ou can wait for us. We have waited for you for more than 20 years!" The speaker, her voice quavering, shouts into the microphone. Applause erupts. It's the first outburst of emotion in three hours.
I have come to a meeting of total strangers who, although unknown to each other, share a strong bond. There are 500 of us, Washington and Baltimore area women, all victims of injuries that occurred while we were wearing the Dalkon Shield, an intrauterine birth-control device.
Some of us gave birth to deformed infants. Many of us have suffered pelvic inflammatory disease, ectopic pregnancies, infection-induced miscarriages and infertility. A number have undergone involuntary hysterectomies. At least 20 women are reported to have died, mainly from infection-induced miscarriages or septic spontaneous abortions.
The majority of us were in our early twenties when we had the Dalkon Shield inserted. Now, two decades later, most of us are in our forties, and have gathered at a Baltimore hotel to learn how to receive compensation from the $2.5 billion Dalkon Shield Claimants Trust, set up from the bankruptcy-induced sale of the Richmond-based A.H. Robins Co., manufacturer of the Dalkon Shield.
The meeting, held last spring, was called by the trust and the Dalkon Shield Information Network, a national support group. The 1,500 women in the Washington-Baltimore area who have not retained lawyers to represent them in their claims had been invited. A third of us showed up.
My first IUD, not a Dalkon Shield, was inserted in May 1972. The Double Coil lasted less than two months. I was 25, married for a year, and my husband -- an admiral's staff officer -- and I were living in San Diego. I had taken birth-control pills and, like many women who switched to an IUD, I was concerned about the effects of the pill and decided to try something different.
When the first IUD fell out, my gynecologist suggested the relatively new Dalkon Shield. It's foolproof, he assured me.
Foolproof it wasn't. Almost immediately, I experienced abdominal cramps and spotting. I thought I had ulcers and went to an internist.
By the beginning of November, I had not had my period for 2 1/2 months. I felt bloated. My breasts were tender. The gynecologist said I couldn't be pregnant and gave me a progesterone pill to induce menstruation. About two weeks later, when nothing had happened, he gave me a progesterone shot. Finally, five days later, I had a pregnancy test: it was positive.
By the end of November I was carrying a fetus that was about six weeks old. The doctor advised me that the IUD should not be removed. In early December, he remarked that he could no longer see the Dalkon Shield retrieval string.
Over Christmas, I had a fever -- the flu, I thought. By Jan. 15, a Monday, I had started spotting. The severe headache I had had over the weekend was followed by abdominal pain and a 101-degree fever. The doctor gave me an antibiotic and sent me home.
More than 17 years later, I recall the next few days through a haze of horror: writhing in bed in searing labor-like pain; fevers of more than 104 degrees; my husband getting up constantly to change sweat and blood-soaked sheets; and when the fever dipped or the bleeding subsided, praying that the pregnancy would go successfully to term.
Finally, four days later, as I passed bloody tissue after another night of excruciating pain, the doctor ordered a dilation and curettage -- a medical procedure used to terminate a pregnancy following a miscarriage. A male fetus 12 to 14 weeks old was removed, along with most of the placenta -- and the Dalkon Shield.
The doctor told me the placenta detached; he said he did not know why this had occurred.
Later, after we moved to Washington, my troubles continued. I would go for months without a period. I had tests and more tests for abdominal ailments. Eventually, after three years, I did conceive. I worried constantly that once again, inexplicably, I would miscarry. But our daughter was delivered by Caesarean section; 3 1/2 years later, we had a second daughter.
For more than a decade, like the majority of Dalkon Shield victims, I didn't make the connection between the IUD and my miscarriage. Then, in the mid-1980s, it clicked. A newspaper article described my case: a Dalkon Shield user who had gotten pregnant, had searing pain, soaring fevers, heavy bleeding. The only difference was that she had died from a septic spontaneous abortion.
What contributed to my miscarriage, I later learned, was that the IUD had been left in place. Scientific studies later made public incriminated the shield's retrieval string, which typically in pregnancy drew up into the uterus and, like a wick, deposited harmful bacteria, resulting in septic spontaneous abortions.
Whereas most other IUD's had single-filament strings, the Dalkon Shield's was multifilament, allowing bacteria to migrate up it more readily. Robins did not reveal this.,
Robins introduced the Dalkon Shield in 1971. By 1974, 2.2 million Dalkon Shields had been prescribed for American women. An additional 1 million were shipped overseas. The Dalkon Shield was touted as the device for women who had not borne children, and the resulting tragedy is that many women in their twenties consequently became sterile.
A federal court in Minnesota appointed two specialists to review whether Robins withheld information and destroyed company documents that raised questions about the safety and efficacy of the Dalkon Shield. As reports of septic abortions and deaths increased by 1974, the Food and Drug Administration prodded the company into taking the Dalkon Shield off the market.
Lawsuits against Robins mushroomed. By August 1985, having paid $530 million in 9,500 lawsuits and claims and with 6,000 more lawsuits pending, the company filed for bankruptcy. Potential claimants were advised through a massive advertising campaign to contact the court and fill out a questionnaire. I did that before the 1986 deadline.
