Doctors deliver dead fetus from released inmate

By AISLING SWIFT (Contact)
Originally published 8:20 p.m., Thursday, February 5, 2009
Updated 8:23 p.m., Thursday, February 5, 2009

NAPLES — It was a girl.

Doctors removed the dead fetus from Joan Laurel Small on Thursday, a day after her release from the Collier County jail.

The 22-year-old mother cradled baby “Elena Laurel.” Nurses cut a lock of the baby’s hair for a keepsake.

“They cleaned her up and allowed her to hold her,” said Small’s mother, Jennifer Graeber of New Jersey. “The hospital is making her a little remembrance book. They’re putting in a lock of the baby’s hair.”

Graeber said when her daughter arrived at The Birth Place at NCH North Naples Hospital, her blood-pressure had risen and she had a fever.

“That’s the beginning signs of septic shock,” Graeber said of leaving a dead fetus inside a mother.

Because the baby had been left in her womb more than a day, she said, Small could not deliver the baby, but had to undergo a C-section.

Small, a Bonita Springs woman who is recovering at the hospital, could not be reached for comment. Her boyfriend and the baby’s father, Elias Guzman, 24, also could not be reached Thursday.

Graeber said her daughter is very depressed and probably will cremate the baby after an autopsy is conducted.

Small, who was housed in the jail’s medical unit, learned her baby was dead Tuesday morning as she underwent an ultrasound to determine the baby’s sex and to schedule delivery after her Feb. 19 release from jail.

Small, whose 40-week due date was Feb. 21, has said she’d complained about a heavy discharge, which continued for 1 1/2 weeks, but was told it was normal and to monitor it. She told the Daily News the doctor who conducted the ultrasound Tuesday morning told her all her amniotic fluid had leaked out, the baby’s skull collapsed and it had no heartbeat.

A day later, after she remained in jail with the dead fetus inside her, Small’s public defender, Amy Shirvanipour, spoke to Assistant State Attorney Rob Denny, who agreed to a stipulation to modify her sentence to time-served and immediate release. They went to Circuit Judge Fred Hardt, who immediately signed the stipulation.

Three hours later, Shirvanipour was still waiting to take her to a hospital and then learned a deputy would take her. She was released at 3:10 p.m. and Shirvanipour met her at the hospital.

When told of Small’s account, a nationally known medical expert said the death could have been avoided if Small had been taken to a hospital immediately after complaining of the discharge. Dr. Gary Helmbrecht, a member of the The American College of Obstetricians and Gynecologists, called it a case of medical neglect and said the symptoms indicated a pre-term rupture of membranes that required immediate hospitalization.

Small said she’d also requested a RhoGAM shot, which protects her baby from her RH negative blood, but wasn’t given one until Tuesday. The shot is recommended between 28 and 30 weeks and she was jailed on her 30th week.

She’d been held since Dec. 22 after she violated probation by returning home after her nightly 10 p.m. curfew. Small said she’d been attending a parenting class in Naples and couldn’t get a ride home; she has no car. Records show the probation violation involved a 2007 drug charge; an adjudication of guilt was withheld. It’s her only criminal conviction and records show it occurred when she was caught with drugs in the car of her former husband, Ken Enright Small, during a traffic stop; his record includes drug convictions.

Graeber, who said her daughter plans to sue, has contacted local attorneys about the case.

“I feel they were negligent in not taking her to the emergency room when she asked for help and was leaking amniotic fluid,” Graeber said, adding that she hoped a lawsuit would improve care at the jail and help her daughter move on.

Chief Scott Salley, who oversees the jail, said Tennessee-based Prison Health Services, which operates the medical unit, was reviewing what occurred, but said initial reviews show medical and administrative policies were followed.

Sheriff’s Office officials say they cannot discuss details of Small’s case due to HIPAA, the Health Insurance Portability and Accountability Act, which prohibits release of medical information without a signed waiver from Small.

Prison Health Services spokeswoman Martha Harbin said her company conducts a full internal medical review after any “sentinel event,” an unexpected occurrence involving death or serious physical or psychological injury — or the risk of one and that was occurring in Small’s case.

“We offer our sincere condolences to the family,” Harbin said. “The loss of a pregnancy is a tragedy. It’s a horrible thing for anyone to go through.”

“... Like any other patient of any other medical provider, Ms. Small deserves the right to privacy with regard to her medical care,” she said of HIPAA. “That right has not been waived by Ms. Small and cannot be waived by media reports, so Prison Health Services cannot comment even though there are significant inaccuracies in what has been reported.”

Small has told the Daily News her complaints were documented by medical care providers at the jail and she’d also called her mother and boyfriend about the problems.