - it has very serious side effects associated with it which is why Sara was concerned about discovering whether antibiotics were necessary before subjecting her daughter to them:

Nephrotoxicity {02}{04}(change in frequency of urination or amount of urine; difficulty in breathing; drowsiness; increased thirst; loss of appetite; nausea or vomiting; weakness) neutropenia {02}(chills; coughing; difficulty in breathing; fever; sore throat)—usually reversible “red man syndrome” {02}{04}(chills or fever; fainting; fast heartbeat; hives; hypotension; itching of skin; nausea or vomiting; rash or redness of the face, base of neck, upper body, back, and arms)—may result from histamine release due to rapid infusion

Incidence rare Chemical peritonitis {28}{34}(abdominal pain and cramps; abdominal tenderness)—in patients receiving high doses by intraperitoneal administration linear IgA bullous dermatosis {21}{22}{23}{24}(large blisters on arms, legs, hands, feet, or upper body) ototoxicity {02}{11}(loss of hearing; ringing or buzzing or a feeling of fullness in the ears) pseudomembranous colitis {02}{04}(abdominal or stomach cramps and pain, severe; abdominal tenderness; diarrhea, watery and severe, which may also be bloody; fever) thrombocytopenia {02}{04}(abnormal bleeding or bruising) Those indicating possible ototoxicity, nephrotoxicity, or pseudomembranous colitis and the need for medical attention if they occur or progress after medication is discontinued Abdominal or stomach cramps and pain, severe abdominal tenderness change in frequency of urination or amount of urine diarrhea, watery and severe, which may also be bloody difficulty in breathing drowsiness fever increased thirst loss of appetite loss of hearing nausea or vomiting ringing or buzzing or a feeling of fullness in the ears weakness

The other antibiotic administered was Gentamicin. This drug, like Vancomycin, is generally reserved for treating hospital-borne infections rather than the run-of-the mill bacterial infections. Gentamicin can persist in the gut for a very long time and the side effects, which are significant, may appear shortly after use or months down the track. Below is a list of these side effects. Please note that the most common side effects are also very serious.

General

The most frequently reported adverse effects associated with gentamicin therapy are ototoxicity (loss of hearing) and nephrotoxicity (kidney damage). These forms of toxicity occur more frequently in patients who experience prolonged exposure to serum gentamicin trough concentrations of greater than 2 mcg/mL. Patients with renal insufficiency are at an increased risk of developing toxicity.

Renal

Renal side effects associated with gentamicin use have included nephrotoxicity. The overall incidence of aminoglycoside nephrotoxicity is 2% to 10%. Gentamicin nephrotoxicity occurs in two forms: acute renal failure (ARF), and a more gradual, transient, and reversible azotemia. Fanconi syndrome and Bartter-like syndrome have been reported.

Acute renal failure due to gentamicin is usually nonoliguric with an average rise in serum creatinine of 1 to 3 mg/dL. Renal function generally returns to baseline in 7 to 14 days. Rarely, gentamicin produces renal tubular acidosis and renal potassium and magnesium wasting. There is no relationship between acute renal failure and the daily dose of gentamicin, however, an increased incidence has been associated with a serum trough gentamicin concentration greater than 2 mcg/mL. It has been suggested that there is a correlation between the higher peak concentrations associated with once-daily dosing and a higher incidence of nephrotoxicity. Other predisposing factors include advanced age, preexisting renal insufficiency, dehydration, and  concomitant use of other potentially nephrotoxic drugs.

Nervous system

The onset of ototoxicity may be asymptomatic or may manifest as dizziness, vertigo, ataxia, tinnitus, and roaring in the ears. High tone hearing loss is often an early symptom of auditory toxicity. It has been suggested that once-daily dosing of gentamicin is associated with a higher incidence of ototoxicity.

Other side effects possibly related to gentamicin have included lethargy, confusion, depression, headache, pseudotumor cerebri, and acute organic brain syndrome.

Nervous system side effects have included ototoxicity, which generally presents as loss of vestibular function secondary to hair cell damage, but may also be auditory. Ototoxicity is closely related to the development of renal impairment, and may be irreversible. Peripheral neuropathy or encephalopathy with numbness, skin tingling, muscle twitching, seizures, and myasthenia gravis-like syndrome have also been reported.