Along with about 196,000 other "active claimants," I have been waiting since then: through the corporate war over Robins's takeover; through complex legal wrangling among the company, stockholders, judges, Dalkon Shield victims and other claimants; through a myriad of legal appeals; and finally, last December, through the sale of Robins for nearly $3.2 billion to American Home Products Corp.
Now, after months of getting legal packets from the court and chatty newsletters from the trust, the claimants have received what we have been awaiting for years -- final compensation information.
Like everything else in this saga, the procedure isn't simple. We have been given four options to select. In Option One, claimants can receive between $125 and $725 by simply signing a statement saying they used the Dalkon Shield and suffered injury. Almost 96,000 have made this selection, including those who chose this option in the year before the full plan was released.
In Option Two, claimants must show evidence of Dalkon Shield use and injury in order to be paid a set amount for only one injury, even if they had multiple afflictions. Payments range from $850 to $5,500, depending on the injury. For my septic spontaneous abortion, I would receive $2,500.
Option Three requires proof generally through medical records of a cause-and-effect relationship between the Dalkon Shield and the medical problem. The highest payment so far in Option Three has been $195,000, according to Julie Freeman, trust manager of claimant relations. Baltimore attorney Michael Pretl, who has handled hundreds of Dalkon Shield cases, says 90 percent of Dalkon Shield claimants suffer from pelvic inflammatory disease. Pretl says about $86,000 has gone to a 48-year-old woman with several children whose use of an IUD resulted in a hysterectomy; $135,000 to a 32-year-old woman with one child who became sterile, and $195,000 to a childless woman who became sterile in her twenties and has subsequently adopted two children.
If a claimant rejects the trust's offer in Option Three, she is entitled to mediation, followed by binding arbitration or a jury trial. Option Four offers a deferred review for up to three years, particularly for claimants, such as those with pelvic inflammatory disease, whose injuries may worsen.
To qualify for any payment, a claimant must have had one of three injuries: pelvic inflammatory disease or uncontrolled bleeding; pregnancy and injury with the Dalkon Shield in place, or perforation resulting in surgical removal of the device. As a result of these injuries, certain additional consequences ranging from ectopic pregnancy to temporary or permanent infertility, hospitalization, surgery, and pain and suffering are also taken into account.
Since mid-March, 6,000 claimants have selected Option Two; 12,000 Option Three; 100 Option Four, and 1,000 have withdrawn their claims. Since announcement of the compensation plan, the trust has made offers to 5,500 claimants for Options 2 and 3. While the deadline for option selection is July 1, 1991, Freeman estimates it could be five years or more before the last Dalkon Shield payment is made.
Freeman and Cinders Murdock-Vaughan of Westminster, Md., the co-chairman of the Dalkon Shield Information Network, Inc., who sports a huge paper mockup of the IUD on her chest, lead the Baltimore session. They are the first contacts I and most of the other women have ever had with anyone even peripherally concerned with Dalkon Shield use.
I had expected the women to be angry. There are signs of that. But then there is no one to confront. No Robins official is here. Instead, there is an overwhelming sense of sadness in the room. For many of these women with damaged bodies, empty cribs and broken marriages, the attitude is resignation. There's a feeling of 'Let's get this over with and get on with our lives.'
Some women voice disappointment over the compensation plan: Option Two payments are too little; Option Three asks too much and has too many overly personal questions. The trust appears adversarial and won't disclose information on schedules of Option Three payments. Freeman, the trust representative, is challenged on that point. "I am a board-certified cardiologist," one questioner shouts. "What do you mean I wouldn't understand?"
It's out in the hallway that stories are repeated over and over: Dalkon Shields inserted at ages 19, 20, 25, pelvic inflammatory disease and hysterectomies before age 30. "My husband left because we couldn't have children," says one woman. "I lost a husband and a job," a woman in her late forties says.
For many of us, the devastation caused by the Dalkon Shield has become focused on the acquisition of medical records. The 42-page Option Three document with nearly 250 questions calls for the most intimate details of one's life. Medical records are required for every treatment and doctor listed.
It is difficult and expensive to recreate a life over two decades. Letters must be written to every health-care provider. Explanations must be given and assurances made that a malpractice suit against a doctor is not intended. Many doctors have died, retired or sold practices. Many clinics, particularly the free clinics that proliferated in the 1970s, have closed. Many facilities have destroyed records.
I have called and written 26 doctors and employers for my records. One doctor died 16 years ago; his files have vanished. One hasn't responded; several have partial records. Most doctors, however, furnish complete ones. I've been billed over $300 for a foot-high stack of medical files, and it's not over yet. I still have the lengthy Option Three Booklet to tackle.
"You have to be tenacious," Murdoch-Vaughn of the self-help group advises women searching for records. "You have to know the right questions to ask. Don't just ask if the records are there. Ask if records have been warehoused, whether a new doctor bought your former doctor's practice. Be a bulldog."
We ask ourselves why we're doing this: dredging up the pain, reliving the horror and suffering. Somehow, it is a process that I and the other women at the meeting must go through.
Seventeen years ago, I didn't ask enough questions. I believed what little information I was given, and I took for granted that all miscarriages were like mine.
In a way, I suppose, I am one of the fortunate ones. My marriage didn't break up. I was eventually able to give birth to two daughters. I didn't die from the Dalkon Shield. But I could have. And I think of the son I'll never have.
Marguerite Hoxie Sullivan is a Washington writer.