In a lawsuit that challenges the trend toward shorter hospita stays, a Woodlawn woman has charged that an insurance company's decision to allow a stay of only 1 1/2 days for her newborn baby contributed to his death.
Bonita Roberts, 19, said doctors might have cured the strep infection that crippled her son's lungs and eventually killed him if the infant had been allowed to stay longer in the hospital and been monitored for complications.
Koran Amar Robinson was born on Nov. 24, 1991, at a time when hospitals -- reacting to new limits set by insurance companies -- were shortening stays for infants and mothers after uncomplicated deliveries.
The shift, part of a larger effort to control rising health care costs, has drawn angry criticism from doctors and patients, who say it leaves mothers ill-prepared to care for their babies and newborns vulnerable to problems that might not develop until the second or third day of life.
Hospital stays after uncomplicated vaginal deliveries have dropped steadily in Maryland -- from an average of 2.06 days in 1990 to 1.85 days in 1991 and 1.62 days in 1992, according to the Maryland Health Services Cost Review Commission.
Ten years ago, the average stay was 2.84 days.
The day after Koran was released from the hospital, he was readmitted with a fever and given intravenous antibiotics to combat his infection.
But the infection was apparently too advanced to cure. Koran died on Dec. 29 after spending five weeks in intensive care, much of the time hooked to a breathing machine. He died of a Group B streptococcus infection, which kills an estimated 2,000 babies in the United States each year. It is the leading bacterial killer of newborns.
"When he first died, I just couldn't do anything," Ms. Roberts said. "I was just so stressed out. I was at the graveyard every day. I felt like I couldn't breathe.
"I'm not over it now. I'm just starting to cope with it."
Ms. Roberts said she attended a community college after Koran died but dropped out after a few months because she was too upset. She now works at a shopping mall and lives with her mother.
In her lawsuit, Ms. Roberts and the baby's father, Christopher Robinson of Baltimore, seek unspecified damages against Potomac Health, a health maintenance organization owned by Blue Cross and Blue Shield of Maryland; Sinai Hospital, where the baby was born; her obstetrician, Dr. Kenneth M. Goodwich; and the baby's pediatrician, Dr. Patricia Surichamorn.
Also charged is Potomac Physician's P.A., a physicians' group that sees patients covered by the HMO. Dr. Goodwich and Dr. Surichamorn are members of the practice.
"We are sympathetic with the family," said Amy Levy, vice president for corporate communications at Maryland Blue Cross. This is a tragic situation, but we can't comment on the specifics of this case, or any case, for that matter."
Neither the doctors nor a Sinai spokesman would comment.
The case was filed last week with the Maryland Health Claims Arbitration Office, which hears all malpractice suits in the state.
Plaintiffs are not allowed to seek a specific amount of money. If tTC either side is dissatisfied with the decision made by an arbitration panel, the case can be brought before a Circuit Court jury.
Attorney Joanne L. Suder, who represents the parents, said doctors failed to recognize two important risk factors for the infection: The mother's water broke several hours before contractions began, and labor lasted 14 hours, which is considered prolonged.
This meant the baby was exposed for a long time to bacteria that can inhabit the birth canal, she said.
As many as one-third of all pregnant women carry streptococcus B, said Dr. Vern Katz, an associate professor of obstetrics and gynecology at the University of North Carolina. "Long labor with ruptured membranes" can expose babies to the risk of infection, he said, adding that he couldn't comment on the case because he knows nothing of the circumstances.
Koran, who appeared to be a healthy baby at birth, weighed 7 pounds, 7 ounces. He was discharged on the morning of Nov. 26, 1991.
His mother said that when she changed his diaper about 3 o'clock the next morning, Nov. 27, she noticed that he felt warm. Concerned, she called the HMO for advice.
She said the pediatrician told her to watch the baby until later that morning and call back if the fever persisted. The fever worsened, and as she prepared to call the doctor again, a nurse making a home visit told her to rush to the emergency room.