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October 18-24, 2006

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The Byrne Report

Hospital Hell

By Peter Byrne

Cathy and Craig Caddell live on the outskirts of Petaluma, surrounded by woods, grassy lawns, wandering sheep, running dogs and inquisitive cats. Cathy is a childbirth educator; Craig works for an information-service company. The forty-something couple have two small children, Sara and Dylan (not their real names). And on July 23, the Caddell's were taken hostage by the medical system.

On that hot morning, a neighbor had put a few drops of pennyroyal on her pets to repel fleas. Pennyroyal is an essential oil made from a herbaceous plant that grows wild in the North Bay. The oil is used to induce abortion and menstruation, and in doses larger than two tablespoons, it can be lethal.

The neighbor accidentally left an irrigation syringe of minty-smelling pennyroyal on her window sill. Playing doctor, Sara, age seven, picked up the syringe and pressed it against her doll's mouth. The liquid splattered and a few drops went into Sara's mouth. The girl spit it out and ran home, telling her mother that she might have swallowed a little, but she did not think so.

Erring on the side of caution, Cathy called poison control and was told to rush Sara to an emergency room for treatment. Cathy has a background in herbal medicine. She confirmed with the poison-control operator that activated charcoal is a remedy for pennyroyal ingestion, suggesting that she treat her daughter at home with the antidote. The poison-control operator responded that if Cathy did not take Sara to the ER immediately, the authorities would be alerted.

Poison control called ahead to Petaluma Valley Hospital to alert the ER to the Caddell's arrival. But once there, Cathy and Sara were left unattended in an ER cubicle for 20 minutes. Finally, Cathy stuck her out head and, upon seeing the attending physician, Dr. Stephen Krickl, instructed, "If you want to get the activated charcoal, do so. Otherwise, I will go to Whole Foods and get some."

In retrospect, Cathy says, "I think that is when I pissed him off."

After Sara was given a drink of activated charcoal, she received an electrocardiogram and blood tests; neither showed evidence of poisoning. Cathy declined to authorize a chest X-ray or liver medication. After an hour or so, she went outside to meet Craig, who had just arrived with Dylan. The couple recounts that when they walked back into the ER with their son, Krickl made a snap judgment. Thinking that Dylan had been under Cathy's care during the ER ordeal, he accused, "You left the boy in the car outside in 105-degree heat!" Krickl then transferred Sara to the intensive care unit for 24 hours of observation.

The Caddells thought the hospital was overreacting and asked for an Against Medical Advice release form so they could take Sara home. Medical staff informed them that if they tried to leave with their daughter, the police would be called.

Cathy and Craig were stunned. Sara had said she did not have contact with more than a drop or two of the oil, if any. She was asymptomatic and the antidote had been administered.

Pediatrician Dr. Martha Cueto-Salas took over. Recounting Sara's medical history, Cathy told her that Sara was partially immunized, i.e., she does not have the traditional package of booster shots. (Like other modern parents, the Caddells have allowed some vaccines and not others.)

Dr. Cueto-Salas lectured them, they say, as if their informed medical decision was tantamount to child neglect.

With the threat of being arrested hanging over their heads, Cathy and Craig took turns watching Sara in the ICU all night. "I felt like I was wearing a label on my head that said 'Bad Mother,'" Cathy recalls. In the morning, just prior to checking out, they met with Dr. Cueto-Salas and, through her tears of outrage, Cathy expressed how she felt about her family being abused by Sara's doctors under the guise of medical precaution.

Adding insult to injury, the hospital bill came to nearly $12,000, a significant portion of which the middle-class Caddells had to cover because their health insurance has a high deductible.

The nightmare continued when Robert Tim Konrad of Sonoma County Child Protective Services (CPS) showed up at the Caddell house two days later with an official complaint alleging child neglect. Konrad was not allowed by law to tell the Caddells who it was that had filed the complaint. They stood accused of under-immunizing Sara; leaving her alone with a toxic substance (pennyroyal); leaving Dylan alone in a hot car for an hour and a half; and for being uninsured. The Caddells were terrified. Child Protective Services has the power to instantly remove children from their homes.

After meeting the Caddells and interviewing Sara, Konrad deemed the complaint to be without merit. End of case. Except that the Caddells felt utterly violated. Cathy says that when she tried to empower herself and Sara as consumers of medical procedures, she was treated as a possible felon. She believes that the poison-control operator framed her as a child neglector to the ER staff, so that when she and Sara arrived they were prejudged by the attending physicians given flawed information. The Caddells decided to go public with this story as a cautionary tale about what can happen to anybody when you question medical authority.

On Oct. 11, the Kafkaesque plot took another turn. After telling me her story, Cathy went to the records division at Petaluma Valley Hospital, which is operated by St. Joseph Health System, and asked to see Sara's medical records. She filled out a record request form and was told that she could not see the records for five days. Cathy called me and 15 minutes later we went back to the record room together. I identified myself as a reporter, and she asked for her records again. Higher-ups quickly entered the picture. Phyllis Drummond, the hospital's risk manager, told Cathy, "We do not just hand records over to people to look at." She then told Cathy that the attending physician had to review the records before Cathy would be allowed to see them, and that the hospital did not have to produce the records for her inspection for five days.

The California Health and Safety Code contradicts Drummond. The law states that the hospital must allow her to see the records within five days of request. Furthermore, the law does not require Petaluma Valley Hospital to allow Sara's attending physicians to review the records prior to Cathy's inspection, because the records belong to the hospital, not the physician.

In a telephone interview, Laurie Clayton, the hospital's corporate compliance officer, told me that the hospital's policy is to allow a physician to review requested records, and for the physician to decide whether or not handing them over to the patient (or the parent of a minor patient) will "harm" the patient.

Five days later, Cathy received a copy of Sara's records. The record shows that Krickl made the CPS complaint about the Caddells. He wrote: "They have demonstrated a lack of compliance with immunization and presumably possible mistrust of the medical system." Krickl incorrectly asserted that Dylan was Sara's sister and that Cathy had left "her" sleeping in a super-hot car.

In her written comments, Cueto-Salas backed Krickl up. Both physicians repeatedly took umbrage at having their medical judgment questioned by so-called "non-compliant" parents, even though the record shows that Sara was in no danger.

Summing up the experience, Cathy says, "I am fearful of the ever-broadening trend toward the lessening of civil liberties in this country. I am fearful of our culture of fear itself."

Contact Peter Byrne or send a letter to the editor about this story.