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Marc Fisher

D.C. Family Detoured by Mixed Signals

By Marc Fisher
Thursday, March 3, 2005; Page B01

T here's little in life more frightening than having a child who is dramatically ill. Lily Bass was 8 months old, and she had had three truly scary days. It was an all-orifice extravaganza -- vomiting, diarrhea, bloody stools.

Her doctor ordered her admitted directly to Georgetown University Hospital's pediatric ward. But as the hours ticked by, it became clear that Lily was recovering. Her condition -- eventually diagnosed as a bad reaction to an antibiotic that had been prescribed for strep throat -- seemed to have run its course.

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So despite the fact that doctors wanted to keep Lily overnight to run tests and make certain she was okay, David and Hope Bass decided to take their daughter home, just a few blocks from the hospital.

A couple of hours later, after 11 p.m., an investigator for the District's Child and Family Services Agency knocked at the Basses' door and told the parents they had to return Lily to the hospital. If they refused, she would summon police. The caseworker wouldn't leave until David Bass called Lily's pediatrician and everyone agreed that the doctor would see the baby in the morning.

Over the course of the next month, city investigators repeatedly contacted the Basses, wanting to question them about employment, sleeping arrangements, discipline style, substance abuse, criminal records and domestic violence. They even wanted to see how much food there was in the house.

"When we left Georgetown, our child was jumping up and down, laughing and playing," says David Bass, former deputy publisher of the Weekly Standard and now a public relations executive in the District. "At what point are we permitted to exercise sound judgment about our child?"

Leaving the hospital against medical advice (AMA) -- especially for a little baby -- sounds like the act of a fool. To the frustration of doctors, hospitals and their attorneys, it happens all the time. Sometimes people just tire of sitting in the waiting room for hours on end. Sometimes doctors wink at patients about hospital protocols that seem like overkill. (That's happened to me a couple of times, and I'll take the honest, off-the-record advice of doctors over hospital rules any day.)

But there are also plenty of cases in which leaving AMA is just plain dumb. Studies have shown that patients who leave in defiance of medical advice disproportionately end up being readmitted, often with worsened conditions.

The hospital says it notified the city both because it is legally obliged to do so and because medical ethics require that doctors put the child's health ahead of the parents' judgment. "Despite the fact that the family appeared to be respectable people," says Richard Goldberg, Georgetown's vice president for medical affairs, "we discharged our legal and ethical obligation to protect the child."

Bass says he got two different kinds of advice -- an informal green light to bail out, and the pro forma instruction that you're not supposed to leave AMA.

"There was no attempt whatsoever to keep us there," he says. "The doctors told us we should be fine and waved us away. One of them said he'd probably do the same thing." Lily's chart shows that everyone agreed she was doing much better, that she was active and playful, that the diarrhea had stopped and her vital signs were strong.

But Georgetown officials strenuously deny that anyone winked Bass toward the door. To the contrary, Lily's chart shows that at least two doctors, a social worker and a nurse sought to keep the family at the hospital. Tamara Katy, the chief resident that night, wanted the baby kept overnight to rest her bowels, rehydrate her and conduct tests.

Bass signed two forms acknowledging that he was taking his baby home against medical advice. But he said the forms were at odds with the message the parents got from the staff. "If they had said anything remotely like, 'You really should stay,' we would have," he says. "I don't feel we should be subjected to the humiliation" of a city investigation.

Diarrhea can be dangerous in infants, so doctors contacted hospital social workers, who decided to report the Basses to the city. Goldberg adds that some hospitals that failed to report parents to child services have faced criminal charges.

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