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Tuesday
Jul212009

Refusal of Unnecesarean Leads to Loss of Custody: V's Story

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On April 16, 2006, V and B, a married couple, went to Saint Barnabas Hospital after V began experiencing contractions. V is described in court documents as a 42 year old, college educated woman who was thirty-five weeks pregnant and in labor upon arrival at St. Barnabas Hospital in New Jersey, which boasts a 49.3 percent cesarean rate. V signed the consent form for the administration of intravenous fluids, antibiotics, oxygen, fetal heart rate monitoring, an episiotomy and an epidural anesthetic. However, she refused to the blanket consent forms for c-section or fetal scalp stimulation. According to the court documents, hospital personnel explained the “potentially dire consequences of not allowing a c-section in the event of fetal distress.”

 

In the hospital records, V is described as “combative,” “uncooperative,” “erratic,” “noncompliant,” “irrational” and “inappropriate” while in labor. V requested that the obstetrician leave the room and called the Livingston Police to report that she was being abused and denied treatment. She exercised the right to refuse to wear an oxygen mask, would not consent to fetal heart rate monitoring and “thrashed about to the extent that it was unsafe for the anesthesiologist to administer an epidural,” but records do not indicate whether or not she had requested an epidural. While yelling loudly, she exercised the right to refuse a bedside ultrasound.

 

Dr. Mansuria, the obstetrician, explained the possible complications that could occur if the fetus went into distress and a c-section was not performed, such as brain damage, mental retardation and fetal death. Mansuria claimed that “an examination” revealed a nonreassuring fetal status. B said that he understood the risks and V would not consent to the procedure.

 

The legal findings show that the “hospital responded appropriately to confront V’s mental state and her refusal to consent to the c-section.” The staff requested an emergency psychiatric evaluation to determine V.’s competency. Dr. Devendra Kurani spoke to V for approximately one hour and while Kurani was there, the anesthesiologist was able to administer an epidural. V informed Kurani that she had a “psychiatric history” and had been on medication prior to getting pregnant. B confirmed that V had been treated by a psychiatrist for post-traumatic stress disorder and had been prescribed Zoloft, Prozac and Seroquel.

 

Dr. Kurani concluded that although V was anxious, she was not psychotic and had the capacity for informed consent with regard to the c-section. The staff called in a second psychiatric evaluation from a Dr. Jacoby. Before the second psychiatrist was able to complete the examination, V gave birth vaginally to J without incident in spite of Dr. Mansuria’s repeated claims that V’s baby was in distress and could suffer brain damage, mental retardation or fetal death without the recommended cesarean.

 

A social worker at Saint Barnabas Hospital contacted the Division of Youth and Family Services on April 18, 2006, two days after J’s birth to report concerns over releasing the baby to her parents’ care. Caseworker Heather Frommer went to the hospital, interviewed staff and spoke to V and B, who denied that V “had ever received psychiatric treatment, had ever refused to consent to a c-section or had ever been evaluated by a hospital psychiatrist.”

 

Frommer was told by Dr. Kurani that he prescribed had Zyprexia for V (while in labor) but she refused to take it and that V “distorts everything that is told to her.” His interactions with V were while she was in labor.

 

Frommer told the parents that once J was medically cleared for discharge, she would not be going home with them. V became upset, started yelling and called the police. Frommer told B and V that there would be a court hearing on the matter on April 20, 2006, then V was discharged from the hospital.

 

Later that day, Frommer went to the parents’ apartment to complete a home assessment and reminded V.M. and B.G. about the court hearing on April 20, 2006. She called on the morning of the hearing to remind the couple of the hearing and B denied that he knew Frommer. They did not show up to the hearing and J was discharged from the hospital on April 24, 2006, and placed in foster care.

