The Death of Tori Bowie, Pregnancy and Social Determinants of Health

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.

 

“I’m on Maternity Leave Without a Baby”

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.

My 25th ACOG Rejection While Black Maternal Death Continues to Rise

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:

  1. 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?
  2. 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.
  3. 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.

Respectfully,

Linda Burke (formerly Burke-Galloway), MD, MS, FACOG

You Saved My Baby’s Life

As Preeclampsia Awareness Month comes to a close, I want to share a blog post I wrote on 2/28/2011 that provides a better description of my former patient’s birth that resulted in her amazing son. If nothing else, please pay attention to what her blood pressures were and how the resident physicians had a false sense of security that almost led to her baby’s death. 

I was greeted by those words during a patient’s recent postpartum exam and was both gratified and humbled.  A potential disaster was avoided and her pregnancy had a happy ending.

Katina* (name changed) had registered for prenatal care early so when her blood pressure was a little “different” at 32 weeks, the change was duly noted. She wasn’t complaining of a headache, her feet weren’t swollen but this was her first pregnancy which placed her at an increased risk of developing pre-eclampsia.  A blood pressure of 120/82 would seem normal to most people but in Katina’s case it wasn’t. She was sent to the hospital and then discharged home with instructions to monitor her blood pressure daily and I asked her to return in one week for closer scrutiny.

Upon Katina’s return, her blood pressure was 140/90 so off she went to the hospital’s labor and delivery triage department for further evaluation. Upon her arrival, her blood pressure appeared to have improved. The resident physicians on duty made snide remarks, insinuating that she was referred inappropriately.  As she was about to be discharged, the baby’s heartbeat dropped precipitously. Before Katina could blink, a team of physicians and nurses descended upon her with full force. They shoved papers in her face requesting a signature for an emergency c/section and informed her that it was possible she could die as well as her baby. Her blood pressure had escalated through the roof and her heart raced dramatically. She was quickly put to sleep, a “stat” c. section was done,  and her baby was born alive. For the next four days, the hospital staff had difficulty controlling her blood pressure and her heart continued to pound at rates above 150 beats per minute. It was one of the most harrowing experiences of her life however, in the end, both mother and baby were discharged home and are now fine. Katina experienced what we in medicine call a “diagnostic save.” A life was saved because the proper diagnosis was made in a timely manner. How often does that happen? Not often enough. If you can “see it” then you can treat it. Pregnant moms must be empowered to help their healthcare providers “see” the problem before it spins out of control.

 

Soulmates Left Behind on Mothers’ Day

Charles Spurgeon Johnson, Anthony Wallace, Juwan Lopez, and Bruce McIntyre III.

On this Mother’s Day, I honor the soulmates of mothers who left before their time on earth based on clinical incompetence, arrogance, and, yes, that dreaded word no one wants to discuss but is ever apparent racism.

Here are some examples of why Sha-Asia Washington, Amber Rose Isaac, Kira Johnson, and Dr. Chaniece Wallace are no longer with us:

Dr. Dmitry A. Shelchkov, a foreign medical school graduate, failed to provide adequate oxygen or monitor three previous patients before finally killing Sha-Asia Washington. He did not give her oxygen when she became short of breath and placed her epidural catheter incorrectly. His mistakes had been known for years, but it took the death of a 26-year-old first-time mother before the New York Medical Board suspended his medical license.

The obstetrician who performed a 17-minute elective C-Section led to a postpartum hemorrhage and the preventable death probably of Kira Johnson. Unfortunately, he probably still has privileges at the infamous Cedar Sinai Hospital.

The ob-gyn residents and their attending physicians at Montefiore Hospital who missed Amber Rose Isaac’s dropping platelets are probably still practicing without any accountability except providing a pathetic apology that will not bring her back to life.

And then there’s the case that keeps me up at night involving my fellow physician colleague and sorority sister, Dr. Chaniece Wallace. The horrific two-hour delay of starting an intravenous line in the setting of her hypertensive crisis is chilling. Yet, St. Vincent’s Hospital in Indiana purports to have given her the best care.

Yet, amid this madness, four remarkable men have turned their pain into action on behalf of their departed soulmates. Their comments and posts on social media platforms demonstrate a palpable love. They speak about their beloved in the present tense. They not only continue to love these women but remain IN love with them despite their physical absence of 6 years for Charles Spurgeon Johnson IV and two years for Anthony Wallace, Juwan Lopez, and Bruce McIntyre III.

These brothers teach us that love continues to win, even in death, and has created beautiful children that represent their legacy.

Today, I salute the soulmates of Kira, Sha-Asia, Amber, and Chaniece, who continue to teach all of us that death has no real power over love, just as it had no power over Jesus, the Christ.

