Dr. Rebecca Dekker – 00:00:00:
Hi everyone. On today’s podcast, we’re going to talk with Kimberly Turbin and Michele Monserratt-Ramos about their advocacy efforts to combat obstetric violence and the maternal mortality crisis for Latina women. Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.
Hi everyone, and welcome to today’s episode of the EBB podcast. We have a very important episode for you today with some special guests. I do want to let you know before we get started that this episode will contain discussion of obstetric violence and maternal mortality and listener discretion is advised. Also, if you’d like to read a complete transcript of this conversation in English or español, it is available at evidencebasedbirth.com/327.
Now, I’d like to introduce our two honored guests. We are so fortunate to have both Kimberly Turbin and Michele Monserratt-Ramos here today. Kimberly’s advocacy journey began after the birth of her son in 2013. After experiencing mistreatment and assault during her delivery, she took the bold step of videotaping the birth and sharing it on YouTube, igniting the public debate on these issues. Kimberly’s experience served as a catalyst for her to become actively involved in advocating for the rights of mothers and babies in healthcare settings and to seek meaningful involvement in organizations such as Birth Monopoly and The Birth Nurse.
Michele Monserratt-Ramos is the Kathy Olsen Patient Safety Advocate for Consumer Watchdog, where they focus on healthcare safety, patient safety, maternal health, legislation, and regulatory board matters in the state of California. Michele has 20 years’ experience working for the public interest. She is a statewide and national patient advocate and brings that experience to Consumer Watchdog, an organization we’re going to learn more about today. Who was leading the effort to organize advocates to work on medical board public policy, medical board sunset review, maternal health and maternal mortality issues, legislation, and public participation in legislative hearings.
Kimberly and Michele, thank you so much for being here today and welcome to the Evidence Based Birth® podcast.
Michele Monserratt-Ramos – 00:02:26:
Thank you, Rebecca, for having us.
Kimberly Turbin – 00:02:28:
Thanks, Rebecca.
Dr. Rebecca Dekker – 00:02:29:
So Kimberly, I was wondering if you could start off by sharing with us your advocacy journey and what inspired you to become actively involved in advocating for the rights of mothers and babies and in maternity care.
Kimberly Turbin – 00:02:44:
Yeah, well, I had a baby in 2013, and it was my first baby, my first pregnancy. And I was just curious on researching. I think it was like the beginning, I guess, for me, where you could go online, Google, look up documentaries. I remember growing up watching The Business of Being Born. So I was just curious. So I watched that movie and I was like, oh, you can ask questions or you can be curious about your birth. And one thing it pointed out was the Pitocin. And that’s another thing that always crossed my mind. So when I gave birth, I really went in super happy. I was in perfect shape. I had a perfect pregnancy for me. I didn’t have any complications. Nothing was wrong with me, really. I didn’t even have nausea. And I went in. And I checked myself in because my water had broken. And after that, I caught it on video. With that being said, I had a pretty scary, horrific, traumatizing birth. And I questioned what happened to me. And even if I fought it the whole time, I still questioned that. Was I crazy or was I not crazy? And so what I did advocate for myself after was put it on YouTube. I said, either people are going to tell me that, you know, I blew it out of proportion. I’ll let it go. Or people are going to tell me that something went wrong. And so that’s kind of where I began my journey of advocating. And then I was seeing how women were being treated. And mothers were being treated at the clinic where I was seeking care. It was like long wait lines and it was just awful. That’s kind of where I began.
Dr. Rebecca Dekker – 00:04:27:
So, Kimberly, I want to hear more about how you put the YouTube video up and what the response was. But in the meantime, Michele, since you’re here, can you tell us a little bit about what Consumer Watchdog does and how your organization is involved in maternity care?