 

At another hearing on May 9, 2006, V’s PTSD and psychiatric history was discussed with the trial judge, who directed V to release her psychiatric records to DYFS, and if they confirmed what she said, J would be returned to her. V’s previous psychiatrist had diagnosed her V as suffering from post-traumatic stress, panic disorder and major depression as a result from being forced to participate in a boxing match at work in 1993. Notes showed concern that V had not made progress and was demonstrating paranoia and psychotic ideations.

 

According to the court documents, V offered the judge “information that proved to be in significant conflict with the hospital records,” stating that she signed the consent form as soon as she arrived at the hospital and “even though she was in extreme pain, it took the anesthesiologist several hours before administering an epidural. The first time he tried, the nurses were pushing her back and forth so violently that he could not administer the injection.” Dr. Kurani was called at V’s request to “deal with the inappropriate behavior of the nursing staff.”

 

V stated that she had been prescribed medicine prior to pregnancy for panic attacks, which she didn’t take due to side effects. She also said that she did not learn of DYFS’s involvement in the case until April 21 and that she never received notice of the court proceeding on April 20.

 

With regards to the issue of whether J was in imminent danger in the first 48 to 72 hours of life, the trial judge stated that “a series of events transpired in the hospital that were alarming and that might have caused a reasonable person to believe the child was in danger.” He did not base his decision that J was in imminent danger in the hospital solely on the refusal of a cesarean. The findings state that “he observed that there were probably many instances where a mother’s refusal to accept a c-section would not constitute abuse.”

 

The judge reviewed the medical records of V’s erratic behavior and commented that V.M. appeared to care about having a healthy baby, yet found that she was “negligent” in not acceding to the doctors’ requests and found that J was an abused or neglected child. The judge rejected B as a custodial parent because B allegedly did not comply with DYFS and agreed that J would be returned to B under the condition that B:

  1. receives a psychological evaluation within the next week

  2. the evaluator concludes that the child would be in no danger with B

  3. the child’s mother is not in the home

  4. a mechanism is in place for monitoring V’s visits.

 

B and V refused these conditions and the judge expressed frustration on September 15, 2006, observing that he “wanted desperately to reunify this family,” but the parents were “snatching defeat from the jaws of victory.” He asked if V would waive her right to sue psychiatrists so that the psychatirst would not be concerned that they would be sued if they undertook the evaluation. V said she would not waive that right.

 

At the March 19, 2007 permanency hearing, J’s foster mother stated that V and B visited J once every two weeks and always brought shopping bags full of supplies for the baby.

 

Dr. Vivian Chern Shnaidman performed a psychiatric evaluation of V and B for DYFS and noted that “despite V’s high level of intelligence and education, she was not able to comprehend her situation.” She diagnosed V with chronic paranoid schizophrenia and B with “folie à deux, a rare condition in which one person subscribes to the psychoses and paranoid delusions of another.” According to Shnaidman, V and B function in a very “paranoid and secretive way, with each person’s paranoia supporting the other’s.” She noted that J would be in danger in their care, as they are unpredictable and “want nothing to do with the world that we live in.”

 

V and B countered with the expert opinion of Dr. Marc Cantillon, who stated that B was anxious and distraught over DYFS’s removal of his daughter, but he had no mental disorder of any kind. He concluded that B and V would be suitable parents. Cantillon opined that V’s “bizarre” behavior at the hospital could have been caused by oxygen deprivation and that she expressed a willingness to obtain ongoing psychiatric care.

 

The trial judge stated: “I don’t think I’ve ever seen a case of mental disorder where the diagnoses … [were] so diametrically opposed. We’re in different worlds.” Observing that Dr. Shnaidman’s wording in advising against reunification was the strongest language he had ever seen in this type of case, the judge sought an impartial third party opinon, then entered an order on March 19, 2007, reflecting his findings that the couple would not get custody of their child.

 

Defendants V and her husband, B appealed this judgment. On July 16, 2009, the appellate court offered that did not concur with the previous ruling that V’s refusal to consent to a cesarean section can, as a matter of law, be considered abuse and neglect, but found that there was “substantial additional evidence of abuse and neglect that supported the ultimate findings.”

