Jodie Roberts was beaming at her family’s Fourth of July cookout.
The Lexington County native was set to enter the hospital five days later to give birth to a second son, Walter Roberts Jr. After months of setting up the baby’s new room, buying diapers and a baby monitor and feeling Walter Jr. kick inside her belly, she told her close-knit family she was ready to see him for the first time.
“She was full of smiles,” said her aunt Becky Kelly, who has known Roberts since she was born in 1983 — long before “the family go-getter” graduated high school, put herself through Midlands Technical College and got a clerical job at a doctor’s office. “That was the last time I (saw) her walking and talking.”
What followed was a nightmarish medical episode that no one at the joyous 2018 cookout imagined would change the trajectory of their lives forever. It left Roberts nearly brain dead, in a vegetative state in which she is unable to move, speak or even recognize her newborn boy or her 17-year-old son.
It has transformed Roberts’ family into round-the-clock caregivers who have turned her uncle’s house into a makeshift hospital ward and trained themselves to handwash her, change her colostomy bag and feed her through a tube as they pray for a miracle recovery.
It has sparked a lawsuit, filed last month, that accuses Columbia’s Prisma Health Richland Hospital and Roberts’ doctors of medical malpractice by failing to recognize and treat critical warning signs when it mattered.
And it again highlights South Carolina’ sky-high — and preventable — rate of pregnancies that end in death or serious and long-term medical consequences.
“She went into that hospital walking,” Becky Kelly says. “And this is how she comes out.”
Waiting for a miracle
When stepping through the front door of Burrell Kelly’s double-wide mobile home in rural Lexington County, a few miles north of Pelion, Roberts’ hospital bed is the first thing that catches the eye.
It’s a strange sight — a squeaky clean medical setup between couches in the middle of a living room, where the family has propped up Roberts in front of a TV that plays her favorite shows: Live PD, Cops and 48 Hours.
Wipes, sponges, gloves, tubes and other medical supplies are stacked in boxes on a shelf nearby. Cans of liquid food sit on a counter a few paces away. A vacuum that sucks mucus out of Roberts’ airway — she can’t cough it up herself — rests on a bedside table.
This is the new normal for Burrell Kelly, Roberts’ uncle, and his common-law wife, Michelle Stevenson, who together began taking care of Roberts shortly after she was discharged from her five-month stay at Prisma Health in November 2018.
Working as a team with Burrell’s sister, Becky Kelly, and the family’s children, they handwash Roberts’ three times a week, change her colostomy bag daily, feed her three times a day through a tube and crush and administer 14 medications every day. They work hard to keep her free of the infections and bed sores that led to several more hospitalizations after her initial discharge.
Stevenson quit her job as a meat cutter to watch over Roberts full time. She sleeps on the couch beside Roberts’ bed so she can wake up and respond at a moment’s notice if Roberts is in distress.
“I love her, and that’s what you do when you love somebody,” Stevenson said.
Roberts has lost anywhere from 85 to 96 percent of her brain activity, doctors have told the family.
Roberts can breathe on her own. She opens her eyes and sometimes glances around, but her family has no indication that she can see, hear or understand what’s going on around her.
Still, relatives closely watch her face for blinks, twitches, any sign she is improving. They hope a familiar voice, word or face will spark a miracle moment that unshackles her mind and starts her path to recovery. But doctors say the chances of that happening grow slimmer every day.
Even as Burrell Kelly’s stack of medical bills grows, they refuse to resign her to a nursing home. Kelly, a subcontractor who paints and hangs wallpaper, said he has done enough work in nursing homes to know Roberts wouldn’t get as much attentive care in one.
“I feel so obligated to her,” he said. “I’ve been around her since she was a baby.”
A spiraling situation
Roberts was aware her pregnancy would come with risks. She was 34 at the time and overweight. She had diabetes and high blood pressure, according to a legal filing made last month by the family’s attorneys, Eric Bland of Columbia and Ronnie Richter of Charleston.
Her doctors were aware of those concerns, too, which is why she was admitted to Prisma Health’s high risk obstetrics department in Columbia, Bland said.
Roberts checked into the hospital on Monday, July 9, 2018.
When Becky Kelly visited after work Tuesday afternoon, something was wrong.
Her neice looked panicked and was visibly having trouble breathing, Becky Kelly recalls. She said Roberts had been complaining of her discomfort to staff and repeatedly requested a C-section. Kelly says she left to find a nurse several times but was told Roberts’ physicians wanted to wait for her to deliver the baby naturally.
Roberts was suffering from preeclampsia, a little known but dangerous condition that affects one in 25 pregnant women, according to an affidavit from a Texas-based OB/GYN who reviewed her medical records at Bland’s request.
Preeclampsia causes a pregnant woman’s blood pressure to spike, leading to headaches, blurry vision, upper stomach pain, vomiting, swelling of the hands or face and breathing problems.
It is highly treatable if caregivers recognize it early and act quickly, usually by administering magnesium and deciding to deliver the baby via C-section. But it isn’t always diagnosed in time, in part because its symptoms mirror other ailments. Left untreated, it can lead to seizures, strokes and serious, long-term health problems.
In Roberts’ case, according to Bland and his expert witness, Houston-area OB/GYN Amber Samuel, Prisma Health waited far too long to administer magnesium or perform the C-section Roberts was requesting.
Roberts complained she couldn’t breathe at 8:46 p.m. Tuesday, according to the lawsuit. Three hours later, she complained of pain and discomfort that her epidural hadn’t relieved, the filing reads.
A blood pressure reading of 140/90 is considered mild preeclampsia. A reading of 160/110 is considered severe, the point at which experts advise treating patients with anti-hypertensive drugs and magnesium to prevent seizures.
Roberts’ blood pressure rose to over 200/150 as her caregivers delayed treatment, according to her attorney, Bland.