Michele Monserratt-Ramos – 00:04:44:
Absolutely. Consumer Watchdogs works with the public to gain accountability on issues such as: healthcare, energy, insurance, privacy, and other issues. As you mentioned, I’m the Kathy Olsen Patient Safety Advocate at Consumer Watchdogs, and my focus is on health care. And we became involved in maternity care and the maternal mortality issue during our campaign to update the medical negligence caps in California, which we successfully did a couple of years ago. And during that campaign, I worked with families across the state, and I found a mother who had lost her daughter in the Central Valley. So, I reached out to her, and she needed some assistance, and I was able to get her some media coverage. And once those media stories hit, Rebecca, my phone started ringing off the hook. And another mother called, whose 23-year-old daughter had died and a grandmother called who her 23-year-old granddaughter died. A father whose son had only lived for 18 hours, and there was just a domino effect from that particular part of the state. And like I mentioned, I worked with families across the state from Chula Vista, from the border, all the way through deep into Northern California. But there was nowhere else like the Central Valley where there was the crisis in maternal mortality and maternal care as in that part of the state. So that’s how we became involved. And I work directly with the families to try to help them. You know, through the process to try to gain accountability for their families. Part of that process is also helping them deal with grief. Because their losses were new. And their grief was complicated. And I understood that because I had lost my husband due to medical negligence. So, every step that they had had to take throughout the process. I myself had taken those steps and I myself had faced those obstacles and hit those walls, et cetera. So, what was interesting about that part of the state is that there were so many mothers that had lost their lives only by maybe three physicians that were involved, in deaths that reached double digits.
Dr. Rebecca Dekker – 00:07:18:
So, you’re saying there were three physicians who had double digits of maternal death?
Michele Monserratt-Ramos – 00:07:22:
Yes, of young mothers and babies.
Dr. Rebecca Dekker – 00:07:26:
Okay.
Michele Monserratt-Ramos – 00:07:27:
That had died, lost their lives. You know, due to negligent maternal prenatal care and maternal care. Some that had survived but had lifelong harm. But as I found, as I spoke to all these families and worked with them, there were maybe three physicians involved. Where, I had a family who… the mother had had her first child. And her first child was harmed during the delivery with one particular OB, so she changed. She changed OBs and she had another baby later and ended up dying before her baby was born. And another family, her daughters were seeing an OB-GYN for gynecology. And they had learned through a media report that that OB had been accused and had received discipline by his regulatory board because of sexual assault allegations and negligence, etc. So, of course they were concerned and they changed physicians. And the 23-year-old daughter later changed OBs. And she became pregnant and she ended up passing away. And her baby only lived for 18 hours. So, it was such a crisis situation because you had families that were interlinked between three physicians. So, I decided. When one particular family, one of the physicians had been accused of being linked to mothers’ and babies’ deaths for 25 years. And he was still practicing. And so, one family that had reached out to me. They had been promised that this time that the physician involved would go all the way to administrative law judge hearing. For possible revocation. But just before that occurred, the regulatory board settled with the physician. And he received probation again. And he’d already received probation before, for the deaths of two babies, and license suspension for the deaths of two mothers. And with this 23-year-old mother, again, he received probation. So, I had other families that also had lost their daughters and children. And the care was linked to the same physician. So, I decided. We couldn’t keep doing the same thing and expect a different outcome. So, I actually organized a campaign in the Central Valley, called Bakersfield Families Call to Action. I organized a campaign. There’s an educational outreach campaign about maternal health, maternal negligence, and how to advocate for yourself. And through that campaign, a lot of other families reached out that had also been harmed. And there were a lot of mothers that reached out that were currently pregnant, and they were experiencing pregnancy complications. And nobody would listen to them. And they didn’t know what to do. So, through that effort, there’s a lot of one-on-one advocacy with the moms that needed help. And more families came forward. You know, with their tragic stories of what happened to other young mothers and babies.
Dr. Rebecca Dekker – 00:11:03:
So, your story is just, I’m trying to think back to how it started with your own experience, but then with getting media attention on one case of obstetric violence slash maternal mortality, and then the floodgates kind of opened and all the reports started coming in. And you mentioned negligence. So, for our listeners who aren’t familiar with that term, because it tends to be used in like a legal context, can you describe what that means?
Michele Monserratt-Ramos – 00:11:31:
Negligence can occur in your health care, whether it’s maternal care or any other type of health care. Where something goes wrong in terms of the delivery of your care, whether it’s during labor and delivery. Or whether it’s during pregnancy. And you have you know, all the symptoms of preeclampsia, but concerns are ignored and you’re left undiagnosed. It happens so very often now. And, you know, unfortunately, when something goes wrong, and maybe a life is lost… a lot of times, the family isn’t told. Exactly what happened. You know, they just know that, you know, they went to the hospital for the happiest moment of a young mother’s life, and they left that hospital without their daughter. Without a mother for the baby.