 

It all started with exercising the right to not sign St. Barnabas Hospital’s blanket cesarean consent form, which caused staff to question V’s competence. Things escalated when V refused an oxygen mask, electronic fetal monitoring and a (proven) unnecessary cesarean.

 

According to the author of the ICAN of Somerset County, NJ blog who has spoken with V since the findings were released, “…the custodial issue only came up because she delivered at St Barnabas and they wanted the freedom to do a c-section at will.”

She sat in on the proceedings and heard the judge tell V in one of her hearings that he felt she would be “too argumentative and that would wind up hurting her child. For instance, she would argue with teachers and receptionists at the dentist office.”

In her opinion, the undue burden of repeatedly trying to disrupt and stop V’s birth process while she was in the throes of labor would be enough to make someone paranoid and distrusting.

They call V paranoid and claim there is something wrong with her. I think I’d be paranoid too if someone took my baby away from me. Physically and emotionally, that has to take an incredible toll on a woman who is not expecting that. V wishes the doctors had told they didn’t believe she was fit to be a mother so she could have made arrangements to have her child cared for by someone she knew. V is being told that doctors can decide which people are fit to be parents.

This is a tough case. It was all instigated over a cesarean that was not ultimately needed. How much time and money are being invested into keeping V’s child away from her rather than trying to work with her and help her learn whatever parenting skills they feel she needs?

 

Read the appellate court’s findings here.

 

Related Posts:

Superior Court of New Jersey Terminates Cesarean-Refusing Mom’s Parental Rights (July 20, 2009)

New Jersey Cesarean Refusal Case: The “System” is Schizophrenic (July 23, 2009)

St. Barnabas Medical Center’s Cesarean Rate is 49.3 Percent (July 29, 2009) 

Anonymous Comments about New Jersey Cesarean Refusal Case (July 30, 2009)

 

 

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Reader Comments (46)

Dou-la-la, Louise Marie Roth is great. She's a sociology professor. HuffPo only allows comments of a certain length and I probably should apologize to Lousie for deluging her comment section with three simultaneous quotes the other day.

July 23, 2009 | Unregistered CommenterJill--Unnecesarean

quote from article above:

"A social worker at Saint Barnabas Hospital contacted the Division of Youth and Family Services on April 18, 2006, two days prior to J’s birth to report concerns over releasing the baby to her parents’ care."

two days prior? this is incorrect - either you mean two days AFTER or you mean April 14th - something is wrong with this statement.

July 23, 2009 | Unregistered Commentertracy

Ohh, crap. Thank you, Tracy.

Edited at 9:15 am on 7/23/09 to reflect the change Tracy mentions... "prior to" changed to "after"

July 23, 2009 | Registered CommenterJill

I saw the Huffpo piece first, then finally found this one. IMO the Huffpo is so stripped of info as to be misleading. It omits all the pyschiatric information, and does not include the court's explicit statement that the c section refusal was not the reason to take the daughter away. Readers of the Huffpo piece are left with the impression that a nice educated middle class woman had her baby taken away from her solely for refusing a C section and being surly. This is not correct. There is plenty here to be appalled about without being so misleading...

July 23, 2009 | Unregistered Commenteranon

This entire case is a joke. Judge James Rothchild who made the original decision on April 20, 2006 to illegally place the child in foster care was investigated by the Supreme Court Judicial Conduct Committe and the Committe seized 30 cases out of Rothchild's courtroom and transferred them to other Judges and Rothchild was being monitored by another judge for all of his other cases. Obviously the Judicial Conduct Committee had concerns with regard to Rothchild;s capacity to follow the law. Another Essex County Family Court Judge wo presided over the guardianship proceedings because of his close friendship with Rothchild became an advocate for DYFS and manipulated the proceedings so that due process was denied to defendants. Callahan also helped DYFS and hired expert witness's for them who were on the DYFS payroll. Even though a DYFS docter who Callahan hired to help DYFS with the case testified that the parental rights should not be terminated Callahan stated there is a problem with doctors.

