Books You Should Buy

  

« The Unnecesarean Has a New URL: www.theunnecesarean.com | Skol v. Pierce Update: Doctor Fined and Placed on Probation »
Thursday
Jul232009

New Jersey Cesarean Refusal Case: The "System" is Schizophrenic

Bookmark and Share

Share 

The parental rights of a woman in New Jersey were recently terminated. The court findings can be found here in full, and a summary found here.

What I find most troubling about V’s situation are the diametrically opposed opinions of all of the so-called experts involved in the case. Reading the appellate court’s findings has given me a case of “folie à deux” and I am paranoid by proxy. I hereby use my degree in Psychology to diagnose myself with “folie à trois,” as diagnoses in this case are totally arbitrary, subjective and random.

 

V’s psychiatric history before pregnancy came into question.

Seltzer diagnosed her as suffering from post-traumatic stress disorder, depression and panic; but in 2005, a psychiatrist working for the State of New York Worker’s Compensation Board told her that she was cured and no longer needed treatment.

During labor, after having refused a cesarean and yelled at the hospital staff, V received not one, two psychiatric consults.

Although he acknowledged that V.M. was very anxious, Dr. Kurani concluded that V.M. was not psychotic and had the capacity for informed consent with regard to the c-section. At no time did anyone seek judicial intervention or the appointment of a special medical guardian.

After Dr. Kurani left, the staff requested a second psychiatric opinion from Dr. Jacob Jacoby. Before Dr. Jacoby’s evaluation was completed, V.M. gave birth vaginally to J.M.G. without incident.

V said her baby was fine and that she didn’t need a cesarean. Dr. Shetal Mansuria told her repeatedly that she needed her baby cut out from her uterus because it was in danger, but her baby was most definitely not in danger and V was correct.

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

The trial judge said the hospital reacted appropriately to V’s “extreme” behavior and was therefore justified in not sending her home with her baby after how she behaved in the labor and in the immediate two days postpartum while still in the hospital.

The judge identified the issue before him as whether J.M.G. was in imminent danger between April 16 and April 18, 2006. He observed 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 emphasized that although he believed that J.M.G. was in imminent danger, he did not base his finding solely on V.M.’s reluctance to consent to a c-section. In fact, he observed that there were probably many instances where a mother’s refusal to accept a c-section would not constitute abuse.

Then, the appellate court disagreed with the judge’s decision to include failure to submit to Mansuria’s cesarean as evidence of abuse and neglect, but agreed with the decision that the hospital acted appropriately.

The hospital responded appropriately to confront V.M.’s mental state and her refusal to consent to the c-section. After considering V.M.’s “extreme behavior” and signs of developing fetal distress, the hospital staff requested an emergency psychiatric evaluation to determine V.M.’s competency.

As a result of her birth, Dr. Jacoby called in DYFS because he felt V “need[ed] to be more fully evaluated by state social services.” And so the couple was forced to leave the hospital without their baby. He took V’s past psychiatric history into account, even though a different psychiatrist had called her “cured.”

Enter Dr. Vivian Chern Shnaidman in 2007…

Dr. Vivian Chern Shnaidman performed a psychiatric evaluation of V.M. and B.G. for DYFS. She stated that her review of Dr. Seltzer’s records indicated that V.M. was being treated for a psychotic disorder. She noted that despite V.M.’s high level of intelligence and education, she was not able to comprehend her situation. The doctor concluded that V.M. suffers from chronic paranoid schizophrenia and that her prognosis for improvement is poor without psychiatric treatment.

Dr. Shnaidman stated that B.G. was cognitively intact, but that he also suffers from psychosis. She described his diagnosis as “folie à deux,” a rare condition in which one person subscribes to the psychoses and paranoid delusions of another. She explained that V.M. and B.G. function in a very paranoid and secretive way, with each person’s paranoia supporting the other’s.

Dr. Shnaidman concluded that J.M.G. would not be safe in V.M. and B.G.’s care. She stated that it would be dangerous and reckless to return the child to them, because “[t]hese are parents who live in a world that has nothing to do with the world that we live in. And anything could happen there at any time and there’s no way to predict it.” Her written report concluded that “[w]ithout appropriate psychiatric treatment, including aggressive psychopharmacological intervention, neither [V.M.] nor [B.G.] presents as a fit parent at this time.”

Then comes Dr. Marc Cantillon, who concluded that it would be safe to return J.M.G. to her parents’ care immediately.:

Dr. Marc Cantillon… stated that B.G. was anxious and distraught over DYFS’s removal of his daughter, but he had no mental disorder of any kind. He concluded that B.G. would be a fit parent for J.M.G. He also believed that V.M. was a suitable and fit parent.