Dr. Rebecca Dekker – 00:12:31:
Kimberly, you were also an example of someone who had a lot of media attention, you know, which I think took a concerted effort, because your YouTube video got a lot of attention. But then with the help of others advocating with you, you got more national media attention around your story. What was the reaction to your story? Because I know you were saying when you were talking—when you were in the middle of experiencing obstetric violence. You thought, “Am I crazy?” Like, you know, it was a very like gaslighting experience where you weren’t sure what was happening to you. What was the response and how did that make you feel?
Kimberly Turbin – 00:13:09:
Yeah, the response online was a lot of mothers on different stages of life. Were responding with saying, “That happened to me.” And, “I was told the same thing. I was told 20 years ago that I was crazy or that I was exaggerating.” And I even learned about really mean terms like the “husband stitch.” Well, we could just sew you back up and things like that. So, I think with my video, it just kind of proved to a lot of women that this is a real thing. And this really did happen. And I was harmed and that they were harmed, too. A lot of these stories and a lot of things, even if you go back and read the comments 10 years back. It’s validating that their feelings, that what they felt at that time, it really did happen. And it’s something that just doesn’t go away. So, I saw those stories and those were some of the comments that I remember back then. And then I think some people also saw that I had a baby and that my baby came out okay. So why am I complaining? And that I’m fine. But the reality is that I wasn’t fine. Because we fast forward to around like 2020. And then in the media, I started, I thought this was just an obstetric violence problem among people giving birth. I didn’t realize when I started reading stories that mothers were actually dying, is when I took it a step further with advocating. And that’s when I met Michele. And, you know, I cried to her on the phone. I said, I cannot believe like these mothers are dying. I was reading news left and right about mothers dying. And it just bothered me. So, I joined this advocacy group called Consumer Watchdog that she’s a part of. And I haven’t left since.
Dr. Rebecca Dekker – 00:14:55:
You mentioned it seems there’s this link between obstetric violence and maternal mortality. And Michele, with your experience in patient advocacy, can you talk a little bit about how this is impacting Latina women, particularly in California?
Michele Monserratt-Ramos – 00:15:13:
It’s definitely impacting Latina women and Latina mothers, especially in the area that I spoke of. In the area that, because we found so many families that come forward, we decided to focus on that part of the state. Part of the problem is that the state is focusing on 5% of mothers. And, you know, the state has done a really good job of providing resources and funding where there’s committees in every county of the state. And there’s some programming in every county of the state. But we’ve continued to see the maternal mortality crises. The numbers are increasing. They’re not decreasing. And one of the reasons why we feel that’s the case is because 50% of the birthing population in California are being ignored. They’re not included in those resources, in those committees. We feel that the only way that we can begin to address this issue is by including a larger percentage of the birthing population. One of the problems that Latinas face in California is that many of moms have Medi-Cal. They don’t have private insurance. And many times, they don’t have private insurance because their employers don’t offer private insurance. And Latinas… You know, have the lowest paid range of the majority of all men, and the majority of women of different ethnicities as well. And every family that I’ve worked with, has been a Medi-Cal family. And with Medi-Cal, a lot of the moms are going to clinics. And what I’ve seen is that a lot of the moms are not regularly seeing their OB. They’re being seen by nurse practitioners and other healthcare professionals. And part of the problem with that is that the moms are not able to form a relationship with their OB. By the time they’re ready to deliver the baby. You know, some moms have seen their OB maybe twice during their prenatal care. And that’s a problem. You need to develop a relationship. We know what your OB means. So that when that time comes to deliver your baby, you’re familiar with them. They’re familiar with you. You know, they know your past history and whether it’s been complications with prior pregnancies or what have you. And the moms are not in such a vulnerable position. You know, and I think that kind of leads back to Kim’s story as well. You know, because with Kim, she’d only met her OB one time before she delivered.
Kimberly Turbin – 00:18:17:
The day before.
Michele Monserratt-Ramos – 00:18:18:
And that potentially led to some of the issues that Kim ended up having. And so… you know, with Latinas predominantly having MediCal- that’s an issue. Latinas more than other moms tend to receive less prenatal care than other moms. And so, I think there is a lot of issues there that lead to some of the complications that all moms are experiencing. But in regards to your question, Latina moms are experiencing. That’s why. You know, we’re transitioning to advocacy. You know, we want to develop advocacy training, starting in the Central Valley. But extending statewide. Because I truly believe, you know, it was safer for our mothers and our grandmothers to have a baby than it is for moms today. And so, we truly believe that a pregnant mom needs an advocate with the office visits and also at the time of delivery. Someone that could help them coordinate their care, someone that could, you know, build that team environment for them, someone that could ask the questions, you know, and ask for certain things when they see things going wrong because the mom is in such a vulnerable position. You know, at that point. And I think that is… one piece that’s missing. And I think that it would really make a difference.