May my sisters continue to rest in Power, and may their memory continue to be a blessing.

 

The U.K. Approves an Early Preeclampsia Diagnostic Test. Will the U.S. Follow?

A decision made by the British version of our NIH, the National Institute of Care and Excellence (NICE), sheds a flicker of light onto a very dark landscape regarding maternal mortality. They are authorizing the use of a blood test that will diagnose preeclampsia as early as 20 weeks. This decision is groundbreaking news and will change the landscape of how preeclampsia is currently diagnosed, treated, and hopefully save lives.

NICE is developing a draft of clinical guidelines and believes that African, Caribbean, and Asian women will benefit the most based on their history of adverse birth outcomes.

Here’s what you need to know in plain English about the test:

  • It measures Placenta Growth Factor (PIGF), which is a protein that plays a role in the development of blood vessels in the placenta
  • Women who have preeclampsia have low levels of PIGF. Low levels of PIGF means that the placenta blood vessels do not grow well

Can these tests diagnose as well as exclude preeclampsia?

Yes, according to published literature cited in the article.

Who makes these tests?

Four independent labs: one in San Diego, two in Germany, and a lab in Finland

What are the benefits of using this test for pregnant women?

The tests will make it easier for healthcare providers to diagnose preeclampsia and make fewer mistakes regarding clinical management.

Are there any economic benefits of using this test?

According to NICE literature, the saving was between 26 pounds ($34.06) to 2,896 pounds ($3,793.76) per patient.

Are there any other early diagnostic tests for preeclampsia?

Yes, there is a test using different technology that measures cell-free RNA as a means of early preeclampsia detection, according to an article published by Nature.com. However, healthcare providers do not currently use this test because it has not been approved as part of clinical guidelines.

I anxiously await the use of PIGF in mainstream obstetrics. We once thought that the adverse effects of preeclampsia stopped when the baby and placenta were delivered. However, we now know that reasoning was wrong based on the number of women who died during the postpartum period. Hopefully, with the future use of this test, women will no longer be discharged from hospitals or emergency departments prematurely. Anything that decreases maternal mortality gives me a glimmer of hope.

 

The Business of Medicine and Black Maternal Health and Death

This week, as thousands of Black women commemorate Black Maternal Health, Becker’s Hospital Review reported that one of the leading U.S. health plans made an astounding  $5 billion profit in the first quarter of 2021, in the middle of a pandemic no less.

Shareholders are happy. The CEO is happy. The company’s employees are happy because they will all receive big, fat bonus checks, but do you know who isn’t happy? The families of 700 mothers who die each year from preventable, pregnancy-related deaths.

The business of medicine is killing us. According to CDC, in 1990, our pre-managed care healthcare system had a maternal mortality rate of 8 deaths out of 100,000. Thirty years later, the rate has more than doubled to 17.4 per 100,000 in the setting of managed care.

The infiltration of managed care eliminated the three-day stay for vaginal deliveries and five-day length of stay for cesarean sections in order to cut costs.

After a vaginal birth, mothers are booted out of the hospital after 24 hours (pre-pandemic).  Women who had C-sections leave in 48 hours. Is it any wonder that 50% of pregnancy-related deaths occur at home?

Does implicit bias and racism contribute to the death of black and brown mothers? Absolutely, because they receive inadequate care. However, if we do not move the dial beyond the discussion of racism, we will never get to the root cause of the problem or, more importantly, fix it.

Until our healthcare system reverts back into a noble profession and not a profit-by-any-means business, regretfully, a disproportionate number of mothers and babies will continue to die.

“He who accepts evil without protesting against it is really cooperating with it.” MLK.

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Follow Dr. Linda on Facebook | Order your copy of The Smart Mother’s Guide to a Better Pregnancy: How to Minimize Risks, Avoid Complications, and Have a Healthy Baby | Dr. Linda is a board certified Ob/Gyn and an expert in the area of pre-eclampsia and high-risk pregnancies. Contact Dr. Linda about an appearance at your next event or media placement opportunities.

 

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In Praise of CDC’s “Hear Her” Campaign

One of the first things a first-year medical student learns is the importance of taking a patient’s history because if you listen carefully, you will figure out the diagnosis. Yet it is often the failure to listen that leads healthcare professionals down the rabbit-hole of misdiagnosis that frequently leads to preventable death.

Each year, 700 U.S. families lose a wife, mother, girlfriend, daughter, cousin, niece, neighbor, or friend to a pregnancy-related death, and one of the most common refrains repeated over and over again is “they wouldn’t listen to her.”

