Preemies

What are my legal options?

My 20 month old DS was premature and stayed in the NICU as mainly a feeder/grower for 17 days. He came home on a monitor for apnea.

Now, my 6 day old DD is in the NICU because they suspected that she might have an infection. The cultures came back with no growth but they are still keeping her there for 7 days of treatment. 

Here is where my problem comes in. She has the suck, swallow, breath reflex the thing is they, like most NICU's, do the cluster care. Therefore she is forced to eat according to their schedule every 3 hours, 60-65 mils in 15 minutes or less. She, however, is more of an on demand feeder. She wants 1-1.5 oz every 1.5-2 hours. They will not let her do this. So she is in an open crib, off all oxygen, no IV (except her antibiotics that she will have the last of tomorrow), no heat, etc. She does have a gavage.

We are not waiting for the S,S,B reflex to click, we are just waiting for our DD to take feedings on THEIR schedule. 

Do we ask for discharge AMA? Do we need a lawyer? Etc?

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Re: What are my legal options?

  • Have the NICU staff been willing to discuss your concerns?  If not, I would start by asking to speak to the patient advocate at the hospital.  They would be able to help you navigate 'the system' and would be less costly/stressful than acquiring legal counsel.  GL!
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  • We tried to talk to the doctor. He was down right hostile towards my husband. The doctor informed him that that was the way they do things and there is nothing we can do about it. The doctor wouldn't even discuss it with him.

    We have tired to get a hold of an advocate but so far they have not called us back (it is the weekend so we might have to wait until Monday). 

    By Monday she will just be sitting in her open crib sans antibiotics waiting for her to get on their schedule. They haven't even talked about getting her moved to special care she is just stuck there in the NICU.

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  • Your post caught my eye because we are in a similar situation - the only thing "wrong" with her is that she was a few days earlier than their cut off. She is breathing, eating, not losing more weight than a normal newborn, all lab work is normal (glucose, bilirubin) but they won't let her go. They are not even giving a reason for it. It is very frustrating and I am looking forward to the responses to your post. We haven't pushed the neo on it yet, so that's our next step.
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  • I am a nurse and all I can tell you is that you are able to pull her out against medical advice.  However, your insurance company will deny your claim and not pay for entire NICU  stay and possibly birth and any expense r/t this.  Whether you can afford that and if it is worth it is up to you.  I would do my best to convince the "good" nurses to speak to the doctor/social services department on your behalf and be your patient advocate.  After all one of the many hats nurses wear is that of patient advocate.
  • I am an NICU RN. So Im a little confused. Why would you want to feed every 1.5-2 hours? It is normal for an infant to eat formula every 3-4 hours. If they are preemie then they have to be fed every 3 hours. It helps their growth. Also the more stimulation they get then the more calories they loose and not gain from the formula. THe less stimulation and the less time she takes to eat, then the more weight she will gain and not lose. It will shorten your NICU time. Normally a special care nursery is the same as a level 2 NICU. If you leave AMA, the Doc might think you are harming your child and call DCF. Im not sure what your hospital protocol is but our hospital we would have to call DCF if a mother takes her child out AMA. You can request a transfer to another hospital if you are not satisfied with the care at your current hospital. Also try to find the CEO of the hospital. They should be able to help you. PM me if you have any questions
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  • She isn't a preemie. She is a full term baby.
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  • imageMegaloo05:
    I am an NICU RN. So Im a little confused. Why would you want to feed every 1.5-2 hours? It is normal for an infant to eat formula every 3-4 hours. If they are preemie then they have to be fed every 3 hours. It helps their growth. Also the more stimulation they get then the more calories they loose and not gain from the formula. THe less stimulation and the less time she takes to eat, then the more weight she will gain and not lose. It will shorten your NICU time. Normally a special care nursery is the same as a level 2 NICU. If you leave AMA, the Doc might think you are harming your child and call DCF. Im not sure what your hospital protocol is but our hospital we would have to call DCF if a mother takes her child out AMA. You can request a transfer to another hospital if you are not satisfied with the care at your current hospital. Also try to find the CEO of the hospital. They should be able to help you. PM me if you have any questions

     

     

    Actually, it's normal for an infant to feed on demand. Some eat more often, some eat less often.  I am shocked and appauled that it's considered child abuse to do what you feel is best for your child medically.  

    OP good luck to you! I had this same issue when DD was in the NICU as a 34 week preemie. I hate "cluster care". It goes against all my instincts. We were also breastfeeding so I'd be there and she'd be rooting and the nurses would get mad if I fed her when she was rooting. They wanted to weigh her before and after but none of them were "available" to do so. Grrr....  We didn't have a choice to transfer her and our insurance wouldn't pay if we took her out AMA. We didn't have 90k+ to fork out so I kept working on the nurses and doctors until the buttheads finally listened to me. Can you request a different doctor or a transfer?

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  • That's frustrating.  When my little guy was very tiny he was on a Care Time schedule (every 3 hours at first because he was on the oscillating vent and needed his head rotated every 3 hours, then every 4 hours when he was a bit older and more stable).  But after he started taking feedings by mouth, he was put on an 'on demand' schedule meaning that he dictated his feeding schedule based on when he was hungry.  They just kept track to make sure that he was getting enough volume and growing appropriately.  All of the babies in my NICU were handled this way, seems more natural.  Our NICU operates on a "developmental care" model, maybe that's why?  I would be really frustrated with it if I were you, too.  I hope the patient advocate is able to help.  Does the NICU have a social worker on staff that could help?  Ours had one there every day for things like this or any other concerns. 
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  • imageBeccaboo0713:
    She isn't a preemie. She is a full term baby.