Dr. Rebecca Dekker – 00:19:52:
Michele, I think I want to take what you said and ask Kimberly if you have any more thoughts, because while Michele was talking about advocacy, it’s not just enough to self-advocate, because as we saw in your video, Kimberly, you said “no,” you spoke up for yourself. You talked back. You didn’t, you know, just let things happen to you, but nobody else in the room advocated for you. So, we had a situation where not only was there a bad actor, a doctor who had never been held accountable for abuse, but also nobody else helped protect you. Can you talk a little bit about the importance of having advocates in the room?
Kimberly Turbin – 00:20:30:
Yeah, I think it’s really important because what happened to me looks really bad on camera. But what’s worse is that it’s happening all the time, and nobody has it on video. Right? And I look back and I, you know, I get asked a lot, like, what could you have done different or what would you want them to have done? And that question has always been really hard for me to answer because I think everybody like allowed this doctor to practice that way. Nobody ever stood up to him, and he was just allowed to do it. And a lot of the nurses, they were my age or even younger that I remember. And I think they just like genuinely feared him. So having like an outside advocate who’s not with the hospital, I think it would have helped me. It would have helped me a lot to someone to intervene and actually like do something about it.
Dr. Rebecca Dekker – 00:21:24:
But then that person actually having the power and the skills to be able to speak up and have people listen to them, too, because you could be, for example, like a newer doula and just feel like deer in the headlights. I don’t know what to do as well.
Kimberly Turbin – 00:21:37:
Yeah, it’s a complicated situation. I think everybody needs to be kind of like retrained on like what not to do. I think my video should be used as training purposes for like a what not to do video. And it should be one of those videos that they show at conferences and at like convention centers. You know, it should even be given with a little piece of paper saying, like, if you were in the room, what would you have done? Or what do you think is wrong with this situation? I think it would be just like a teaching moment. We did. There’s this woman named Michele McCartney. She’s my friend in Chicago. She’s an artist. And she sent the transcripts of my birth video to about 80 OBs in the Chicagoland area. Nobody responded back, but we did send it to 80 different OB offices so they could read it. But we never got a response from it.
Dr. Rebecca Dekker – 00:22:31:
Michele, you know, I think one of the things that Consumer Watchdog is working on with advocacy, it seems like is accountability. And we’ve had Cristen Pascucci on the podcast before talking about the lack of accountability. Like if you complain to a hospital, nothing necessarily has to change. You can complain to a medical board, and they can just ignore if they feel like it. What are some of the solutions that you see for creating more accountability so that there’s actual like rules that you can’t do this. And then if you do it, you get punished.
Michele Monserratt-Ramos – 00:23:06:
Well. There’s many ways to approach that. What I do with individual families, as I work with them directly. And I’ve known… You know, like I mentioned before, previously, some of the families that I’ve worked with, they have been dealing with repeat offender physicians. And it was a matter of really organizing in the community and organizing to elevate their complaint to a high-level complaint. But besides the work we do with families, we also work on policy change. And legislation, you know, with the medical board. So, you know, I have a team of advocates that attend medical board meetings, osteopathic medical board meetings, and medical boards of California meetings with us. And we present as a team. And we come up with our own legislative priorities. And we’ve been able to work with the medical board, so they support our legislative priorities and take those legislative priorities. Some of the most recent changes that we’ve been able to make, that has given complainants or family members more of a voice in the process is a recorded interview. Before a complaint is closed by the medical board, and also a patient impact statement, similar to the victim impact statement that families are able to give in a courtroom. And I had actually asked for three priorities, and we got two out of the three. The third that we were pushing was for contact with the family after the physician interview. Because what we learned through the process is that the process is very one-sided. You know, a family member can file a complaint and typically they do that alone. You know, with some of our families, I do that with. But when the physician’s notified, he comes in with his lawyer and he comes in with his lawyer. He is able to bring his own medical expert. Even though the medical board has medical experts. And he’s able to bring additional medical records that the family may not know. So, I really thought that was a key point, of trying to get some family contact or response. And then, of course, the physician gets to be interviewed with his lawyer. But throughout the process, most families are doing this alone. You know, they submit their complaint. And they believe or hope that it’s a fair process because the mission is that the board’s responsible for consumer protection. But throughout this process, we discovered, as I said before, it was very one-sided. So those are some of the things that we do legislatively, and it’s kind of a step by step.