The Center for Disease Control (CDC) has taken those words to heart and initiated a public service campaign to raise awareness regarding the importance of healthcare professionals listening to the complaints and concerns of pregnant women and postpartum patients.

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Copyright © 2020 by Linda Burke, MD. All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.

Follow Dr. Linda on Facebook | Order your copy of The Smart Mother’s Guide to a Better Pregnancy: How to Minimize Risks, Avoid Complications, and Have a Healthy Baby | Dr. Linda is a board certified Ob/Gyn and an expert in the area of pre-eclampsia and high-risk pregnancies. Contact Dr. Linda about an appearance at your next event or media placement opportunities.

How Do We Prevent Future Deaths Like Those of Amber, Kiara and Gabriel?

Eight months of torture caused the death of 8-yr old Gabriel Fernandez. Kira Dixon Johnson bled to death shortly after giving birth because her husband’s pleas and concern were ignored. A busy clinic missed an important risk factor of first-time mother, Amber Rose Isaac who hemorrhaged to death a late diagnosed HELLP Syndrome immediately after her son was delivered.  What do these tragedies have in common? They were all victims of system failures.

Are you tired of witnessing these disasters because I am. As an OBGYN physician for over 30 years and a former social worker, here are my proposals for change regarding missed diagnosis of child abuse and OB risk factors:

  1.    When a social worker receives a suspected child abuse case, he or she should be mandated to take pictures of the child to document well-being or abuse. Gabriel’s mother consistently hid him from social workers in a cabinet.
  2. A social worker should be required to speak with said child and not merely take a report from the parents as was the case with Gabriel.
  3. A volunteer corps of retired social workers and pediatricians should be activated to assist overworked child abuse workers and help manage more complex cases.
  4. A “second opinion” model should be activated that would provide independent risk assessments, by board certified ob-gyn physicians if a pregnant mom has concerns about her present management
  5. “Real-time” assessment of a fetal monitor strip to screen for potential and unrecognized fetal distress by an independent board-certified ob-gyn physician that can be done remotely while the patient is in labor
  6. All hospitals should be mandated by the Joint Commission to participate in their state Perinatal Quality Collaboratives which include monthly patient simulations regarding obstetrical emergencies and use “patient bundles.” Failure to comply would mean loss of hospital accreditation and state funding.

 

The greatest gift we can give the families of the deceased is to prevent these mistakes from recurring.  I have shared some of my ideas and would love to hear yours. Let’s turn future scary challenges into happy endings.

 

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Follow Dr. Linda on Facebook | Order your copy of The Smart Mother’s Guide to a Better Pregnancy: How to Minimize Risks, Avoid Complications, and Have a Healthy Baby | Dr. Linda is a board certified Ob/Gyn and an expert in the area of pre-eclampsia and high-risk pregnancies. Contact Dr. Linda about an appearance at your next event or media placement opportunities.

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Honoring Allyson Felix: An Olympian and Preeclampsia Survivor

As the mother of two cross country athletes who won three high school state championships and made it to the Nike-sponsored national meet in 2015, I celebrate Allyson Felix’s victory as a record-breaking Olympian. However, as a board-certified African American ob-gyn physician, I celebrate her victory over preeclampsia and motherhood even more.

On November 28, 2018, Felix developed preeclampsia at 32 weeks that necessitated an emergency cesarean, and her daughter spent approximately one month in the NICU recovering. Felix could have easily lost her life and baby as a black woman based on irrefutable statistics regarding black maternal health. Gratefully, Felix’s physician had the skill set to recognize her risk factors and instructed Felix to go immediately to the hospital rather than an ESPN photo shoot.

California, where Felix was delivered, has one of the lowest maternal mortality rates in the U.S., a testament to their California Quality Collaborative for its forward-thinking and provision of tools to healthcare providers to prevent and reduce maternal death and near-miss disasters.

Thank God for the courageous physicians who delivered Felix at 32 weeks based on her emergency and did not hesitate because of the clinical guidelines that state babies shouldn’t be born before 39 weeks. Many women and babies have died because of their providers’ inability to recognize their risk factors and hesitancy to deliver them sooner.

Felix’s personal experience inspired her to testify before the U.S. Congressional Ways and Means committee in 2019. She also challenged Nike’s policy of cutting her pay by 70 percent three weeks after she delivered.

Felix’s fierce and relentless advocacy forced Nike to change its rules, but they lost her as an influencer. So instead, she started her athletic shoe brand, Saysh, and proudly wore them as she claimed her 11th Olympian medal in Tokyo.

Most people will remember Felix because of her athleticism, but I will honor her as a preeclampsia survivor, advocate, and, most importantly, a mom. Oh, and by the way, I’m in desperate need of a new pair of running shoes and one guess as to which brand I will buy?

 

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