Intraventricular and intrathecal administration of gentamicin has rarely been associated with aseptic meningitis, transient hearing loss, and seizures. Neuromuscular side effects including ataxia, paresis and incontinence have been reported after large intrathecal doses (40 mg to 160 mg) of preservative-containing gentamicin. Concurrent administration of parenteral and intrathecal gentamicin has been associated with eighth nerve dysfunction, fever, convulsions, leg cramps, and increases in cerebrospinal fluid protein.

Musculoskeletal

Musculoskeletal side effects have rarely included neuromuscular blockade, which occurs most commonly in patients who are predisposed including patients with myasthenia gravis, hypocalcemia, and those receiving a concomitant neuromuscular blocking agent. Tetany and muscle weakness may be associated with gentamicin-induced hypomagnesemia, hypocalcemia, and hypokalemia. Joint pain has also been reported.

Respiratory

Respiratory side effects have included case reports of respiratory depression and respiratory arrest. Gentamicin has also been possibly associated with pulmonary fibrosis.

Hypersensitivity

Hypersensitivity reactions possibly associated with gentamicin have included anaphylactoid reactions and laryngeal edema. Suspected allergic reactions against gentamicin with sodium metabisulfite preservative have been reported.

Local

Local reactions have occasionally included pain at the injection site, and rarely subcutaneous atrophy or fat necrosis at the injection site. Reactions associated with intrathecal injections have included arachnoiditis and burning at the injection site.

Dermatologic

Dermatologic side effects possibly associated with gentamicin have included rash, itching, urticaria, generalized burning, and alopecia.

Hematologic

Hematologic side effects possibly related to gentamicin use have included anemia, leukopenia, granulocytopenia, transient agranulocytosis, eosinophilia, increased and decreased reticulocyte counts, thrombocytopenia, immunologic thrombocytopenia, and purpura.

Hepatic

Hepatic side effects possibly related to gentamicin use have included transient hepatomegaly, and increases in serum transaminase, serum LDH, and bilirubin.

Cardiovascular

Cardiovascular side effects possibly related to gentamicin have included hypotension and hypertension.

Gastrointestinal

Gastrointestinal side effects possibly related to gentamicin have included nausea, vomiting, weight loss, decreased appetite, increased salivation, and stomatitis.

Ocular

Ocular side effects have included case reports of retinal ischemia resulting in loss of visual acuity after inadvertent intraocular injection of massive doses of gentamicin.

Other

Other side effects possibly related to gentamicin have included transient splenomegaly and fever.

Other

Pyrogenic reactions with symptoms of shaking, chills, fever, rigors, tachycardia, and/or hypotension have been reported with intravenous gentamicin. These reactions generally occurred within 3 hours of administration and were believed to be due to once-daily gentamicin doses delivering sufficient endotoxin over one hour to be pyrogenic.

No right to question

For some reason, despite these known side effects, Sara was considered to be mad to worry about her daughter receiving these drugs.

The day after being readmitted to hospital, a hearing was held more than 300kms away - too far for Sara to attend to defend herself nor was she able to arrange for a lawyer to represent her on such short notice. Even the Family Services representative wasn't there - the information was faxed to the Judge who, based on what was written and without access to the other side of the story, issued a 14-day order for Sara's baby to be made a ward of the state. Sara was told that she would no longer be able to be with her baby or to hold her because she was considered to be a threat to her child.

The only way in which she would be allowed to see her child was if she became a voluntary psychiatric patient. She agreed to this because she knew that she needed to be with her child. She was told that she would be moved to a closed psychiatric ward where she would have no contact with the outside world; she would not be allowed phone calls nor would she be able to receive visitors. She was not even allowed outside the doors of the hospital.

She was informed that she could express milk to feed her baby but she would not be able to hold her or to spend any time with her. There was also no guarantee that the expressed breast milk would be used for her child – it all depended on whether staff had enough time to bring the milk to her or not.

Think about this. Imagine if this were your child. How would you handle it? And any one of us could be in this position. All it takes is doing things slightly differently and asking questions of the medical staff.