Dr. Rebecca Dekker – 00:26:09:
And state by state, right? Because each state has their own laws that govern medical practice, essentially.
Michele Monserratt-Ramos – 00:26:16:
Yes.
Dr. Rebecca Dekker – 00:26:18:
Okay. And were you saying that anybody can attend a medical board meeting, or do you have to be invited?
Michele Monserratt-Ramos – 00:26:26:
No, there are four quarterly board meetings a year. They’re open to the public. Anyone can attend. And now with the Medical Board of California, they also webcast the meetings. And they offer meetings by teleconference or by WebEx. So, you don’t actually have to travel to the meeting location. You can still participate online. And that’s something that really changed during COVID, but the actual webcasting and the actual teleconferencing was something I moved the board to do years ago. To increase engagement with the board, because California is a big state.
Dr. Rebecca Dekker – 00:27:09:
Yeah, it would take a long time to drive there.
Michele Monserratt-Ramos – 00:27:12:
Yes.
Dr. Rebecca Dekker – 00:27:13:
Yeah.
Michele Monserratt-Ramos – 00:27:13:
You know, so it may require jumping on a plane. And a lot of families can’t do that.
Dr. Rebecca Dekker – 00:27:18:
Right.
Michele Monserratt-Ramos – 00:27:19:
So, it took a while, but the board eventually agreed. And they initiated teleconferencing. Because when I first started to participate in medical board meetings, you physically have to be there. There was maybe one camera person in the room. You could request a video, but you never did receive it. And if you were advocating on an issue like I was many years ago. And there was a meeting in San Francisco, and this is actually what caused me to do this. There was a very important vote in San Francisco. And I was caregiving for my father. And he was really ill, and I couldn’t leave him on that particular day. So, I contacted the medical board. “Can I submit my testimony by email?” I was told no. You know, “Can I call in?” I was told no. Every way that I tried to participate in that vote, I was told no. So, I knew at that point that, I filed it away. And at a later date, I would have to approach that issue. And like I mentioned, it took a while, but we did get teleconferencing out of it. So, the outcome is any Californian can participate in any public board meeting by Webex or by teleconference, their webcast and all the meetings. If you’re not able to participate on that day, you can go on YouTube and you can look at past medical board meetings.
Dr. Rebecca Dekker – 00:28:47:
That’s really good to know. It’s also encouraging to hear that groups like the Consumer Watchdog are out there attending those meetings, trying to like literally do what your name says. That’s super encouraging. Kimberly, we didn’t really talk a lot about accountability for the obstetric violence you experienced. Did you feel like you got some measure of accountability, either from the state or from the legal system? And if so, how did you do that?
Kimberly Turbin – 00:29:12:
That’s a hard question. So, just talking a little bit about my process with the Medical Board of California, I did submit a complaint. What they did was they called me, and they just said, wow, like, you know, that’s really messed up. It was two gentlemen. And they told me a little bit about how their wife’s births happened and how mine was really bad because I was able to submit a CD and show them what actually happened to me. What they did with mine was they allowed the doctor to surrender his license. They gave him a choice. And he did that. He surrendered his license to the medical board. And at the time, I thought like. I didn’t give that part much thought, but I said, okay, at least I got the doctor not practicing anymore. You know, I did that. I had a team of advocates with me at the time too, but you know, I still submitted my complaint and everything. And I was just glad because at the time I had met Dr. Abbassi, just the day before at a clinic. And like Michele mentioned, I only saw nurse practitioners the whole time. So, you know, I was able to get him off, you know, from practicing. And then later I did find out that he was fired from the clinic and then he was suspended at the hospital that I met him at, too. They said that they couldn’t tell me why, though. I still don’t know why to this day.
Dr. Rebecca Dekker – 00:30:27:
There was no transparency with what happened for you.
