Welfareloser's Blog

okay. i’ve reached a milestone today. for the first time ever, i have a strong desire to bite someone’s face off. i’m attempting to sublimate it into a desire to merely sue. it’s not really working yet. maybe another candy bar will help.

as you might recall, i sent this letter on April 8. in response, i first received this letter dated April 15. i was stupid enough to think that might to lead to an actual investigation and improvements. yeah, not so much. today, i received this letter, dated April 27.

i have never sued anyone. and i’ve never wanted to until today. not that suing my husband’s employer sounds like a hell of a lot of fun, but goddammit, i am NOT going to drop this. this issue does not get left at “we did everything right.” hopefully, “litigation threat” will spur them to action in a way that “not fucking up little kids lives” apparently did not. this gets fixed, whether they do it themselves or i have to find a way to force them to. fuck them.

seriously. you would think that if you learn nothing else from a career in pediatrics, you learn that you don’t fuck with people about their kids.

WelfareLoser
MyHouse
Iowa City, IA 52242

May 4, 2009

Lori Christensen, MD
UI Department of Pediatrics
200 Hawkins Dr.
Iowa City, IA 52242

Dr. Christensen:

Thank you for your time and your response to my letter. My intent was to point out a delayed diagnosis, indicate that it has had a negative effect on a UIHC pediatrics patient, and hopefully prevent our experience from happening to another UIHC pediatrics patient and family. Your response was to raise points regarding what your clinic did right and also what I did wrong.

Let me first say that there has been a remarkable change in my youngest son’s response to sounds since his surgery. I believe we can now start working on his speech. He has suddenly begun experimenting with consonant sounds; in the last week since his surgery, he has gained command of at least a dozen consonant sounds that were previously entirely absent. The very afternoon he came home with his tubes, he was suddenly able to differentiate between vowel sounds and replicate them accurately. He is excited about hearing and talking, babbling, humming and singing, and constantly engaging others in verbal communication, when just a week ago he seemed to have no interest in doing so. It would take some pretty serious mental gymnastics to convince myself that this explosion of progress came in the wake of the removal of fluid that wasn’t there a few weeks earlier.

Felix hardly ever drooled as a baby. At about 12 months old, he started drooling constantly. All day, every day, his shirt was soaked almost to his belly button. Every shirt he owns in size 2T has a dingy bib of staining from the constant drool. This continued through last week. When I took him to his surgery, it was in a wet shirt. When I got him out of his car seat from the surgery, his shirt was dry. His constant drooling stopped that day, and his shirts have been dry ever since. It seems highly likely that the problem that was fixed by his ear tubes had been missed in your clinic for over a year.

It seems to me that his long speech delay was very likely due to a hearing issue. It’s very likely that this issue was present at his initial presentation to the pediatrics clinic. It also seems to me as though impaired hearing should be very high on a differential diagnosis list in a child with delayed speech.

I believe you that Dr. Benson’s report said that there were no problems with his ears. I also think it is possible that a positive finding can be left out of a review of systems. I also remember hearing more than one person comment on wax present in his ears during clinic visits. My concern is that his hearing was not pursued as a cause of speech delay early on. It seems like the tympanic membranes may not have been visualized. It also seems like this issue has been going on for quite a long time. It doesn’t seem that you are acknowledging these possibilities.

You accuse me of lacking the persistence to pursue adequate care. This is simply not true and is offensive to a frustrated parent who follows her son’s doctors’ recommendations patiently. Let me respond to your insinuation that it was my responsibility to goad you into making the appropriate referrals. I did raise a concern that it was taking too long to obtain a hearing exam, whether that was documented in a clinic note or not. I was asked about his hearing and language in the standard review of previous clinic notes during his acute care appointment between the 18 and 24 month visits. I responded that he had yet to have a hearing test because it takes so long to get in. And then we moved on to dealing with Felix’s acute illness. At his 24-month visit, both the resident and attending asked if his hearing had been checked. Both times I responded that he had not yet had his hearing test because it takes a long time to get in at AEA, and both times, was met with SILENCE. I didn’t miss the fact that other options were offered. No other options were offered. Your department should be able to take the initiative required to provide adequate patient care.

As for your assertion that I was “comfortable” with the CT “at the time” – again, your attempts to put the responsibility for the application of appropriate diagnostic techniques on me are both infuriating and flimsy. Spin it however you like, but the fact remains that you gave the boy a CT before he got a hearing test.

As for your suggestion that I “report my concerns” to AEA – I am not dissatisfied with AEA. I am dissatisfied with you for referring a child with a medical problem to a social services agency.

Your letter also informed me that the otolaryngology department performs hearing exams after tube placement. I was aware of this; they have their own protocol. I am very happy with the care he is receiving from that department. A diagnosis has to be made at some point. It would have been great if a diagnosis could have been made by an experienced practitioner on simple inspection in our son’s case, but it was not. That was my original point. The fact that your letter to me inspired the need to draft a rebuttal aside, this remains my concern.

You’re right; your letter does clarify some issues for me. It’s clear that this was not an “investigation.” This was putting another piece of paperwork in place in an attempt to protect yourselves. I’m not surprised your internal review reveals that you did everything right. I’m also not impressed. Something went horribly wrong here. I am asking you again to explain to me what changes you will be making at your clinic to ensure that this does not happen to another child. That’s all I want. If you choose instead to explain to me again how you would have given my child appropriate care if I had really, really asked you to, I’m going to respectfully suggest that, before sending it, you read your letter out loud to yourself, and add the words “your honor” to the end of every sentence, and make sure you still like how it sounds.

Sincerely,

WelfareLoser

cc: Michael Artman