Lawsuit: Staten Island Hospital Forced Patient Into C-Section Against Her Will

In a lawsuit filed by a New York woman against the Staten Island University Hospital, two physicians and their practice groups claim she was forced to undergo a cesarean section against her will.

Rinat Dray is a 35-year-old mother of three who had delivered her first two children via c-section. When Dray learned she was pregnant a third time she began investigating options for a VBAC, or vaginal birth after cesarean.

As her attorney explained to RH Reality Check, Dray experienced post-operative problems resulting from her previous c-sections, involving prolonged recoveries. After doing some research, she believed she might be a successful VBAC candidate. Dray interviewed providers and eventually switched OB-GYN practice groups to one she believed would support and respect her decision. According to her attorney, when Dray raised the issue of a VBAC directly with physicians in the Metropolitan OB-GYN Associates group, they  indicated it was a possibility for Dray. “He gave her a positive response without a guarantee,” said Michael Bast of the law firm Silverstein and Bast, “which is a good response. It’s all you could expect.” That practice group and two of its physicians are named as defendants in Dray’s lawsuit.

But when Dray checked into the Staten Island University Hospital in labor, she claims hospital staff began pressuring her to consent to another c-section. According to Dray’s attorney, after several hours of labor, the attending physician told her that he would not examine her unless she agreed to have surgery. When she refused surgery, the hospital then consulted with a hospital attorney who authorized doctors to overrule Dray’s refusal to have a c-section.

According to the complaint, hospital staff made the decision to ignore Dray’s express wishes regarding her care without consultation with the hospital’s bioethics department and without engaging the hospital’s patient advocate. According to records in the case, the surgery was approved by the hospital’s legal department over Dray’s explicit objection. A physician noted in her medical records, “The woman has decisional capacity. I have decided to override her refusal to have a c-section.”

In the process of performing Dray’s surgery against her express wishes, doctors perforated her bladder, an injury which forms the basis of most of Dray’s legal complaint. Additionally, Dray is seeking punitive damages from the hospital due to the defendants’ “conscious decision” to violate the law and Dray’s rights. But while the wrong done to Dray in ignoring her refusal for a c-section may seem obvious, a legal recovery is not guaranteed.

Dray’s attorney has asserted a number of claims against the doctors and the hospital. First and most straightforward is a claim for medical malpractice, which states the Staten Island University Hospital and its doctors violated the standard of care in their treatment of Dray by subjecting her to a c-section against her will. That standard of care is set out in, among other places, new, less restrictive guidelines issued by the American Congress of Obstetricians and Gynecologists (ACOG) for attempting a vaginal birth after previous cesarean deliveries. Those guidelines emphasize the importance of respecting patient decision making, which is beneficial to maternal, fetal, and child health, and note that a VBAC avoids major abdominal surgery, lowers a woman’s risk of hemorrhage and infection, and can shorten postpartum recovery time.

Dray’s attorney is also bringing a claim under a New York’s public health law, which among other things provides that patients have a right to refuse treatment. Bast believes it’s the first time the law has been used to affirmatively state a claim like Dray’s. “The Patient Bill of Rights is a good thing. Not just for this case, but for every case,” said Bast. “Patients need to be informed. They need to have things explained to them. And they need a helper in getting this information and the hospital must facilitate that process.”

Despite these ACOG guidelines and affirmative protections like the New York Patient Bill of Rights, many hospitals and providers are unwilling to make VBAC an option for pregnant patients. And with c-section rates still alarmingly high, this raises the concern that cases like Dray’s will be more common. “Overall, forced surgery is extremely rare. However, there are a couple of trends that, unaddressed, raise concerns that this could become more common,” Farah Diaz-Tello, a birth justice activist and staff attorney for National Advocates for Pregnant Women, told RH Reality Check in an email.

“First is the high cesarean rate,” Diaz-Tello explained. “Maternity care advocates and birth justice activists have been concerned with this for some time, but ACOG and the Society for Maternal Fetal Medicine are beginning to take notice and released a joint statement on reduction of the primary cesarean rate just a couple of months ago. Second is the trend to treat fetuses, and even fertilized eggs, as though they are separate persons under the law.”

