Katrina Lauderdale, RIP

Cross-posted at F-words by Sara Anderson.

I've been thinking a lot about this story lately, about a two parents who watched their three-month-old child born with a cleft palate starve to death when they were unable to feed her, afraid to seek medical attention without health insurance.

Their daughter, Katrina Lauderdale, was born in Burns, Ore., on Oct. 24, 2006, with a cleft palate, a facial deformity requiring special feeding procedures. While in Oregon, she was seen weekly by doctors who instructed the couple how to feed their baby and provided them with special bottle and nipple systems, according to a police affidavit.

But after they moved to Spokane last November when Charles Lauderdale took a new job, the doctor visits stopped. Charles Lauderdale lost his job and his wife went to work, leaving the baby in her husband’s care when she was working.

Two Oregon doctors concerned about the baby’s failure to gain weight had advised the parents they needed to keep Katrina under continuing medical supervision in Spokane, but the couple later told police investigators they had no health insurance, the court affidavit says. No Spokane doctors saw Katrina.

It makes me so sad, and so angry.  From the description, it sounds like the couple did act gravely and criminally irresponsible, even in their bad situation.   But I still feel for them.  I'd like to think that there are public assistance programs they could have turned to, or that if I were in the same situation, I'd have brought the child to the emergency room, hospital debt be damned.  I can also imagine some of the fears of the parents'; that if they brought the child to the hospital, she would have been taken away by state services, and if not now, when they hospital bills came due and they lost their home.  Or maybe they hoped to wait it out, until the father found a new job or the mother finished her probationary period at work and began to receive health benefits. But even if these two were simply stupid and cruel, their child was the last person who deserved to pay the price for it. 

If the parents didn't have to think about what a doctor's visit would do to their financial security, things would surely have turned out differently.  Universal healthcare is fallible like any other system, but at least it doesn't punish families like Katrina's for seeking help.  If a child's parents are already stupid and cruel, financial roadblocks between her and the medical care she needs aren't going to help.

And we see this so clearly in Katrina's case, where she thrived with public assistance, and starved to death without it.  There are a patchwork of nurse home visitation programs in Washington, programs that have been shown to work, but Katrina was in the wrong place at the wrong time.

Even the clever and kind among us realize that the Lauderdales had only bad and worse to choose from.  Add some ignorance, a great amount of fear, and probably some wishful thinking, and it becomes clearer how these things happen.  These are the stakes, and consciously doing nothing to change things has a real an impact on peoples' lives as any changes do.  We can punish this couple as hard as we want, but as long as the same system puts the same pressures on all of us, we'll see the scenario play out over and over.

Comments

[Spike]

Well, THAT depressed the crap out of me......

[aimai]

I have mixed feelings about this story. On the one hand, our society is basically telling parents of needy children (and children of needy parents) that they are on their own when it comes to medical care and that "personal responsibility" equals "personal liability" for choosing among health care costs--what else is the "moral hazard" argument *other* than the argument that people should be dissuaded from choosing expensive but necessary health care if they can't afford it or are uninsured? So if the parents had "chosen" to kill their child because they couldn't assume the infinite debts associated with her care who are we, as a society, to charge them with anything?

However, I happen to know a parent of a child with cleft palate. OK, she is highly educated and lives in England under the NHS but most of the care, in any system, is provided by the parents. These young parents had recieved training and care during the crucial first months of the babies life and learning that the child *has to actually be fed directly from the bottle* and *can't feed itself* is the first thing you learn. because they *can't suck* and have to be coaxed and helped into swallowing as the parent squeezes the bottle. I know they were only twenty years old and cleary under a lot of stress and I 'm not sure there was anything they could do once they had made the decision to avoid emergency room care (and costs) and avoid social services brutal foster care system in which children are taken away so someone else can be paid to dot he job the parents want to do but can't afford to do.

If these parents really routinely tried *leaving the child with the bottle propped up near her* then they really are culpable in a way that isn't really the fault of the system.

I am a strong proponent of a national health care system and visiting nurse system but this couple were either too stupid to have been left with this baby or actively harming her.

aimai

[Nate]

I don't see how you can blame this on our healthcare system. Our system offered multiple opportunites to insure this child and the parents passed on them, why would it have been any different under UHC? None of the UHC systems proposed claim they will get 100% coverage, all still require a basic amount of effort by the insured or their parents.

