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At Emergencias Médicas

We were blessed to receive verbal apologies from the medical director, Dr. Goldoni,  at Emergencias Médicas, and also from the ambulance doctor herself, right after the event. Many parents of children with iatrogenic injuries never receive apologies, and are bitter from wanting one. We were lucky. Dr Goldoni took a good amount of time to talk with us.

Still, we didn’t really get to talk with the ambulance doctor herself.  She apologized while I was still in shock and unable to respond well, right after the incident.  She apologized to my husband before he understood the severe implications of what she had done.  Her apologies are a blessing to us.  However, we would still like to speak to her now so that we can find out what she learned and whether she is still practicing emergency medicine somewhere else, or if she has chosen a specialty that involves a lower chance of encountering surprising situations.  Emergencias Médicas has given us the name of the doctor, but it is a common name and we would like their help locating her and encouraging her to talk with us.

Emergencis Médicas’ written report was strangely devoid of the ambulance doctor’s name, and composed almost two months after the event.   In it there is no apology,  minimal information, and some false information.  Worst of all the report states that the normal protocols of Emergencias Médicas were followed.  If that’s true, they are a dangerous company!

Judging from Dr Goldoni’s explanation of the event, and her competence as a communicator, Emergencias Médicas is usually a pretty good company.   It is not really their protocol to enter a room and ask no questions, yell at patients, and jab people violently in the ribs.  It is not their protocol to suggest out-of-hospital cesareans to people whose babies are almost completely born.  Nor to insist that laboring women stop pushing.   Nor to give “episiotomies” that require 52 stitches to repair.  Nor to use a high-school biology-grade scalpel to perform their surgeries.

scalpel

It is also not their protocol to keep newborns naked and alone regardless of the air temperature.

It might be their protocol that when an employee makes a huge mistake, and then quits her job,  someone else invents a report, and slips that sentence into it (“our protocols were followed”),  regardless of what they believe actually happened.

We spoke to Dr Goldoni again, in July of 2013, 30 months after the event.  She is so lovely that we didn’t bring up the oddness of the report.  We asked her how Emergencias Médicas  has changed so that they don’t repeat this mistake.  She said that everyone knew about what happened, and they held a briefing on it to demonstrate what errors had been made. She insisted that if any other employee had come such a thing would never have happened.  She, like many older doctors  we have met, faulted the medical schools for no longer training people in natural childbirth.  The intervention rate is dangerously high in Costa Rica, all births are assumed to occur in hospital, and students are trained that cutting and medicating is the best response to almost every situation.  “They no longer train students the way they taught us that just observing and waiting is usually the best thing and that birth is a natural, normal thing that doesn’t need help,” is what we heard from her and many other doctors.

Given  that students are no longer trained to attend births outside the hospital,  we ask  that Emergencias Médicas  take special care when hiring doctors for their ambulance to test their knowledge and make up for their lack of skills.  Since an older nurse or paramedic usually knows more than a young doctor they should make sure that young doctors don’t travel unaccompanied.

We hope that the dispatcher is trained to ask enough questions so that they can make sure that the employee they send can attend the situation.  The Alajuela Hospital couldn’t understand why they weren’t called instead, since they are closer and have an obstetrician they can send out.

Ideally, inspired by a desire to not repeat their mistake, Emergencias Médicas would hold special trainings for their employees, and even for the larger community of emergency doctors and paramedics.  We also suggest they help sponsor the publication of a good manual in Spanish about Emergency Natural Childbirth.  Dr Goldoni said that she would be happy to help with either project, assuming the business managers of the company grant her the necessary budget.

We also would like Emergencias Médicas to compensate us for our financial costs.  How much?  It is hard to say, since we are from the US where compensation for such fiascoes are sometimes extremely high and may contribute to defensive medicine, which in turn might provoke even more “unnecesareans,” and that is, of course, exactly what we don’t want to contribute to.

Our costs were significantly less than that of the US government, which we estimate spent a quarter million dollars on Miri’s care.  Why US hospitals cost so much more to offer the same level of care as other countries is another story.  The Costa Rican Social Security system also spent freely.  It would be up to these governments to sue for themselves, and while they are at it they could sue our insurance company, Seven Corners. Like the insurance companies of  several families of disabled children we met, they failed to meet their obligations.

But we did have costs, costs of transportation, of medical care, of lost income, and the loss of my scholarship, and of counseling for post traumatic stress disorder, which all of our family suffered from. We suggest that Emergencias Médicas compensate us for all of that, as well as taking clear steps to make sure this doesn’t happen again.