July 23, 2009 | Unregistered CommenterMarie

anon, I thought it was good, but I'd already read the backstory. Blogging for a major blog means you have to follow typical journalistic guidelines that you don't have to on a small blog. While I still do fact checking and keep my citations on file if not cited in the actual post, I have the flexibility to have a copy-and-paste fiesta of information that falls outside of the definition of "article." Plus, I can insert speculation, opinions and feelings as long as I label them as such. I'm still getting used to the blog format.

July 23, 2009 | Registered CommenterJill

Marie, you made my jaw drop. I don't know how I'd verify what you're saying. I'm floored.

July 23, 2009 | Registered CommenterJill

The Essex County Family Court Judges, James Rothchild and John Callahan who presided over the Abuse/Neglect trial
and Guardianship trials are both crooked. Judge James Rothchild made statements to attorneys that he is a crooked
Judge and he asked defense cousel for a $10,000. bribe and said that if he received this money from V.M. and B.G.
he would return J.M.G. to them. Defense counsel informed his clients that they would be committing a crime if they
agreed to Judge Rothchild's request. Judge John Callahan who also has a terrible reputation and is a good friend of
Callahan illegally manipulated the entire Guardianship proceedings by not allowing expert witness testimony from defendants docters and Judge Callahan was having fun and laughing while he was doing this. In addition, Callahan
became an advocate for DYFS after trial because DYFS had not met the burden of proof with regard to the 4 prong
test. After the DAG Wilbur Van Houten was given a copy of Callahan's order on June 16, 2008 Mr. Van Houten
started screaming at the Judge. Judge Callahan then decided to advocate and help DYFS by hiring a docter named
Dr. Ronald Crampton who you guessed it has been on the payroll and working in the Newark DYFS offices. Dr. Crampton told defendants that he did not understand why the Bloomfield, N.J. office was pursuing this case. Dr.Crampton testified before Judge Callahan that he did not recommend termination of parental rights and recommended
that the minor see a psychologist and return the minor to the biological parents. Dr. Crampton was concerned that [portion deleted by moderator]
] This condition has devastating consequences for a person's eyesight. When Dr. Crampton told Judge
Callahan not to terminate the parental rights Callahan became angry and stated the problem with DRS. is they all say
different things. Judge Callahan is considered a layperson and therefore has no right to ignore the expert witnesses
and terminate parental rights because he is an advocate for DYFS. It was also evidenced during bonding evaluations
that the minor fought and was irritable while in the presence of foster caretakers. That makes it obvious that the
foster caretakers are most likely being violent toward the minor and are also abusing the child mentally. IThe statistics
demonstate that it is very common that children are abused by foster caretakers and that abuse is 4 times more likely
t courto occurr in fostercare than if a child is in the care of its biological parents. The DYFS agency throughout the country
keeps the abuse secret and turns a blind eye to it. In addition DYFS gets away with murder because they claim
that everything is confidential so the media never finds out what they are doing. The Appellate Court made the illogical
decision that if anyone who is pregnant is accused by the docters that they didn't follow the docter's instructions to
a T then it is equivalent to not following the instructions of a police officer. I mean if one refuses to obey an officers
instructions they can be cited with a ticket of failure to comply or if an officer claims that a person is loud or
combative then the officer can charge the person with disturbing the peace or a petty disorderly. Well both the
family court Judges and the Appellate Judges are sending a message with this case. First all the pregnant women
and their husbands need to be aware that OBGYNs have the same status as a police officer and if the docter claims
that the patient was not cooperative during prenatal care or labor and delivery the baby might be taken away from them.
In addition, if a person plans to have a child during their lifetime it is not a good idea to seek any mental health treatment
because both the docters and DYFS can use it to deny custodial rights to a parent.
This case boils down to two things: OBGYNs make more money doing c-sections and testing and the more trauma the
pschiatrists can cause to people the more treatment they can recommend. Lets face it docters and hospitals make their
living off of injured and sick people. Interesting that OBAMA made a statement in his address that the current
healthcare system is bankrupting the taxpayers,government and people in general and that Congress is currently
working on a plan to force the docters and hospitals to change their status quo which is to perform surgery because
it is lucrative and not because it is required.
it to preclude someone from ever becoming a parent
family