The trial judge favored Shnaidman’s very “strongly worded” diagnosis and recommendation over the apparently more weakly worded diagnosis and recommendation from Dr. Cantillon:

The trial judge found that he could not reunify J.M.G. with her parents. He commented: “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, he decided to maintain the status quo and obtain a qualified, impartial expert to offer a third opinion.

The family court judge ruled that it was not to return J.M.G. home in the foreseeable future because of the mother’s psychiatric condition and father’s unwillingness to accept mother’s psychiatric condition.

  • The parents did not want to “comply” with the repeated requests that they submit to psychiatric treatment because they didn’t feel they needed it and their psychiatrist, Dr. Marc Cantillon agreed.
  • V had a psychiatrist tell her she was cured before she ever got pregnant; therefore, the pre-pregnancy psych records should not be relevant. She had mental health issues, sought treatment in her own self interest and was cured.
  • She had a doctor try to force her into an unnecessary cesarean while in labor because her baby was supposedly at risk and the doctor was turned out to be wrong on all counts about what V.M. needed in order to give birth to a healthy baby.
  • One psychiatrist found her to be competent to refuse a cesarean while in labor, but the hospital didn’t agree and brought in yet another psychiatrist to try to prove their bias that V was clearly insane to refuse the unnecessary cesarean.
  • Dr. Shnaidman and Dr. Cantillon offered completely diametrically opposed diagnoses of the couple.
  • The trial judge issued one ruling that refusing a cesarean and erratic hospital behavior after birth was factored into the decision to keep J.M.G. from his parents, but the appellate court disagreed in part with this decision.

In the case of V and her baby, she has every right to feel paranoid. The “experts” and “authorities” determining the fate of her birth, her baby and her family’s cohesiveness have behaved in a schizophrenic manner. “The system” appears to be biased toward finding V unstable and unfit to parent, which all seems to stem from her behavior during birth and the immediate days postpartum while still in the hospital; otherwise, she and her husband would have gone home with their baby and had the chance to parent the baby.

I do not read anything in the findings questioning the mental stability or competence of Dr. Shetal Mansuria. Mansuria, who delivers babies at St. Barnabas, a hospital with a 49.3 percent cesarean rate, lied and attempted to coerce her patient into an unnecessary abdominal surgery while her patient was in active labor. Did any psychiatrists question Mansuria’s unjustifiable conduct? Has she been reprimanded for the incorrect diagnosis of fetal distress? Has anyone talked to her about ordering the second psych consult after Dr. Kurani found the patient to be competent? Did anyone look into Mansuria’s psychiatric history for evidence of narcissistic delusions that, using the hospital’s cesarean rate as an indicator, half of all babies will die or be injured without her provision of a cesarean?

And would any of this be happening if V had submitted to an unnecessary cesarean?

With all of the opposing views of so-called experts in this case, V.M. and B.G. are not the only ones who should have their competence come into question in determining the future of J.M.G.

 

Note: The author of this post does not take the diagnosis of schizophrenia lightly and almost resisted using it in a tongue in cheek manner in the title.

 

Related Posts:

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

Refusal of Unnecesarean Leads to Loss of Custody: V’s Story (July 21, 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)

 

Bookmark and Share       

PrintView Printer Friendly Version

EmailEmail Article to Friend

Reader Comments (24)

Amen, amen, amen! Particularly in re: Dr. Mansuria. You're absolutely right. Why is no one questioning her at all?

Thank you for breaking down all the conflicting evaluations so clearly, it's all been maddening to try and muddle through until now. This makes it much clearer - or rather, makes the confusing nature of what's happening much clearer.

This case just gets more sickening to me with every word I read. Even if the child were to be returned RIGHT NOW it's still an unspeakably tragic loss. Imagine losing THREE YEARS of your child's life! Their entire infancy! I get choked up just thinking about it. Of course this probably makes me a paranoid, delusional, inappropriately anxious and thus unfit mother.

July 23, 2009 | Unregistered CommenterDou-la-la

Every time I read about this particular case it always makes me a bit apprehensive. Women are supposed to *want* to give birth in the hospital and to believe that the doctor/hospital/powers that be have their best interests at heart. And yet events like this occur, probably more often than we are aware. So incredibly sad that what should have been an exciting time in a family's life has been so destroyed.

July 23, 2009 | Unregistered Commenterpampered_mom

I can't even imagine how crazed I'd appear if I'd been (almost) forced into an unnecessary cesarean, had my child taken from me, and endured such a horrid ordeal. Yeah I think I'd be looking pretty crazy awful.

49.3% cesarean rate?? Now wait, who's crazy again??

July 23, 2009 | Unregistered CommenterBuscando la Luz

I propose that birthing women reject the hospitals if they want any sense of autonomy. Put the OBs and others who function in the system, out of business. Strike!!!!