Kimberly Turbin – 00:30:30:
No. And when I did meet with the hospital, too, and I submitted my complaint to them, they said, “Honestly, just sue him.” I said, “I don’t want to sue him. I just want you guys to not let him do this to anybody else.” You know, this wasn’t about a lawsuit at the time. And that was a part of my comments too. Like, oh, you just want to sue somebody. It was 80 lawyers told me no, because the baby was fine. So that was a hard process too. So, with accountability, the only thing I was able to do was get him to stop practicing. And I did sue him for assault and battery. I chose to do that because that’s what it was. And I really wanted to stick to what it was, which it was an assault. So, I didn’t want to pursue it as like negligence or like, you know, I just wanted to really set that precedence. And I think I did that.
Dr. Rebecca Dekker – 00:31:19:
Yeah, you definitely did. Kimberly, when you talk with other new mothers, particularly Latina mothers who might be concerned about experiencing mistreatment, obstetric violence, or even, you know, mortality facing that in birth, what advice do you give them or what words of wisdom?
Kimberly Turbin – 00:31:39:
New mothers – it’s really hard. It’s 50-50 for me. I want to let them know. What I do is I ask them, like, how are they doing? Or how do they feel? Do they have any questions about birth? And then I kind of go in with, did you know that you can change doctors? Do you know that if you don’t like your doctor, you could change them? Did you know, like, that you can ask more questions or that you could tell people no? And a lot of times they think that you can’t. That’s my experience. But, when I think of a new mom, it’s I guess because we work in this type of stuff. The last thing I want a new mom to see is my video because it’s so… it’s so like horrible. But it really depends on how I met that mom and that one’s hard. That one. That’s a hard question.
Dr. Rebecca Dekker – 00:32:29:
It’s like you’re trying to protect them from, you know, building more fear. But you also don’t want them to go into it with. You know, not knowing what they could be up against.
Kimberly Turbin – 00:32:44:
The advice I do give, though, is — get to know your doctor. Go with somebody that I want to say like a recommendation, right? Like if someone had this doctor and they recommended and they had them before and they really liked the way they were treated. Pursue somebody like that versus somebody that you absolutely don’t know. And so that’s some advice that I could give. But-
Dr. Rebecca Dekker – 00:33:07:
Yeah.
Kimberly Turbin – 00:33:07:
It’s just it really depends. A lot of this people that I meet is after something has happened, sadly, but it’s 50-50. It just changes. I do work, when I did work, a lot of expecting mothers at my jobs, they would ask me questions. I was like the go to person. So that was kind of cool, so.
Dr. Rebecca Dekker – 00:33:25:
Yeah, knowing and trusting who your provider is, is important. And Michele, it was really eye opening when you were talking about how many moms on Medi-Cal, which you said it’s like more than 50%. They’re just seeing a random provider every time and they don’t even have a chance to meet who might be at the birth. And Michele, something you said earlier stuck out at me about the repeat offenders. And like Kimberly, you know, you had a video of what Dr. Abbassi did to you and how he assaulted you. But it’s possible, I would say likely that maybe he was doing obstetric violence, you know, plenty of other times it was never caught on video. Nobody reported it. But if it was reported, Michele, is there a way to look up your doctor or, you know, nurse midwife or whoever your provider is to see if they have any prior offenses or are those things not on their record? How does it work?
Michele Monserratt-Ramos – 00:34:22:
In California, the first place, and this is what I usually advise families when I meet them, the first place is to go to your regulatory board.
Dr. Rebecca Dekker – 00:34:31:
The regulatory board for your state?
Michele Monserratt-Ramos – 00:34:35:
The Medical Board of California, the Osteopathic Board of California, Board of Registering Nursing. And look up your provider. Look up your provider and see what the information the medical board provides. Unfortunately, because of legislation and medical associations’ influence on legislation, not everything is available. For instance, judgments, past judgments. In California, if you go onto your medical board website and you see one judgment that a physician has received, that actually means that there’s three other judgments out there. So that’s actually the fourth judgment, not the first.
What I also advise families to do is to go to their superior court website and do a civil index search. And a criminal index search on their physician’s name to see how many other families tried to file a lawsuit in civil index, and if there are any issues criminally with the provider. And that gives you a little more information, in order for you to make the best decision possible. I also encourage families… when a lot of times you don’t have the choice in terms of the hospital that you’re going to deliver, it’s based on, you know, your provider, where they have privileges. But I also recommend for families to go to the Department of Public Health website and look up the hospital where they plan on delivering and seeing how many complaints have been filed. And what type of deficiencies that Department of Public Health has found, you know, against the hospital. That’s information that’s public, that you can find. And it’s really important. It’s really important to go into this process as prepared as you can be. We do that with everything else we do. If we purchase electronic equipment, we do our research. You know, what’s the best product to purchase? So why wouldn’t we do that? With our healthcare, with our maternal healthcare.