    She is in the hospital for a 7day course of antibiotics right? It means her labs came back elevated most likely. Just because there is no growth on the blood cultures doesn's mean she doesn't have an infection somewhere. They wouldn't keep her and give her a 7 day course if it wasn't necessary. Preemies need a feeding schedule with cluster care but most full term babies do not. With that being said, if they are keeping her on a schedule they most likely have a reason. Im sorry your NICU experience isn't going well. Because she might have an infection they are most likely trying to not to stimulate her very much. it can cause other problems like burning more calories then she eats and then that would keep her in the NICU longer. I would do what they want you to do within reason so your NICU stay wont be prolonged. 

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  • They came back ever so slightly elevated. The only reason the pedi sent her to NICU was because of my GBS+. Even the pedi said that the levels weren't elevated enough to cause concern. It was only my GBS+ that caused concern.

    Then the neo down in NICU said yesterday that finishing the treatment was just going through the motions. That she is fine as far as infection goes. 

     Basically they admitted her into NICU and she didn't need to be here. 

     They were keeping her on a schedule because it was convenient for the nurses. 

    We finally got to talk to the third doctor in the NICU and he said that we can go on demand feeding every 2-4 hours. 

    They said I can hold her whenever and however long I want to so I don't think they want a lack of stimulation...I don't know what they want. 

    I hope to get her out on Tuesday under the care of this new doctor. 

    Thanks for the replies. 

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  • imageM&M01-07-06:
    I am a nurse and all I can tell you is that you are able to pull her out against medical advice.  However, your insurance company will deny your claim and not pay for entire NICU  stay and possibly birth and any expense r/t this.  Whether you can afford that and if it is worth it is up to you.  I would do my best to convince the "good" nurses to speak to the doctor/social services department on your behalf and be your patient advocate.  After all one of the many hats nurses wear is that of patient advocate.

     Actually, it depends on your state if your baby can leave AMA. An adult can, no problems. But I was just talking about this with the case manager at my hospital (I'm a mom/baby nurse) and we do not allow parents to take their babies AMA and will get protective services and law enforcement involved if they try. that surprised me too. I would have guessed a parent could since it was their baby.

     To the OP, keep raising heck until you get someone who will listen. It seems weird to me that they would force scheduled feedings on a term baby. the NICU at my hospital moved my son to ad lib feedings towards the end of our NICU stay and he was not term.

    Is your LO gaining weight okay?  Maybe there is a concern there that they have not addressed with you properly.  Is there social issues they are concerned about? it jsut seems so odd to me to hold a baby that is ready to go home.

    If the doctor was an ass to you or your husband, you do not have to tolerate that. You can "fire" your doctor and request another one. Ask to speak to the NICU manager and make sure they get the patient advocate for you. Even on a weekend, I assure you someone is oncall and can at least address your concerns over the phone. Keep taking your cocnerns as high as you need to and I promise someone will listen to you. My hospital bends over backwards (to an annoying level, from a staff memeber) to please even the most difficult of patients (not saying you're being difficult) so keep moving up the chain until you're heard.

  • I feel your pain. We are learning that is just how they do things and once you are in the NICU you have little choice but to do things their way. They have complete control. I'm trying to go with the flow but once we are out of here I'm going to need some therapy.
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  • imagerah1218:
    imageBeccaboo0713:

    They came back ever so slightly elevated. The only reason the pedi sent her to NICU was because of my GBS+. Even the pedi said that the levels weren't elevated enough to cause concern. It was only my GBS+ that caused concern.

    Then the neo down in NICU said yesterday that finishing the treatment was just going through the motions. That she is fine as far as infection goes. 

     Basically they admitted her into NICU and she didn't need to be here. 

     

    No snark intended here, so please don't take it the wrong way.  Trust me on this: your DD is better off in the NICU if you were positive for GBS, and the antibiotics will help her avoid more serious complications.  Apparently I'm positive for GBS, but never had a chance to be tested because I delivered too early.  My DD got late-onset GBS, sepsis, and meningitis because of it, and we were in the NICU an extra 2 weeks.  If we had brought her home when we were supposed to, she would've become ill at home, and they wouldn't have caught the infection as quickly, therefore increasing the risk of serious complications from the sepsis and meningitis.  So because you were positive (and I'm assuming your membranes ruptured), they gave her the antibiotics to help prevent something very serious.  All of the neos in my NICU said that this is a standard course of treatment for women and their babies when the mom comes back positive for GBS.

    I'm sorry you have to go through this, but you'll have your D home with you soon, and you can take comfort in knowing that she's safe and healthy.  GL. 

    Don't worry, I see no snark with your response. My membranes did not rupture until I had 1.5 doses of the antibiotics already in me. They ruptured in the middle of the 2nd dose. 

    When did your baby show signs of the late-onset GBS, sepsis, and meningitis? I am glad she is getting the antibiotics, no doubt there. I just don't want her kept for phantom feeding issues. I had a preemie, I know what feeding issues are and I am almost 100% sure that she doesn't have them.

    I talked to the 3rd doctor today and he was very nice. The other two didn't want to do ad lib feedings but this one had her NG tube pulled today and we are doing ad lib feedings for the next 24 hours and just seeing if she will gain weight. 

    She has been gaining great with the NG tube and taking almost full feedings (but not quite all of them) She went from 7lb 5oz to 7lb 8.7 oz in a day. 

     Hopefully under this new doctor we will be out of there by Tuesday. :)

    ETA: I know that I must sound crazy. I don't want to pull her out AMA (and apparently I can't) I am just a hormonal mom who wants her baby. Smile

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  • I hear you. Toward the end of our NICU stay I'd had enough of having little to no control over my girls' care. It seems like until you leave the hospital with them in your care, they aren't really yours!

    Sounds like you have things on the right track though... Good Luck!

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