Thursday, October 23, 2008

A Little More Medical Information

Several people have asked specifically about Down's deliveries, and how common heart defects are - and how reliably they can be diagnosed. This from my husband:

I had a few moments to speak to an obstetrical colleague this morning and lay out the circumstances surrounding the birth of Trig Palin. His observations were as follows:

Amniocentesis is generally performed sometime after fourteen weeks of pregnancy, generally from fourteen to seventeen weeks. In modern times it is always done in conjunction with ultrasound, which may or may not identify cardiac anomalies at that time, because the fetus is so small.

If the amnio comes back with a diagnosis of trisomy 21, or Down's, there are always followup ultrasounds done, because of the very high incidence of cardiac and other anomalies. Generally by twenty weeks gestation most such anomalies can be identified. Certainly by thirty-five weeks or so, any heart anomalies will be detected and characterized as to what treatment will be needed at birth, if any.

Family practice physicians generally deliver only low-risk pregnancies, however there are FPs who have done a one-year fellowship in OB, and they are highly qualified, so it is entirely possible Cathy Baldwin-Johnson, with proper training, could deliver a Down's baby with known cardiac anomalies. However, someone with this much training would never deliver such a child in the backwoods; they would need the pediatric backup provided at a large institution. Of course, IF there were ultrasounds done and IF there were no significant heart defects, she could certainly deliver the baby at more rural hospital, such as Mat-Su.

So, with all the proper circumstances, it is very possible to safely deliver a Down's baby in the backwoods, but after having said this, the good doctor observed, "This does not pass the smell test; there is something very wrong here."

I agree.

Also, as a final point, I would like to say that when I was speaking to my colleague, I did not mention some of the other specifics of the birth that are known, for example that her amniotic membranes had been ruptured 24 hours when she arrived at the hospital, or that she was 4-5 weeks early. I will ask him about this the next time I see him.

From Audrey: When all is said and done, I still can't get past one simple fact: So much could be resolved by the press conference I have been asking for for a month: Cathy Baldwin Johnson, accompanied by the CEO of Mat-Su, standing up and stating that Trig Palin was born in that hospital on April 18th, that Cathy Baldwin Johhnson was the physician in attendance, and that Sarah Palin is Trig's biological mother. Three things. No embarrassing or private obstetrical details, just a basic statement of fact that should take less than thirty seconds to provide.

What is the big deal? Doctors speak to the press all the time. I lived in central Virginia during two *big* medical stories - Christopher Reeve's terrible accident and the infamous "baby swap" both of which involved the University of Virginia Hospital. Good Lord, those docs were on TV every day... you couldn't shut them up. HIPAA notwithstanding, there's no problem giving your physician permission to speak to the press if you want to.

Cathy Baldwin-Johnson's silence is the loudest proof of all that something is being hidden. What, I cannot say with confidence. But something.

Now we hear that Palin *might* release her medical records, and she went out of the way to state that her records will prove she had five children. We'll see. These are the same people that gave us WMD in Iraq, so pardon my pointing out that giving us Trig Palin in Palmer Alaska probably would not be too much of an obstacle.


Anonymous said...

Dr. CBJ is not giving a press conference because the demand for it is not loud enough. Besides this blog and Andrew Sullivan, no one is questioning Trig's birth.

Anonymous said...

I am a board certified pediatrician and there is something very very wrong with this story. A preterm infant, highly at risk for infection from rupture of membranes > 18 hours, with a known congenital syndrome should not be delivered at a small community hospital with no pediatrician in attendance and without a neonatal intensive care unit. Period.

Morgan said...

Palin won't release her medical records because more than some faked birthing records would have to be supplied. No doubt the few brave people following this story would be closely examining her pregnancy records from Trig to see just what tests she had prior to delivering this child.

And the pediatrician who commented above doesn't need me to agree with him/her but as the mother of five (that I can vouch for) when my water began to leak during my first delivery my OB ordered me to the hospital ASAP. It was a good thing, too, because my daughter was compressing the cord.

No knowledgeable OB would wait so long to get to the hospital when leaking fluid. And no caring mother would take such a risk, either.

Anonymous said...

the whole story just smells like rotten fish to me!

I would expect that labor and delivery of one's FIFTH child, especially a small baby, would be much faster than the "timeline" in her story.

It just doesn't add up!

trish in FL

Anonymous said...

Mat-Su Regional is the NEW name for hospital building. The old facility was known as VALLEY Hopsital (which was in Palmer.)

The Valley Hospital Association still operates the facility with its new deep pocket owner, TRIAD.

Here is a link to a website that has a short Bio about Sarah Palin when she was on the Association Board.

Anonymous said...

Re - "Family practice physicians generally deliver only low-risk pregnancies, however there are FPs who have done a one-year fellowship in OB, and they are highly qualified, so it is entirely possible Cathy Baldwin-Johnson, with proper training, could deliver a Down's baby with known cardiac anomalies."