Finally, after hours of complaining, Bland said, Roberts went into cardiac arrest at 1:56 a.m. Wednesday. Her shortened breathing had stopped entirely, and she didn’t breathe for roughly 20 minutes, her family and attorneys say.
The hospital performed an emergency C-section and delivered her son. The baby was taken into intensive care and put into a medically induced coma for nearly a month, the family says. The toddler is doing fine and living with Roberts’ best friend. But it will take years to know whether the traumatic nature of his birth will affect his cognitive development, the family says.
Roberts was resuscitated, her family says, but she has been in a vegetative state ever since.
“Jodie’s injuries were the direct and proximate result of multiple occurrences of gross negligence,” including the hospital’s decision to continue to induce labor even as Roberts’ vital signs showed she was in extreme danger and distress, her attorneys wrote in the lawsuit.
The legal filing includes a Sept. 6 affidavit from Samuel, who reviewed Roberts’ medical records and concluded her caregivers:
▪ Failed to adequately treat her high blood pressure and preeclampsia from her admission until the emergency delivery 42 hours later
▪ Waited too long to treat Roberts with magnesium, typically used to prevent seizures for patients who have preeclampsia, and failed to evaluate Roberts’ oxygen defiiciency for at least 24 hours during labor
▪ Continued inducing labor even though Roberts’ vital signs showed she was severe high blood pressure and hypoxia
The lawsuit names as defendants Prisma Health, the hospital’s high risk obstetrics department, two residents and a doctor in that department.
A spokeswoman from Prisma Health said the hospital could not comment because of patient privacy laws and the pending litigation.
“Prisma Health takes the care of each patient very seriously and strives to provide the best care possible,” spokeswoman Tammie Epps wrote in a statement to The State. “We understand we are responsible for the care we provide.”
Prisma has not filed a response to the lawsuit.
A growing concern
Roberts’ case is severe, but she is not alone.
It illustrates a growing concern over America’s high and rising maternal mortality and morbidity rates.
About 700 U.S. mothers – 14 for every 100,000 live births – die every year from pregnancy or delivery complications. That rate is substantially higher than other developed countries and double neighboring Canada’s rate, according to the Medical University of South Carolina.
In South Carolina, the rate is even worse — about 24 deaths per 100,000 live births, according to MUSC.
About 100 times more common are the serious, but non-fatal pregnancy health complications that affect 52,000 American women a year, MUSC reported in April. Roberts’ case falls into that category.
Many of those cases are due to preeclampsia, which kills five women an hour worldwide and accounts for about 8% of maternal deaths in America, ProPublica reported in 2017.
Women who are African American or have pre-existing conditions, like Roberts, are at a much greater risk of such pregnancy-related complications or deaths, but it can happen to anyone. In May 2017, ProPublica reported the story of a New Jersey neonatal nurse who died from preeclampsia complications a day after giving birth at the hospital where she worked.
Such complications can have long-term health consequences. Some survivors have needed organ transplants or gone legally blind, said Valerie Holloway, managing director of the Preeclampsia Foundation.
“It’s so tragic, and it’s completely preventable,” she said. “The majority of these cases are preventable.”
Holloway’s foundation, based in Florida, works to research and raise awareness about preeclampsia so more patients and doctors know how to spot it and treat it before time runs out.
Most U.S. hospitals soon will be required to be more proactive in addressing the issue.
The Joint Commission, which accredits 80% of U.S. hospitals, announced in August it would enact new standards requiring hospitals to better combat pregnancy-related complications, including preeclampsia.
Those new rules, which go into effect July 2020, require hospitals to develop procedures to identify and treat the conditions, periodically train and drill staff on those procedures and educate patients on the signs and symptoms of those problems.
States, including South Carolina, also are taking notice by creating groups to investigate pregnancy-related deaths.
S.C. lawmakers established the Maternal Mortality and Morbidity Review Committee for that purpose in 2016. That group found 54% of those deaths in the Palmetto State are preventable, in line with national findings that 60 percent of pregnancy-related deaths can be avoided with proper treatment.
‘Don’t give up on family’
Roberts and her family, though, won’t benefit from any changes.
They face a long, improbable road to Roberts’ recovery.
They say they are suing to pay for her medical expenses and therapy. They hope a specialist can trigger a breakthrough that helps her recover enough to recognize her 17-year-old son, Pelion High School senior James Duncan, and the toddler she has never met.
Roberts is covered by Medicaid, but the program doesn’t take care of all the family’s expenses, they say. Roberts’ long-term care could cost millions of dollars, attorney Bland said. “You can’t even start to calculate it,” he said.
The July 2018 episode has wreaked emotional havoc as well. Roberts’ first son, Duncan, says he suffered mental breakdowns in the hospital after his mother’s emergency, punching a bathroom wall and prompting his family to get him into psychological counseling.
After a year of seeing his mother bedridden, he doesn’t always share his family’s optimism about her recovery. “I feel like I’m talking to a wall,” he said of the times he has tried to speak to her.
He looks forward to graduation, then going off to school at Horry-Georgetown Technical College to get away from everything.
The elders in his family, though, remain steadfast. They say they can’t stop caring for Roberts — who regularly took relatives in for prolonged periods — because she would have done the same for each of them.
“It doesn’t feel right not having her be with her baby and other son,” Becky Kelly said. “This should be a joyous time. We pray and we pray and we pray for a miracle to happen.”
The family continues planning for Roberts’ recovery. Her best friend, who has taken in Walter Jr., takes plenty of photos and videos of him so Roberts can one day see what she missed.
Burrell Kelly and Stevenson say they will be here for Roberts as long as she keeps fighting.
“You don’t give up on family,” Stevenson said. “If you give up on family, you ain’t worth crap.”