“Medical ethical guidelines are clear that the autonomy of the pregnant woman is paramount, and that there is virtually no case in which forced surgery is justified. Nevertheless, the idea that the fetus is in there waiting to be saved, with the pregnant woman receding into the background or even disappearing entirely, certainly drives these cases,” she said.

While Diaz-Tello noted that actual forced surgery cases like Dray’s are rare, she acknowledged that it is common for providers to tell a woman that VBAC is not an option at their facility. It is also increasingly common for providers tell a woman that if she is noncompliant with their orders and refuses to undergo a c-section there will be some sort of legal consequence for her, including threats that child services will be called in to investigate.

“This is, of course, not the appropriate use of the child welfare system, which is designed to protect children from neglectful parents,” said Diaz-Tello, “but we have seen cases in which women have been investigated and even had parental rights terminated based on proceedings that started with a refusal of cesarean surgery.” According to Diaz-Tello, cases in which women are threatened with some sort of legal action should they refuse a c-section often come up during the actual delivery: “It is usually the case that these conflicts arise when the woman is in the hospital in labor, but there was a case in Florida last year in which a woman was threatened with arrest if she did not show up for surgery.”

But even in those egregious cases where hospitals and doctors have threatened legal action for refusing to consent to surgery, the medical providers have sought some kind of legal protection first, usually in the form of an emergency court hearing to order the surgery. No such court order was sought in Dray’s case.

In a way, the protections detailed in New York’s Patient Bill of Rights can be seen as a kind of equivalent to the assistance given to individuals navigating the legal system, and Dray’s case illustrates the need for such protections. According to the New York statute, patients have a right to understand their options related to their care, and hospitals must do certain things, like provide interpreters or access to patient advocates to facilitate the process, similar to protections available to those accessing the courts. “When people come to a hospital, they are sick, they are scared, they are not in their usual environment surrounded by their usual resources,” said Bast. “They are in a state of confusion and are confronted with major life-changing decisions. Patients need help understanding what the reasonable choices are.”

But unlike some of the help people get in accessing the courts, based on constitutional due process and equal protection guarantees that protect people against the government abusing its power, most hospitals are private entities, and thus there’s no direct constitutional directive to treat patients in a way that does not deprive them of their liberty and bodily autonomy. But, as Diaz-Tello points out, Dray’s case still raises significant human rights and constitutional concerns. “There are absolutely human rights and constitutional implications to cases like these, which treat women as separate and unequal to other people,” she said. “All people who are conscious and competent have the right to make decisions about their own health care, even in emergency situations. In this situation, they acknowledged that she had the right to make this decision, and unilaterally decided to take it away from her. They didn’t even believe that they needed legal authority to do so. This is a clear sign that they did not see her as a full person.”

The issue of patient consent is crucial here, Dray’s attorney explained. That’s because typically we frame patient consent in terms of “informed consent,” a legal standard developed to make sure doctors and hospitals provide patients with all the necessary information to make informed decisions about their care. But in this case, the issue goes beyond Dray’s providers failing to give her the necessary information to make an informed decision about the course of her treatment and care; her providers, according to the lawsuit, ignored her wishes altogether. “This is really a no consent case,” said Bast.

Dray’s case is still in its early stages. Dr. Leonid Gorelik and Metropolitan OB-GYN Associates served an answer to the lawsuit this week, while the Staten Island University Hospital’s attorney has requested an extension to submit its response to the allegations in the complaint.

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  • purrtriarchy

    She s just an easy bake oven !

  • Chris Allen

    This infuriates me. As another person noted elsewhere, choice on your healthcare and your body does not end the moment you decide to continue a pregnancy.

    Somehow I don’t see doctors forcing a cancer patient against their will into surgery, or radiation, or chemotherapy. I don’t see them forcing someone in a hospital who’s found out they have a faulty heart valve into surgery over their stated desire to forego surgery. I don’t see them forcing a man who’s come in over erectile disfunction to have surgery and get one of those erectile air pumps installed.