When he lost his job he should have been offered COBRA. Since they where young and healthy and short on money they could have skipped it on themselves and just purchased COBRA for the child. This wouldn't have been more then a couple hundred a month. In cases like this you can usually get the providers to pay it for you because they make it up with the treatment. There are also numerous charities that would have covered the cost. Sometimes I have even seen the state via medicade or Social Services arrange to pay the COBRA premium if it would save the State money.

I don't know about Oregon but Washington has very liberal SCHIP eligibility. If they where withour coverage they could have enrolled the child in SCHIP and had great coverage while in Washington.

This is a very sad sitution but no system can prevent parents making terrible decisions.

[Sara]

I'm not discounting the possibility at all that the parents made gravely and even criminally bad choices, though I am reluctant to pass much judgement with the little information that's given. I am willing to give a couple of (hopefully) grieving parents at least some consideration when they actually say they didn't seek care for their child because they lacked health insurance. But yes, child abuse happens, and people do slip through the cracks every system. It would take a little more narrowing of those cracks (nurse home-visiting programs - that I would argue have helped to keep parents from making some terrible decisions - in every county, fewer bureaucratic hoops to jump through to obtain insurance, or maybe even a reduction in the expectation that the parents would have pulled themselves up by their bootstraps) to make me think that this death was practically unpreventable. With the way things work now, I suppose it was, but if this isn't cause to reevaluate things, what is?

[aimai]

Nate, I don't know that I think that they *could* have "cobra'ed" the child--it doesn't sound like the parents were ever in a job that offered any insurance at all. And, in addition, the baby was born with a serious congenital "pre-existing condition". I doubt very much that they could have paid for any kind of insurance for a child with such a severe condition. As for SCHIP or any other local insurance scheme I don't think they are ever set up to be so easy that you can easily get a sick newborn on them, or move while on them and take the benifits and care. I've heard more stories about people being assigned absolutely ridiculous delays of coverage while life threatening illneses go untreated. So I doubt if it was easy to get coverage and,w ithout coverage, we all get what we were all willing to pay for--the death of a child and the imprisonement of her parents. Talk about penny wise and pound foolish.

aimai

[Emma Anne]

I think I see what you mean Sara. The parents were horribly irresponsible, I'm sure because they felt helpless and horrified and went into some wierd state of denial.

The health care system comes into because it made things difficult and scary enough that these feckless parents got into that state. And since there *are* feckless people out there, it behooves us not to make getting care for your sick kid so damn hard. This system can't only work for people who are resourceful and intelligent, because there are a lot of people who are't that way, or not all of the time.

[Nate]

Instead of changing our system maybe we just need to better educate people on how to use it? SCHIP in most states begs people to sign up, usually you can even find a state sponsored charity that will bring the forms to you and help you enroll. States spend millions trying to enroll people. SCHIP also doesn’t care about pre-existing conditions. I assumed if they where receiving coverage in Oregon they must have had some form of insurance. Oregon would have pushed them into SCHIP if they where uninsured. Weekly treatment and training has to be paid for by someone.

The baby weighed 3 ounces less then when she was born, you have to know there is a problem and do something when a 3 month old is losing weight. How do you help people that refuse to be helped, short of taking the kids away from them?

Most self-funded employers know a healthy birth is best for the mom, child, and their bottom line. Thus most offer maternity programs. These programs are incredible, they literally hold the mothers hand through the entire process. They tell a mother everything she needs to know and then some. Every year mother’s refuse to participate and suffer complications that could have been easily preventable. Simple things like the right diet and vitamins. Short of making it illegal to have a baby and not enroll in one of these programs what more do we expect of our insurers and healthcare providers? When something like this happens it seems we fault the system first for their failure when they did all they could. If someone is so feckless they can’t even accept help that is offered them what is next?

Maybe they did fall through the cracks and no one offered to help them, much more likely they where offered help countless times and turned it down.

Personally I am all for mandatory pre-natal and post natal classes. I don't think having a baby is a right to be used and abused as one chooses. This will really offend some but I also think if you give use drugs or drink excessivly during pregancy they state should fix you for good, no child should have to start life fighting addiction. If you choose to havea child you need to be held accountable for it.

[Sara]

Nate, I suppose that I consider ease of access to be part of "the system," but that's sort of veering into semantics. "Universal healthcare" was the first thing that popped into my head as something that could have helped the outcome here, but I sure don't want to limit public policy to what my inexpert imagination can produce.

As for "fixing" women who abuse drugs and/or alcohol during pregnancy, that does only interfere after there's been harm done, and it creates incentives to avoid seeking treatment for addiction while pregnant, and is totally creepy to boot.

