Let me put it right out there. I am the daughter of a schizophrenic, so I am well-versed in discussing mental health issues.
My beloved mother battled schizophrenia from adolescence until well into her adult life. Because of the graciousness of her sisters, who allowed me to live with them, I did not end up in the “system” (aka foster care) despite their limited resources.
Tori Bowie, like me, was not raised by her mother but by her grandmother. We do not know the circumstances, nor is it necessary. She was an Olympian in track and field, and as the mother of two cross-country state champions, I understand that journey well. The discipline. The perseverance. The pressure to be perfect in a very imperfect world.
Tori was found dead at the age of 32, pregnant and alone. It took a well-check visit by law enforcement to discover her death. How does a 32-year-old woman end up dying at home alone while giving birth?
Initially, people speculated that this tragedy resulted from a home birth gone wrong. However, the objective evidence does not support that if you dig deeper, and as a physician and MSW, I did.
The Orange County Coroner’s report states Tori weighed 96 pounds on a 5’9 frame. The calculation of her BMI (Basal Metabolic Index) results is 14.2, meaning she was significantly underweight during her pregnancy. Her weight is the type of weight you see in cancer patients.
Orange County Coroner also reported that Tori also had a medical history of Bipolar Disorder. This objective evidence is a glaring red flag that my poor sister had some deep issues. One of her friends commented that Tori’s world was becoming “more and more isolated.” “People had disappointed her.”
Her agent, Kimberly Holland, commented that Tori “did not trust hospitals.” That statement broke my heart because, as a Black woman, her reasons were valid. But back to her weight and her friend’s comments. Did the father of Tori’s baby abandon her? Was her weight loss reflective of depression? We will never know these answers. I’m not trying to pry into Tori’s personal life, but her case represents teachable lessons for the future. It demonstrates why addressing the social determinants of health of pregnant women, especially women of color, is so important.
Tori Bowie’s case highlights the importance of checking in on friends and family even when they don’t want us to. Even if it means getting on a plane, especially if they’re pregnant, it may mean you get your feelings hurt, and I have borne witness to that regarding a personal family issue that I will not discuss.
Yes, Tori died from complications of pregnancy that included eclampsia and respiratory failure, but I suspect my sister also died of a broken heart.
A young, Black woman, pregnant with her second child, leaves the hospital empty-handed because no one would listen to her. It is a social refrain that bears no repeating. She had a previous delivery at 37 weeks because of preeclampsia. When she became pregnant again, her ob-gyn told her she was not a high-risk patient, but he was wrong. She didn’t receive baby aspirin during the second pregnancy, although she should have. Her provider told her he would prescribe it at 28 weeks, which was wrong because the optimum time to receive it is 16 weeks. She never saw a high-risk pregnancy specialist, although she should have. Instead, she developed the HELLP Syndrome at 25 weeks, and her baby expired.
One might say that the baby died from prematurity. However, evidence-based research reports a 67 to 76% survival rate for preterm babies born at 25 weeks.
She went to a social media group, seeking solace and comfort for her grief, and the disparities were glaring. Painful. Everyone in the group knew what a maternal fetal medicine specialist was except Laney, and no, they did not look like her.
I am weary of those sad stories. I am frustrated that things get worse instead of better regarding our healthcare system. However, I am committed to “Be the change I want to see.” So, I, along with other Black ob-gyn physicians, are rolling out a Black Obstetrician-Gynecologist Directory/Database so people like Laney can receive care from people who respect her culture and, most importantly, LISTEN to her.
Representation matters. Healthy Babies Matter. The dignity of this patient matters.
We, as humans, matter, and that means ALL of us.
Dear Dr. Abbasi-Hoskins:
Thanks for your response regarding my 25th rejection to become a member of ACOG’s Medically Underserved Women’s Committee. Please be advised that I will not be submitting any future applications.
Although I have paid my annual dues for the past 25 years, I cannot guarantee that I will continue to do so in the future.
Have you noticed the dwindling number of obstetricians-gynecologists who pay their dues, especially those who look like me?
Although I originally planned to write a lengthy letter, my former high school photographer teacher (may he rest in peace) once said, “A picture is worth 1,000 words.”
The picture of this Black woman’s unassisted homebirth speaks volumes and represents our dismal failure as effective clinicians in keeping pregnant women safe and unharmed. Some Black women would rather stay home and deliver their babies in a tub without assistance than come into a hospital where they are often disrespected, ignored, and clinically mismanaged. How do we change that narrative?