    Yet we see a case where they forced this woman into surgery *without even bringing in the patient advocate, without even attempting to discuss why they thought it was a good idea*, and certainly with total disregard for her wishes.

    A similar case happened a while back to a woman in Florida, who was literally arrested by a sheriff’s deputy, hauled to the hospital in handcuffs, forced to go through a c-section, and then handed over to the local DFACS to harass her on her motherhood skills. The deputy, under a court order from some activist forced-birth judge, literally *dragged* her out of her home. Again, the Florida woman was one who’d had prior c-sections and wanted to try a vaginal birth for her next child.

  • JamieHaman

    Property. This woman was treated like a prize breeding dog, forced to undergo surgery, not for her own sake, but for the sake of a child. These doctors literally valued the child above and beyond this woman. Choosing to be pregnant, choosing to have a child doesn’t mean all of a woman’s brains have fled. Not every woman is confused while in labor.
    I hope she wins this lawsuit. I hope this obgyn pays for this, and the hospital as well.

  • Goldenblack

    People react in different ways. I had a birth when I wanted a C-Section because of health issues and illness – I was left extremely badly damaged and nearly dead with ongoing problems to this day. And for the first six months, I didn’t care a thing about the baby. I wasn’t grateful. I wasn’t anything. I was numb from the horrors of the experience.

    So yeah. People react to awful experiences in different ways – god damn, expressing ‘gratitude’ when you’ve experienced a forcible surgery?

    • Jennifer

      Be grateful for your assault! Because really, let’s not mince words here. What else do we call being sliced open against one’s wishes?

    • ldwendy

      But you’re supposed to forget that you had to have surgery! Remember the baby is alive! That’s all that counts! – sez the forced-birth folks.

      I had preeclampsia at 29 weeks and my first daughter had to be delivered via an emergency C-section. She was in the NICU for 2 months. Even after we brought her home, it took me a long time to bond with her as well.

  • Jennifer

    “not one time in this article did I see where this woman is thankful that she had a healthy newborn
    baby” That’s probably because it has absolutely nothing to do with what she’s suing for, which is *being cut open without her consent*. You’re also implying she wouldn’t have given birth to a healthy baby otherwise. Do you have some proof of THAT?

  • Unicorn Farm

    “As with any legal case, there’s always another side”

    The fact that she eventually had a healthy baby in NO WAY relates to the fact that she did not give informed consent to this surgery. It is not an element of her cause of action, it is not a defense to her cause of action. It is irrelevant. So why does she need to mention it?

    You’re just using it as an excuse to shame her, so shame on you.

  • ldwendy

    ” Saying to be thankful for the ‘healthy’ baby says she didn’t matter.”

    My sentiments exactly. Thanks for saying it so well.

  • runthegamut

    It wasn’t mentioned because this isn’t some touchy-feely blog post. This is a description of a legal case. You’ll notice they don’t quote the woman at all, only her attorney. Her gratitude, which you have no right nor evidence to doubt, has no place in this article.

  • cjvg

    And you are assuming that she could not complete a VBAC and deliver a healthy newborn because you had issues?!

    Are you aware that your experience is in no way the norm for every VBAC out there? In the rest of the civilized world VBAC is the automatic default position for a subsequent delivery and the vast majority of them do just hunky dory. The largest risk for septicemia and death is for women who have C sections so these doctors willingly and deliberately put this woman at risk fo that without any indication that she could not deliver through VBAC (they even admitted as much) May I also note that the maternal and neonatal death rate is significantly lower in countries who take that default position that a vaginal delivery is best barring unusual circumstances

    “Maternal Death. The risk of maternal death during childbirth is greater with cesarean delivery compared with vaginal delivery. A study that examined births between 1983 and 1992 in the Netherlands found that the risk of maternal death was 0.04 per 1000 vaginal births compared with 0.53 per 1000 cesarean deliveries”

    In short it is extremely insulting and denigrating to suggest that a woman must accept any treatment even if it is against her wishes and without medical need as long as she is handed a newborn. It is perfectly acceptable to treat a women with respect and only perform medical treatment that is needed!