I have done a bit of research on Dr. Cathy Baldwin-Johnson and have seen no indication whatsoever that she did a fellowship in OB.

Nobody has mentioned the medical malpractice angle. I wonder if Dr. Cathy's medical malpractice carrier knows that part of her practice is delivering high-risk babies. Maybe some of the doctors on this board can comment further, but obstetricians have some of the highest malpractice premiums of any physician. If delivering high-risk babies is part of your practice, that would need to be disclosed on your application for insurance. One of the reasons that family doctors do not deliver babies in my town is that they can't get malpractice coverage for doing that, since they lack special training in delivering babies and that makes them a higher risk from a malpractice standpoint.

Maybe some of the doctors can also comment on hospital peer review or Quality Assuarance - QA - committees. I just think it is exceedingly strange that Dr. Baldwin-Johnson no longer has staff privileges at the hospital where she delivered Trig.

There are only two possibilities -- either she resigned for some reason from the hospital where she had been on staff almost her entire career -- and where the fellow doctors at the practice she founded are still on staff -- or she was kicked off staff after a QA meeting. I do not know which it is, but it is exceedingly curious.

I also love this article about Dr. Cathy.

Here is what Dr. Cathy has to say about Sarah's belowed Wasilla -

"The doctor said Alaska has the highest rate of substantiated child abuse in the nation: three times the national average. Reasons are multiple and include isolation, a transient population, and a high incident of alcohol and drug abuse. "The Valley's No. 1 cash crop is marijuana. There are a lot of methamphetamine labs out here. It's easy to make and inexpensive. It's a huge problem. Also, there's a lot of folks under financial pressure. About 40 percent to 45 percent of my practice qualifies for Medicaid or Denali Kid Care."

So, apparently, the real patriotic America that Sarah loves so -- we grow good people in our small towns -- is a place of child abuse, alcohol and drug abuse and where almost half the population is on the government dole.

Beautiful, really beautiful. How about another $150,000 shopping spree for Sarah? Anything to forget about the meth labs at home.

BS said...

I don't know if this means anything but on her interview with Dobson of Focus on the Family she said she was tested at 13 weeks and found out about Trig's Downs. Just another piece to put in the puzzle.

Anonymous said...

She really said she was tested at 13 weeks?

That is truly odd. According to Audrey's post, generally amnio is done between weeks 14 and 17.

I find it really odd that this anti-abortionist had an amnio at all, but now it is even odder than she allegedly had it done at 13 weeks.

Here is a link to a medical journal article that discusses the safety of very early amnios

'Conclusions: Early amniocentesis is a safe and valuable procedure and may be safely performed as early as technically possible. Although the differences were small, these results suggest that amniocentesis may have fewer complications when performed after 14.0 weeks. Likewise, more than one puncture is more common prior to 14.0 weeks. Finally, the need to reschedule the procedure is increased before 13.0 weeks.'

Sarah's week 13 amnio, like many things, just does not pass the smell test.

Also do family practitioners, like Dr. Cathy Baldwin-Johnson, routinely perform amnios when they have had no oby training?

Anonymous said...

To the one anonymous poster who said that nobody cares except Andrew Sullivan and this blog: WRONG. This story is still generating real buzz at a grass-roots level. Even if Trig were Sarah Palin's child, let's not forget: she opted to disprove the rumors not by producing a few simple documents, but by announcing her daughter's deepest (supposed) secret to the world. What all of this says about Palin's character, McCain's judgement, and the GOP machine is truly frightening.

~Emma said...

I don't think Sarah or the mother knew that Trig had Downs Syndrome. I don't believe it. Nothing was said before the birth that the baby had Down's. You could argue that she wanted to keep it a secret.

But I don't think she knew. Why else would the mother deliver in a small town hospital by a family physician as opposed to a medical center with the proper care for a high risk baby?

Sarah cares a lot about what other people think of her. She would not willingly sully her reputation by putting her baby willingly at risk.

Put together the story without Sarah knowing the baby has Downs and it makes more sense.

And as for the mother breastfeeding, I think that is fiction, too.

Anonymous said...

I agree with what ~emma said about not knowing the baby had downs...

Morgan, you said you have 5 children, did you get bigger, smaller, quicker or slower with the increasing number of babies you had?


Miguel said...

I have been asking on the Anchorage Daily News blog whether there are is a medical examiner board in Alaska. It seems clear that the doctor in question is complicit in either fraud or negligence.

Is there not at least probable cause for serious examination?

As with the circumstance surrounding the building of the Palins' house, they seem to be avoiding even a mention of the topic.

Just too hot to handle. It in other respects to seem to commit true journalism. Any Alaskans want to weigh in there?