[aimai]

Nate,
"if you use drugs or drink excessively during pregnancy they (sic) state should fix you for good.." is a *great* idea. I'd like to see it applied to, say, the fathers too. For instance: if you offer a drink to a pregnant woman, smoke near a pregnant woman, or batter a pregnant woman the "state should fix you for good" by castrating you. And why stop at pregnant women and fetuses? Why not extend the prohibition against doing harm to fetuses to a prohibition on doing harm to children? Factories that spew pollution in the air and poison our fish? The owners should also be "fixed for good." Companies that allow workers to handle toxic chemicals? They should be forbidden too. How likely *is* that? Not likely at all.

These "protect the fetus" laws are always fairly thinly disguised anti woman laws that simply seek to punish rather than to protect. There are *lots* of people out there *begging for help*--and even begging for help *not to have a baby* who are denied the help they need when they ask for it. What was the hyde amendment but a refusal by the govenrment to allow women *so poor they couldn't afford a baby* to opt out of pregnancy before they were crushed by its physical and financial burdens?

I amall for mandatory pre natal and post natal classes and mandatory home health aides and nurses for everyone. Oddly enough, they have those in some countries and they work darned well. Its only here where your health care is thought to have something to do with your job or the state you live in rather than, say, your body and your actual health that people can fall between the cracks and get *no services at all*.

Lets not start talking about punishing people for failing before we have tried to give them the tools to suceed.

aimai

[Nate]

aimai, at what point do you finally admit some people have been offered all the help in the world and still do terrible things?

I would be all for expanded pre natal and post natal programs. This is a perfect example of the problem with our system, those services should have nothing to do with insuance. Nothing stops our government, at the state level, from implementing such programs. The politicans in this country try to force such programs on employer insurance and that isn't where it belongs. Something like that should be paid out of generl funds, the staff and providers should be state employees or outsourced to private companies to deliver the service. Natal care isn't an unknown event or expense and thus should not be insured. Employers delivering true insurance is a very cost effective distribution system. That's another argument though.

If you pollute you should go to jail so you don't pollute, if you use abortion as birth control you should be fixed so you don't do that any more. Not every one is a victum, to many people have no excuse for the wrong they do.

[aimai]

Nate,
"at what point do you finaly admit some people have been offered all the hlep in the owrld and still do terrible things?" Absolutely.all.the.time. I'd put into this category Paris Hilton, George Bush, Dick Cheney and any number of important people. I don't know what kind of help this miserable couple were offered, or when, or whether they could access it. And unless you know more than the article states you don't know either. Three months is an incredibly short time to be a new parent. I've been one twice and you are sleep deprived and anxious and (certainly the first time) you hardly know what you are doing. People make a lot of the "losing weight" since birth issue but one of the most surprising things about babies is how fast they gain weight. Most people aren't really expecting it and don't know what it looks like when it happens and are surprised by it. I'm *not* surprised that an ill educated, frightened, overwhelmed, couple of barely-out-of-their teens products of our stunningly effective educational system didn't know what to look for, or what to do. They may have been ill intentioned. The husband may have been an absolute bastard. But lets not pretend that they couldn't have ended up exactly where they are through ignorance and fear and lack of help. Because they could.

People kill their kids, and abuse them to death all the time. Its far from clear that this is what this couple did. From reading the article I think the father, certainly, was seriously negligent and maybe even criminally negligent (depends on what he was taught about baby care at the hospital and by his wife). That's pretty common, actually, that male caregivers who are unrelated to the child end up killing the child. Slightly more unusual when its the actual father.

but in any event blaming the individuals who have already been caught and will be facing trial is not really a particularly interesting or virtuous or helpful thing to do. The question is: what can we as a society do to prevent further such deaths. First, we have to identify the cause of this child's death. Negligent parents? Ok, how could we ensure that children are not left in the care of such negligent parents? Ill informed and desperate parents trying to do the best they can? OK, its a different diagnosis, so lets find a different solution.

OH. I'm sorry, I missed the nutty "if you use abortion as birth control you should be fixed so you don't do that any more.?" Forced sterilization to prevent voluntary and even medically necessary abortion? And *thats* your solution to a problem of society trying to interfere too much with the rights of the individual to starve and die? Massive government interference in the right to choose when and where adn how to bear children?

I'm sorry I ever responded to you as though you were a reasonable person.
aimai

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