July 23, 2009 | Unregistered CommenterRj

It's frightening that the first judge decided that refusing a c/s constitutes abuse/neglect. Rejecting c/s has resulted in women who are forcibly removed from their homes in the middle of the night by the police on more than one occasion, but this is the first I've heard of losing custody as a punishment. It is her right to refuse interventions. I think that some of this would have been ameliorated if she had stayed calm and allowed more fetal monitoring, after all, this was a 35 week old premie baby. Nothing excuses the combative, overbearing, and manipulative behavior of the doctor though, or the resulting decisions of the judges to remove and uphold the removal of this child, without consistent psychological reports.

July 23, 2009 | Unregistered CommenterAnon

This also calls into question situations like intentional fetal distress. It seems as if it would constitute abuse/neglect if a mother agreed to a "pit to distress" order, which lead to fetal compromise, and would then possibly be in the position of losing her baby to the system. But the doctor who ordered the pit, and the nurse who administered it? What responsibility falls upon them without a civil court case? Especially if the fetal compromise ends in serious injury through traumatic contractions, O2 deprivation, instrumental vaginal birth injury, or cesarean birth injury? Intentional fetal distress falls into the category of a criminal offense as an intentional harmful act. Should mothers and babies who are put through the wringer be reporting doctors and nurses for assault and child abuse/neglect?

July 23, 2009 | Unregistered CommenterAnon

I don't even know what to say. Disturbing. I think I'm done having babies.

July 23, 2009 | Unregistered CommenterJenny

Ummmm, let's see. For those of us that actually attend births, I can not possibly fathom administering a psych eval to a woman in labor, pardon my Internet French, but WTF?????

Much less TWO!!!!

We are well inundated with sit-com TV laboring women, definitely Craaaazy. Isn't that how we are suppose to be, anyone remember Murphy Brown?

No jokes aside, we all who deal with birth understand the altered state of a laboring woman, particularly a laboring woman with PTSD.

What I do not understand for the life of me is why this is not reversed, why she as a laboring woman with PTSD can't sue the hospital for inadequate care. As a maternity care provider well versed and trained to recognize when some one is presenting with trauma, it seems that the responsibility lies on the side of the provider to provide responsive care to the laboring woman and their incumbent history. I am not a proponent of civil suits but, jeeze does not this woman have a case?

Maybe someone should give the hospital staff and the judges complementary copies of Penny Simkin's " When Survivors Give Birth"

July 23, 2009 | Unregistered Commentertracey

I think this story is extremely frightening. There is no doubt in my mind that VM and BG are both sound parents and that under a situation that is notably emotional to begin with, were put in to extreme states of stress and fear that resulted in further complicating the situation they were in. As much I have scoured the internet, I have failed to find any detailed accounts of the behavior that VM and BG exhibited in the hospital, other than refusing a cesarean, that contributed to the conclusion that they are unfit.

However, I do not believe that the answer to the problems we face in the maternal health care system can, or will be solved by striking against hospitals and their physicians. This will only increase feelings of animosity between the opposing sides of this important issue, and that is creating more of a problem. The truth is, we are encountered with situations that warrant a physician's help, and in those cases, having a good working relationship, that is based on trust and mutual respect will ease that delicate situation. Ostracizing ourselves is going to end up breeding excessive resentment, and makes us no better than they are. The only way we are going to stop things like this from happening, is by making ourselves heard, but by also supporting those physicians who DO preform their jobs without abusing their power.

What has happened here is awful, but I hate reading extreme statements that encourage the same sort of blanket opinions of physicians, as many physicians feel about those who support and aid in natural childbirth.

July 24, 2009 | Unregistered CommenterKM

The more I hear about this the more sad and angry I become.

I couldn't imagine getting two psych evals during labor. I couldn't even fathom having one!

Whatever happened to our country, where we have to bully people into believing us, and following our way of life? And since when can you do this with a major surgery for a woman that clearly doesn't need it? And you can take their baby away for refusing?

Sounds a lot like secret police and such to me...

We can't continue to go down this road. This doctor needed to be sued and something needs to happen to her. You cannot bully people into procedures they don't need! That is not evidenced based care and that is definitely not following the hippocratic oath.

How many more women does this have to happen with before people take notice and finally realize that the hospital is not the best place to have a baby? Or at least to research your options and find the care giver and hospital that suits you.

I am not putting the blame on women, because it isn't supposed to be our job to educate and treat ourselves. But our caregivers aren't doing it, and so we much take the responsibility. And when we don't doctors like this gain more power and we will be forever unable to stop them.

I am terrified of having another baby because I want a VBAC so bad and I will refuse a cesarean to my last remaining breath if I have to. Which would probably make me an unfit mother and with the way that is going, I will either be dragged from my house late at night with a court order cesarean or my child with be taken from me.... Oh, what a great country we live in...

July 24, 2009 | Unregistered CommenterKayce
Comments for this entry have been disabled. Additional comments may not be added to this entry at this time.