This week’s JAMA opinion hits home. Medicine is an art as well as a science. Since ACOG will not allow me a membership to the Medically Underserved Committee, let me offer this advice based on my 35 years of clinical and professional experience:
- Stop allowing ob-gyn residents to “cut and paste” history and physicals and feign them as their own. This practice represents cheating and does not enhance their clinical acumen. How are residents supposed to learn if they use someone else’s data?
- Initiate mandatory competency exams regarding the diagnosis and management of preeclampsia. Some residents do NOT know how to manage preeclampsia effectively, and I have reviewed those dismal malpractice cases to prove it: The case of the late Dr. Chaniece Wallace is a prime example. The state of Indiana could use some much-needed help.
- Adopt the California Maternal Quality Care Collaborative’s clinical guidelines that have proven they can reduce maternal mortality. The present ACOG clinical guidelines for the management of preeclampsia are as clear as mud, especially as it relates to patients who demonstrate preeclampsia symptoms before 39-weeks. My late residency director, Dr. Sterling Williams, former V.P. of Education at ACOG, is greatly missed. We did not have confusing clinical guidelines when he was alive.
I wish you a successful year as the new ACOG president and hope you will consider some of my recommendations.
Linda Burke (formerly Burke-Galloway), MD, MS, FACOG
The public should be wary of certain physicians, and the late Kira Johnson’s physician is one of them.
According to Case No. 800-2016-021723, the California Board of Medicine received six complaints of medical negligence against Dr. Arjang Naim, who is a board-certified obstetrician-gynecologist who practices in Los Angeles and Beverly Hills, California.
On April 12, 2016, Johnson entered Cesar Sinai Hospital for an elective C-Section accompanied by her family but left the hospital without her.
I attended medical school and did my internship with men like Arlang Naim and know them well. Cowboys is what we called them back in the day. They took pride in whizzing through operative surgeries like they were in a race against time. Safety rules did not apply to them. They breached standards of medical care, and no one held them accountable.
In cases of emergency C-sections, the expected length of time is thirty minutes. Kira Johnson had no emergency conditions, and her C-section was an elective procedure. Naim had two medical practices in Hollywood and Beverly Hills and was probably multi-tasking.
Johnson’s procedure began at 2:31 p.m. and ended at 2:48 p.m., 17 minutes, including her delivery. Unfortunately, in Naim’s haste, he failed to close the bladder flap. Shortly after that, he left the hospital, leaving Johnson’s care to the resident physicians who were in training.
At 4:40 p.m., Johnson developed abnormal bleeding in the bag that collects urine (known as the Foley catheter). Then, at 5:45 p.m., a massive blood clot could be felt through her skin incision. Her pulse then increased dramatically, and is a classic sign of impending shock.
Johnson received multiple blood transfusions and exhibited signs of a dangerous condition called DIC (disseminated intravascular clotting) which meant her blood was not clotting properly. Naim did not arrive at Johnson’s bedside until 8:47 p.m. Despite Johnson’s unstable condition, he wrote orders, including a CT scan and then LEFT THE HOSPITAL.
Johnson’s condition deteriorated further, and the resident physicians called Naim again. He arrived at the hospital at 11:45 p.m. but only wanted to continue to merely observe. However, the resident physicians convinced him to return to the operating room to determine the site of her bleeding.
At 12:25 a.m., Johnson was taken back to the operating room, and at 1:15 a.m., the resident physicians scrambled to find a general surgeon to assist Naim with the procedure. Unfortunately, Kira Johnson’s heart stopped beating.
Further evidence from the California Board of Medicine reported that Johnson was not the only patient who experienced medical neglect.
- On August 21, 2015, a patient had a ruptured tubal pregnancy. Naim performed her surgery but failed to achieve any follow-up hospital care for three days despite her requiring a blood transfusion
- On March 14, 2016, a patient had a ruptured uterus after experiencing a 16-week pregnancy loss. The uterus was repaired, the patient required a blood transfusion, and Naim did not see the patient during her entire hospital stay.
- On May 31, 2016 (approximately one month after Kira Johnson expired), Naim performed a C-section on his patient with a placenta previa (placenta covering the baby). Unfortunately, the placenta could not be removed, and the patient required a hysterectomy performed by Naim and a GYN oncologist. Although it was Naim’s patient, he failed to see her daily during her hospital course.
The California Board of Medicine placed Naim on probation in 2018 for two years, but he is practicing medicine again, including delivering
Would you want him to be your physician?