Dr. Rebecca Dekker – 00:36:45:
It’s almost like you have to do your own background check on the providers at your clinic.
Michele Monserratt-Ramos – 00:36:50:
Yes. And the hospitals.
Dr. Rebecca Dekker – 00:36:53:
That’s true. Yeah. So I know we’ve been talking about obstetric violence, the maternal mortality crisis. And one thing I was wondering if you could shed some light on either one of you is, you know, is there a maternal mortality crisis for Latina women? Because sometimes when you see the numbers, it shows it’s not as bad as other groups per se, but I’m wondering from your perspectives, like how big of a problem is this? Obviously, any death is unacceptable, but what’s going on? What are you seeing on the ground?
Michele Monserratt-Ramos – 00:37:26:
Well. There is definitely a problem. And I think one of the problems that we’re having is a lack of data. Because when research is done and data is collected, it’s collected based on race. Not based on ethnicity. So, when you look at different research, you’ll see Latinas grouped together with Caucasian women. And that’s a problem. And I believe that if more entities did research based on ethnicity, the numbers would change. Just in terms of the data we get from the Department of Public Health, you know, it shows that the maternal mortality crisis is greatest in the Central Valley. Initially, when we first started working on this issue, it was South Central Valley. It’s moving further into the north Central Valley now. But that’s agricultural community. You know, there is a large percentage of Latinas that live in those communities. Another issue that we’re dealing with legislatively is the maternity care deserts in California. Where a lot of hospitals are closing their labor and delivery units. And all they have to do is just put a notice up on the website, that their labor and delivery units are closed. And some may make suggestions as to where a pregnant mom may find other resources. There is one particular hospital that they just closed their labor and delivery unit in March. And when I went to the website, their referrals were 86 and 113 miles away from the hospital. And when I read, there’s legislation that we’re supporting that’s starting to look into, that’s requiring community impact assessments. And it’s requiring public notification. It’s requiring the hospital to actually hold a community meeting to alert families that their labor and delivery unit is closing. And where their closest resources are. But, you know, it’s not just a matter of traveling 86 miles or 113 miles to deliver your baby. There are no longer OBs at that hospital. Yes, you can go to the emergency room, but if you’re experiencing complications, it’s not going to be an OB there. So, you’re going to have to travel that far. And in the analysis, the bill analysis literally states that where these hospitals are closing their labor and delivery units is primarily in rural areas in California and in underrepresented areas in California, and greatly impacts Latinas more than anyone else in the state. There has been 46 labor and delivery units closed in California.
Dr. Rebecca Dekker – 00:40:35:
Wow.
Michele Monserratt-Ramos – 00:40:36:
That there has been you know, multiple units since then that are currently closing. Right now. There was a labor and delivery unit in Chula Vista that was closed last month in May. Yes, in May. And there was actually a protest. And… There were pregnant moms and families, but there were also OBs and labor and delivery nurses protesting the closure as well.
Dr. Rebecca Dekker – 00:41:07:
It was not their choice to close down.
Michele Monserratt-Ramos – 00:41:10:
Right. And they would have to find somewhere else to practice as well. And they called on, this is before the legislation was introduced. They called on the Department of Public Health to conduct a community impact assessment in order to determine the closest maternity care resources for that community. And the Department of Public Health declined. And so that’s kind of where the legislation, you know, came from. But it got to a point where providers were protesting alongside pregnant mothers, in San Diego, because in that situation, those mothers are going to have to travel very far, as well, to receive maternity care. But like I mentioned in the bill analysis, it specifically states that of all communities mostly impacted by these maternity care deserts, it’s Latinas.
Dr. Rebecca Dekker – 00:42:11:
Kimberly, any words you want to share?
Kimberly Turbin – 00:42:15:
Yeah, I just want to add that we make up such a large population here in the state of California, and it would just be impossible to act like it’s not happening to us. It’s just there’s no way. I think the data has to be redone. I’ve been in rooms where I even mention it slightly, and they jump up and show me some data chart that’s completely outdated. And they say, no, no, no, no, you’re included right here, you see? And it’s one thing out of a bunch of other charts and a bunch of other datas that they have so many of those. But they save one and say that, no, no, no, you’re in here. It needs to be redone. I think it’s just impossible to act like we’re not here.
