It couldn't have come at a worse time.
For months, Anne Arundel Medical Center has promised that its Rebecca M. Clatanoff Pavilion will be the premier place to deliver baby. Excited obstetricians have told their patients about it. At a hospital-sponsored aerobics class, pregnant women were envious that Stephanie Bedard is due just in time for the facility's June opening.
"Everyone wants to have their kids there," said Mrs. Bedard, 26.
But after the Jan. 31 incident in which three babies at the Annapolis hospital's downtown campus developed breathing problems after they were mistakenly given morphine, the momentum toward the opening of the $28 million facility has been shaken -- if only for a while.
"It certainly doesn't help their reputation," said Michael Cohen, a hospital pharmacist and president of the Institute for Safe Medication Practices, which is nationally recognized as the leading authority in medication error cases. "But I think the public has come to accept that these situations do occur, that they're rare. We know that these things happen; we just pray to God that they don't happen to us."
Fallout from the incident -- from anticipated lawsuits to the charges of reckless endangerment and practicing without a license against the pharmacist, Susan E. Kron -- is expected to continue for several months. Yet Mr. Cohen said the affair probably will cause only a slight, temporary drop in the number of patients at the hospital.
Hospital workers acknowledged that the affair has temporarily dampened enthusiasm about the Clatanoff Pavilion and other new facilities, including a breast cancer center, radiology unit and physician offices.
But perhaps the longest-lasting effect may be the emotional memories of those involved.
For two weeks, workers at the hospital's main site in downtown )) Annapolis attended update meetings and discussed every possibility. They had to contemplate the worst possibility: that someone among them had deliberately tried to hurt the tiniest, most vulnerable patients of all -- three babies in the special care nursery.
"We just wanted to know what happened. It was the unknown," said Cheryl McCleary-Bowser, who, as a hospital liaison with physicians, was busy faxing them updates. "I think that everyone felt they were being scrutinized," said Mrs. McCleary-Bowser, who is pregnant.
Parents of infants born in the hospital around the same time had nagging doubts, wondering if their baby might have been hurt.
Lorie Webber remembered the locked stairwell across from her room, and that the alarm kept going off. She wasn't sure if it was broken, or if someone was trying to sneak in. Other parents were haunted by the five minutes their child was taken away for a test or shot.
Jill DeMarco has frantically tried to remember the face of the nurse who took her baby to be weighed about 3 a.m. "Did I see that nurse before? For all I know, I never saw that nurse again," Ms. DeMarco said. "I'm paranoid."
Other parents weren't as concerned, but found themselves keeping logs, worried that 20 years from now they may discover that their child was somehow exposed.
Now that investigators have determined that the babies got the morphine because of a pharmacist who mistakenly pulled the wrong bottle out of the refrigerator, the hospital's staff is trying to make corrections and move on.
"I believe the recent incident will not have a major impact on the pavilion and on this community. I believe the people in this community look to this hospital to be a really good provider, and we try to deliver that," said Carolyn Core, the hospital's vice president for corporate services.
Struggling to adapt
Like all hospitals in Maryland and across the country, Anne Arundel Medical Center is struggling to adapt to the new realities of health care. Increasingly powerful health maintenance organizations -- which represent almost 40 percent of insured Marylanders -- can demand discounts from hospitals or threaten to take the patients elsewhere. At the same time, from 1983 to 1993, outpatient surgeries increased by 168 percent, while surgeries in the hospital dropped by 33 percent.
So places such as Anne Arundel -- which has outgrown its downtown campus -- are building more outpatient facilities and renovating maternity wards to attract more patients.
Clearly, the Clatanoff Pavilion has gotten women's attention. It is expected to be gorgeous, with hardwood floors, big windows and high ceilings. Hints of teal and peach will highlight borders around the ceilings. A large covered rocker that reclines will sit in the corner of each room. New parents will be able to watch their favorite videos -- even the video of their child's birth -- in their comfortable private room.
Mrs. McCleary-Bowser and other pregnant women who have planned to deliver at Anne Arundel Medical Center's new facility say they have no doubts or worries.
"Everybody says it's like a hotel room," said Mrs. Bedard. "I don't think anything like this could happen to my baby. It's more unlikely that it will happen again.
And other parents -- including one woman who just delivered twins, her eighth and ninth children, said that during the joyous and nerve-wracking time of child birth, they felt safe at Anne Arundel Medical Center's downtown maternity unit.
Incidents occur elsewhere
And what happened on Jan. 31 at this hospital happens at many around the country.
According to Mr. Cohen's data, roughly one hospitalized American dies a day from medication errors caused by a list of mistakes, including a physician's illegible handwriting or a pharmacist mixing up drugs that are similarly packaged or named.
In the Anne Arundel Medical Center case, state investigators believe that pharmacist Ms. Kron mistakenly took the wrong bottle out of the refrigerator and filled the syringes with morphine instead of heparin, a common blood-thinner.
The relatively safe pain-killing drug can dangerously slow the breathing of infants, which is why the three babies were quickly put on ventilators.
Hospital officials maintain that the infants didn't suffer any long-term harm. Two are still in the hospital in stable condition because of unrelated medical conditions.
But the incident has sparked some positive outcomes.
Pharmacy found unlocked
State health department investigators found record-keeping errors by nurses, an unlocked pharmacy and pharmacists who weren't documenting when heparin was used to keep the babies' intravenous lines open.
Carol Benner, director of the state Office of Licensing and Certification, which inspected the hospital last week, said the hospital already has corrected some problems. From now on, the hospital will purchase morphine in powder form, so it can't be easily mixed up with heparin, officials said. The morphine will be moved to a different location.
Heparin flushes have been a particular problem because manufacturers don't make them in the tiny dose that infants need, and pharmacists must mix the heparin and diluent themselves, increasing the risk of error. In a Philadelphia hospital five years ago, three babies died because of a mistake in their heparin flushes, and experts say they aren't surprised there has been another incident.
Armed with information about the Annapolis hospital's case, Mr. Cohen said, he reached an agreement Friday with a pharmaceutical manufacturer he declined to identify to look into the prospects for manufacturing heparin flushes in pediatric doses.
But manufacture of the commonly used dose by a pharmaceutical house might add thousands of dollars to a hospital's expenses, at a time when cuts in public programs such as Medicare and pressures from HMOs are forcing hospitals to reduce spending.
Some hospitals would pay for it, Mr. Cohen said. And others wouldn't.