Hospital fails to test for drugs; days later, a newborn is dead

By Duff Wilson

DEVILS LAKE, North Dakota (Reuters) – Two days after giving birth in the summer of 2014, Reanne Pederson left a hospital with her baby boy Avery and a prescription for 20 hydrocodone pills to treat pain.

A day later, Pederson was prescribed another 15 pills. That night, she crushed and snorted a hydrocodone, boosting its narcotic effect. High, she breastfed Avery and then fell asleep on top of him, suffocating the newborn.

Efforts to revive him failed, and he was pronounced dead on June 14, 2014 – five days after he was born.

“I’ll regret it forever,” she said in an interview here, in her hometown of Devils Lake.

Now 32, Pederson pleaded guilty to negligent homicide in the death. She said she spent 100 days in jail and another 180 days in two drug treatment centers. She admits to snorting hydrocodone late in her pregnancy and smoking methamphetamine the day before Avery was born.

But the police detective who investigated the baby’s death also faults those who treated Pederson at the place where Avery was born, Essentia Hospital in Fargo, North Dakota.

Hospital records reviewed by Reuters indicate that the hospital appears to have made little effort to scrutinize mother or child. Although a labor and delivery nurse caught Pederson in a lie about having a doctor’s approval for one drug, no one at the hospital checked a state prescription database. It would have revealed Pederson’s extensive use of addictive drugs during her pregnancy, records show.

Medical records also described Avery as “jittery,” a possible symptom of a condition called Neonatal Abstinence Syndrome. But the hospital never tested the newborn or his mother for drugs, the records show. Neither test was required.

Almost a decade ago, a survey done by the U.S. Department of Health and Human Services highlighted how rarely hospitals test children for drug exposure. “Nearly all states test infants for other health conditions like human immunodeficiency virus (HIV) and phenylketonuria (PKU), which, in reality, impact far fewer children than prenatal exposure to alcohol and illicit drugs,” according to a report about the survey.

The survey was done in 2005-2006, when the U.S. painkiller epidemic hadn’t reached nearly the proportions it has today. In 2013, the number of newborns diagnosed with Neonatal Abstinence Syndrome had grown dramatically from what it was a decade before, swelling to 27,000, a review of federal data show.

Unless they test for drugs, hospitals may never realize a newborn is dependent on opioids. That’s because most infants delivered vaginally are discharged with their mothers just 48 hours after they are born, while some babies won’t begin exhibiting withdrawal symptoms until later – 48 to 72 hours after birth.

Derek Cruff, the police detective who investigated Avery’s death, said the hospital had more than enough evidence to test the child and mother for drugs. Not only had the baby been born premature, he said, but Pederson also had tried to persuade a nurse to give her drugs that a doctor had not authorized. Both are signs that a mother may be struggling with addiction.

“Why their protocol wasn’t followed, ask them,” Cruff said of the hospital.

Citing privacy laws, the hospital won’t comment on Avery Pederson except to say that it did follow its procedures. A spokeswoman for the hospital told Reuters that the doctors who treated Pederson also would not comment.

LuWanna Lawrence, spokeswoman for the North Dakota Department of Human Services, said the state could have provided services for the mother if it had been notified about the case. It also would have assessed the situation without accusing Pederson of neglect or abuse, Lawrence said.

“I WAS IN DENIAL”

Pederson said her addiction to opioids began with a doctor’s prescription for painkillers. The pills were meant to help treat jaw pain, but she said she began to crush and snort them. When Pederson got pregnant, she vowed to stop once she could hear the baby’s heartbeat at the doctor’s office.

“I was in denial,” she said. Doctors continued to prescribe the drugs, according to Pederson and her medical records.

James Volk, chief medical officer for Sanford Health in Fargo, another hospital Pederson visited, said she came to the emergency room three times in a 17-day period when she was more than seven months pregnant. Each time, she complained of dental pain and was given 10 to 15 hydrocodone pills.

“It was not an unusual presentation or an unusual treatment,” Volk said. If Pederson had come in a fourth time, however, Volk said she would have been put on a “care plan” that would have prompted doctors to more critically assess her situation before providing the drugs.

After Avery was born, records show, a doctor at Essentia noticed the baby was “jittery.” So did Pederson’s friend Robbie Lee, who visited the hospital. He later told police that he “could visibly see the baby shaking.”

Although Avery was given morphine to combat “pain” and “agitation,” a hospital pediatrician diagnosed Avery’s discomfort as related to his mother’s pack-a-day smoking habit and her use of Prozac, records show.

A notation in the file dismissed without explanation the need for a drug test or an assessment for withdrawal.

Days later, Avery was dead.

(Edited by Blake Morrison.)

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