WRIGHT-PATTERSON

Doctors change, records go astray

Continuity of care is often a luxury in military hospitals, and lack of it can be fatal.

By Jim DeBrosse DAYTON DAILY NEWS

Kayla Reardon retrieves a stack of children's books from the sofa. `These are my books,' she says, handing them over to a visitor.

Like most 8-year-olds, Kayla likes books. But Kayla is not like most 8-year-olds in other ways. She still wears diapers, cannot walk on her own and might never read above a first-grade level.

Kayla Reardon speeds toward home plate during a tee-ball game in a physical education class at her Louisville, Ky., elementary school. SKIP PETERSON / DAYTON DAILY NEWS

Kayla has cerebral palsy, but what's hardest for Kimberly Reardon, her mother, is not that Kayla has a handicap. It's that Kayla is the way she is because "doctors made mistakes," she says.

Those doctors were at Wright-Patterson Medical Center, where Reardon and her husband say poor records management and a heavy reliance on physicians in training ultimately led to Kayla's brain damage.

Kimberly Reardon was 34 weeks pregnant on June 6, 1989, when she was admitted to Wright-Patterson Medical Center complaining of migraine headaches, nausea, vomiting and asthma, according to depositions in a lawsuit she and her husband, Richard, filed.

Sometime after midnight June 8, 1989, Reardon suffered a severe asthma attack and lapsed into respiratory failure for an estimated 9 to 10 minutes. Kayla was delivered by an emergency Caesarean section, but the oxygen loss damaged key portions of her brain.

Patient records not consulted

Nor, she says, did anyone consult an inch-thick set of medical records detailing her 60 prior asthma treatments at Warren Air Force Base, Wyo., where her husband was stationed. She was transferred to Wright-Patterson two months before Kayla's birth for medical reasons and to await her husband's discharge.

`They said they had no way of knowing how bad an asthmatic I was, but they had the records from Wyoming,' Reardon says. `No one made the effort to look at it.'

Poor records management at health facilities is a common complaint in the military, where transiency can be a way of life. Many military personnel and their dependents say they must carry their medical records with them from base to base and from office visit to office visit to ensure that health professionals are familiar with their histories.

Wright-Patterson officials would not comment on the Reardon case. But in written responses to some general questions, a base spokeswoman said Wright-Patterson "strives to provide the highest quality medical care. In so doing, we fully comply with all applicable federal laws and regulations."

A Daily News analysis of malpractice cases found 37 filed against Wright-Patterson between 1986 and 1996 - far fewer than most military installations.

"They have exceptionally well-trained people, and they have much tougher standards than most institutions," said Randolph P. Arnold, a retired Air Force colonel who was director of the military's health service for a seven-state region that includes Ohio. Randolph said record-keeping throughout military medicine has improved in the last two or three years as more records have been computerized.

The Air Force settled the Reardon case in 1993. Reardon said the Air Force agreed to a seven-figure trust fund, owned by the government, that will care for Kayla's medical needs for as long as she lives.

Wright-Patterson officials admitted no wrongdoing in the case, but a court deposition by Kimberly's doctor that evening, then third-year medical resident Dr. Evangeline Andarsio, raised serious questions about the way records were handled at the hospital.

"Knowing the base, you never know" if a patient's record is available, Andarsio testified.

In the deposition, Andarsio said Kimberly Reardon was ultimately responsible for what happened to her daughter because she missed her two appointments at the base's asthma clinic prior to Kayla's birth. "We are dealing with a situation where we didn't have ample opportunity to take care of this patient," she said.

But Andarsio couldn't explain why no one at the hospital looked at Reardon's medical record after she was admitted, and she blamed the hospital's record-keeping system for her lack of knowledge about Reardon's condition. Andarsio said she couldn't even say for sure whether Reardon's records were at the hospital that night.

"I can't tell you how many times I've requested records and you don't get them or they're not there because somehow they never got there, and that's just the bureaucracy of the federal government," she testified.