Dr. Rebecca Dekker – 00:43:04:
But yeah, they’re treating you as if you are invisible and these things aren’t happening.
Kimberly Turbin – 00:43:09:
It feels really invisible. And when obstetric violence happened to me, At the time, my initial reaction was, oh, my God, this is happening to all the mothers here that don’t speak English. They’re not from this country, that I met at this clinic. And the reason that I’m here and still talking about this, because I felt like I had to do a service for my people because I was lucky enough to be born in this country and do something about it and not be silenced, that I had to pursue a career in advocacy. It’s just no way that I could turn my back on my people because I know that there was something wrong, that we were completely invisible in this argument, in this fight. So that’s why I’m still here today. And I think I did not meet Michele by accident.
Michele Monserratt-Ramos – 00:43:57:
You know, we don’t want to take resources from any other mothers. From any other community. We spent the past five years working on this issue, working on these crises. Seeing the numbers increase instead of decrease. We just want to make sure that more mothers are receiving these resources. You know, receiving these educational opportunities. And even the Nurse-Family Partnership and other opportunities that are available out there. So, and we feel that if more mothers are included in the narrative, in the process, that we’ll start to see a change in the numbers. And that’s really what we want.
Dr. Rebecca Dekker – 00:44:44:
Yeah, I’m so grateful you two have joined forces and that you’re working together. And I want to encourage our listeners to go to consumerwatchdog.org and click on the healthcare tab and you can see a lot more detailed information about everything you were both talking about today. Are there any other resources or anything else you want to share with our listeners?
Kimberly Turbin – 00:45:05:
I’ve made myself available to anybody who needs me online. I’m very close to any family I’ve ever helped. To me, when I help a family in need with advocacy, you’re not just a headline on a story that I repost on Instagram or Facebook. I genuinely talk to you forever and I’m there for you. That’s what I offer. That’s what I was taught and that’s what I learned.
Dr. Rebecca Dekker – 00:45:29:
And how can people find you, Kimberly?
Kimberly Turbin – 00:45:32:
Yes, you can find me on Instagram. My name is lolita_rios_kimberlyturbin.
Dr. Rebecca Dekker – 00:45:40:
We’ll make sure to share that in the show notes. So, Michele, any, anything else you want to share?
Michele Monserratt-Ramos – 00:45:44:
Gosh. We could talk about this issue forever. We just have more resources that we’re going to be producing in the future. But like Kim said, you know, we have a growing team. And, you know, we’re here for anyone that, as I always tell people, it’s so much harder to fight this alone than it is, you know, it’s so much easier to do this in a team effort. And, you know, we found that. You know, working as a team, it’s been successful for us here in California. So, anyone that needs help and whether you’re currently in a crisis. Because we do that too. Or you’ve already lost your family member. Feel free to reach out to Kim or to me, it’s at Consumer Watchdog.
Dr. Rebecca Dekker – 00:46:37:
Yeah. Thank you for making yourselves available like that. And also, I think just educating us all about the work that you’re doing and about Consumer Watchdog and that a stat that always strikes me is I think it’s like one out of every nine births in the United States happens in California. So, this is like, you know, it’s a huge issue. It’s a lot of families and we really appreciate all the advocacy you’re both doing. Thank you so much.
Kimberly Turbin – 00:47:04:
Thanks, Rebecca.
Michele Monserratt-Ramos – 00:47:04:
Thank you.
Dr. Rebecca Dekker –
Thank you everyone for listening to this important conversation with Kimberly and Michele. I know we did not go into depth about Kimberly’s experience and video, we talked about it at a higher level, but if you want to learn more about what happened to her in detail, we will link to the YouTube video in the comments. I want to give you a head’s up that there is a strong trigger warning with that video, as it has direct views of a very violent episiotomy. However, as Kimberly said, she hopes it will be used for educational purposes, particularly with medical students. Also, I encourage everyone to follow the work that Consumer Watchdog is doing. Next week, we will be back with another important guest who is coming on to help us celebrate National Hispanic Heritage Month, and we’ll be talking about the importance of bilingual doulas and how having doula care in your native language can make a huge impact. So please join us then, and I look forward to seeing you next week! Bye!
Dr. Rebecca Dekker –
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