July 23, 2009 | Unregistered CommenterMarie

This article is rather hard to get through honestly, due to the extremely poor writing of the author. For instance, the sentence-
"The judge medical records of V’s erratic behavior and commented that V.M. appeared to care about having a healthy baby" does not make ANY sense whatsoever. If the time cannot be taken to write a coherent sentence, how can one assume that the accuracy of ANY of it has been looked into. I have been watching this case. I have found it very sad on many levels. This article however, leaves no way, for me at least, to make heads or tails of what is even being said. Please take the time to edit your writing into coherent and correct English. THANK YOU!

Thank you for catching the typo. The words "reviewed the" were returned to their proper place in the sentence. And if a typo makes you so angry, you have the right to not read. I'm sorry you're very frustrated by word omissions. I just looked up your IP address in the access logs and it looks like you've returned to the site over and over tonight, which adds a nice touch of creepy.

July 24, 2009 | Unregistered CommenterWTF?

I can't believe there is a law in the state of N>J. that if a woman ever had a c-section that by law she is required to
have a c-section if she becomes pregnant again. That is absurd. I mean much of the time OBGYNs lie to women
and then the second time around the women finally realize how damaging a c-section really is since they have already
had one. I think that law needs to be changed. In addition, I think that if the state of n.J. and DRS. were doing this to
men there would be so many drs. beat up and shot at that the state would have to change that law. I do not agree
with the people who wrote in and said it is not a good idea to strike against DRS. and hospitals. If we take away their
money they will be forced to change their ways. IIf there are birthing centers staffed with midwives in the state of
N.J. that will help the situation. The only way we will change OBGYNS is if we boycott hospitals such as ST. Barnabas Hospital..That is the only way to get through to them. The DRS. and hospitals will ignore all the groups
and all the talk in the meantime. Due to the fact that most women fold under the pressure to consent to c-sections
it makes it extremely difficult for the few who do not. We live in a society that where the victimization of women
is very common. The judges made the decision that they did not because they gave a damm about fetuses but
because it scares them as men that a woman is smart enough to figure out that the OBGYN was lying to her and
was strong enough through all of the beatings she endured from the nursing staff and she still didn't fold. Well
that just plain scares the men. They want to send a message with their decision that they will not tolerate intelligence
and strenght from women. They will only tolerate that from men. It is time for a change. IUnless a pwerson has a terminal illness or is injured we do not really need DRS> If birthing centers staffed with midwives are available in
every state then who needs an OBGYN. After all an OBGYN is a surgeon and tha t basically means that is you go to
one as a patient you are setting yourself up for surgery. For instance, I have all my exams done by a primary
care DR. so I do not need an OBGYN. If I ever become pregnant I would use a midwife at a birthing center or do
a home birth but I would never go to a hospital. I think there should be a demonstration in front of St. Barnabas
hospital and the media should cover it. It seems as though there is something very wrong at that hospital. The CEO
Ronald DElMauro is not doing a good job managing the hospital. There have been so many deaths from c-sections
because any kind of major surgery should not be taken lightly. I wonder if Ronald DelMauro's wife died from a c-section or if his child was taken away from him and his wife how would he react.. He could not have any empathy
unless it actually happens to him. So things will continue as status quo at St. Barnabas forcing women into surgery
that damages their fetuses and their bodies. The leg of a fetus was severed during a c-section and another one
of his incompetant DRS. caused a child brain damage but Ronald DEL Mauro doesn't care because it didn't happen
to his children. The only thing he cares about is profits.

July 25, 2009 | Unregistered CommenterCara
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