My friend visited with Sara every night to bring her organic food, lend her a mobile phone so she could speak with people outside of the hospital and just to cheer her up. Below is a report he made on the Sunday, 3 days after Sara was 'recaptured'. He covered his experience of being with Sara when the police caught up with her and her situation in the hospital:

Some more bits from my angle. I was not intending to to be away from work all day when I drove Sara to her car on Thursday, so I was a bit impatient with all the goings on. As far as I could see, once the police were there, they were going to stay all day if necessary though I got the impression that they had the power to section Sara at any time and cart her off. In all, the police were great. The problem was that at the clinic there were another 4 police waiting there with their own separate orders. The first police crew still hung around for another hour or so once we got there.

So there were about 6 Police for around 2 hours. Quite a costly exercise. In the meantime, resources would have been stretched for about 200Km in every direction for this 'very dangerous' person who was not under arrest. It was amazing. I don't like driving with the radio on which was a pity because I would have turned around long before we reached Sara's car and this ridiculous situation would not have arisen. Apparently, the radio was telling everyone that the baby was seriously ill and certain transmissions used the word “escaped” from Hospital. I Know the police were expecting to find a baby near death. That was soon put to rest when they saw her. The staff at the Caravan Park where Sara's car had been left were also wonderful and supportive of Sara and her girls. They also agreed that the baby looked fine.

A free spirit, when found, must be dealt with severely and held up as an example for the rest of the community. The media were all singing the same tune. As I said before, I do not listen to the radio but I will have to start soon. That message about the "escape" and the “baby in danger” was still being played at about 5pm. Police had the baby and mother under their observation/control from about 9AM. This can only be a public relations propaganda exercise to abuse taxpayer funds keeping that false statement on air beyond operational necessity. If it was not an oversight, then the effect of the unflattering message could demonise the victim so that if other incidents arose with this case in the future, the public would be numbed, or even hostile to the victim. It would also entrench in the idle mind, a notion that it is illegal to walk out of hospital.

In casual conversation with one of the Family Services officers, I mentioned the right of the victim (Sara) to refuse treatment. The officer responded abruptly "Yes, but not for the baby". I found that statement quite profound. Do the new intervention laws state this? Note that at this point, the intervention law had not been used. From my experience and the text available, Sara had not been sectioned under the Mental Health Act even at that point. I used to believe that the mother also had the right to refuse treatment for her baby. Especially one who was being medicated without any sign of the ailment for which that medication was indicated. What hope have we all got if this is the view of Family Services officers who appear to enjoy mega power?

Not one Law was broken. Not one arrest or even mention of such for myself. The pseudo law of not bowing to the medical establishment will only get stronger if we stay silent.

Pressure brought to bear

With the incredibly prompt intervention of the Ombudsman who got the ball rolling within hours of being informed of this situation by myself, Sara was given permission to stay with her child as long as her [Sara’s] condition did not deteriorate (they were referring to her supposed mental condition). This was on a Friday and she knew that there was nothing that could be done until Monday when she was hoping to find a legal representative to appeal the custodial orders on her child.

Once the Ombudsman became involved, the hospital quickly did some of the things that they should have done initially like allowing a Community Visitor to see Sara and to witness her assessment by psychiatric staff; tell her of her rights as a patient; inform her that she was allowed to use the phone and receive visitors, etc. All of these were denied to her previously.

Sara spent her first 2 nights back in hospital in a ward with 8 children – her baby was one of them. She was sleeping on a cot next to her daughter’s bed and was not allowed to leave the room for any reason. There was a guard at the door of this room at all times, watching to make sure she did not try to leave. She told me that when she goes to the toilet, the guard pounds on the door every 30 seconds to make sure she is still there. This is torture - plain and simple.

There was a secret staff meeting which a sympathetic nurse told Sara about. At this meeting, the psychiatric staff and Family Services officers discussed Sara's refusal to allow the Hep B vaccine and how this reflected on her mental state. It seems that they felt that anyone who refused vaccination was obviously mentally imbalanced.

This is the state of the law in Australia today – and who is protected by these sorts of draconian measures?

Not the mother – she was caring for her baby in a loving and caring way. Not the older sister – she has been incredibly traumatised by this whole episode. Certainly not the baby who has been medically assaulted, ripped from her mother’s arms and is now looking at spending 14 days (at the least) with a total stranger.

Today, Sara and her family are the victims – tomorrow, it could be you or someone you love.

Tomorrow: Weight gain, antibiotics and control over every aspect of Sara's and her baby's lives.