Asthma is a chronic affliction of the airways that can leave a person suddenly wheezing and gasping for air. It can kill in a matter of minutes when the lung's tiny airways, called bronchioles, overreact to the presence of allergens and clamp down, shutting off oxygen to the body or to a fetus.

Women with severe asthma can and do have normal babies, if their condition is carefully monitored and treated.

Lack of follow-up by doctors

"I was assuming things would be like at Miami Valley Hospital where you get a consult, and then the doctor comes back periodically to check on the patient," she said.

Andarsio also testified that she ordered tests on Reardon to measure how well her lungs were working and didn't find out until much later that the tests were never performed.

"If I had known the severity of her asthma, or her history, I might have given her steroids, I might have done things differently." However, she said, "Probably that baby might have had problems regardless because of the woman's history."

Reardon now lives in Louisville, Ky., with her husband, Richard, who is no longer in the Air Force, and their three children, including Kayla's two older, healthy brothers. She traces Kayla's problems back to her pregnancy when she "saw different doctors every time I went into the clinic. The way it works in the military is you don't have your own obstetrician."

Pregnant women may see a variety of doctors in the civilian world, but usually those doctors work together in the same obstetrical group. The key to good prenatal care in such circumstances is for the doctors to keep accurate records that are easily shared, said Dr. Tariq Siddiqi, a professor of obstetrics and director of the obstetrical department at the University of Cincinnati Medical Center.

"Everyone having the same records is what coordinates the care," he said.

Changing doctors produces confusion

"In the last four months before my delivery, I don't think I saw the same doctor twice," she said. "Actually, most of the time, it wasn't doctors. It was normally like a physician's assistant."

Lara Rickling says a nurse at Wright-Patterson "laughed me off" when she called about pain and bleeding she was having. The next day, doctors told her that her unborn baby had died. ALAN ENGLISH / FOR THE DAYTON DAILY NEWS

Rickling said a nurse came to the phone when she called the labor and delivery department at Wright-Patterson.

`The nurse who talked to me laughed me off," Rickling said. "She said, `Don't worry about it. You're a first-time mom. You're overreacting.'

`I was on the phone with her for about 20 minutes and, at one point, I was close to crying because I felt something was really wrong. I must have asked her five times if I should come in and she just kept saying, `No, don't worry about it. It's your first baby.'"

In the civilian world, Siddiqi of Uc Medical Center said it is standard practice for patients to have an emergency number where they can reach a doctor familiar with their cases at all times.

If a nurse should happen to take such an emergency call, Siddiqi said, "the proper response should be, 'Whose patient are you? Talk to your doctor. And if you think you have any problem, come into the emergency room immediately.'"

When Rickling showed for her regularly scheduled appointment at 10 the next morning, a physician assistant couldn't locate the baby's heartbeat with a fetal monitor, she said. Later, an ultrasound confirmed the worst.

`The head of the department came into the room and told me my baby had died,' Rickling said.

Rickling, who at age 26 now lives in North Carolina, filed a federal tort claim against Wright-Patterson for malpractice. The Air Force denied the claim and now Rickling says she might sue.

In the statement to the newspaper, Wright-Patterson spokeswoman Laurie McCoy said the hospital two years ago instituted "continuity of care clinics," in which pregnant women are given an opportunity to enroll with a doctor who will monitor their care throughout the pregnancy.

"Depending on call schedules and the time of delivery," McCoy said, "this provider may or may not be present for the delivery."

Main Story:

Too Many Patients; Too Little Time
Understaffing, poor records management and the constant shuffling of personnel in military hospitals and clinics undermines continuity of care

WRIGHT-PATTERSON
DOCTORS CHANGE, RECORDS GO ASTRAY
* Continuity of care is often a luxury in military hospitals, and lack of it can be fatal.

MENTAL HEALTH CARE
SOME STAFFERS AT ALCOHOL CLINIC HAD MINIMAL SKILLS
* Some counselors were kept on the job while mentally ill themselves.

Special Licenses For Some Doctors
Despite a mandate that doctors in the military hold state medical licenses, at least 77 practiced without meeting the minimum licensing requirement.