is irresponsible and incompetent. Following are the details of my letter to the head of the practice.

Mrs. Tiffany McCawley
303 Trappers Rd
Hubert, NC 28539
Phone (910) 333-0461

February 8, 2010

Dr. Timothy Edwards
Women’s Health Associates
…..
Jacksonville, NC 28540

Dear Dr. Edwards,

Today I received a registered form letter from your office, terminating my care. To say that I was taken aback by such action would be an understatement. Frankly, I am utterly shocked that as a physician you would take such action with consulting with me first. I feel that the events that occurred this week in connection with my medical care have been extremely distressing, to say the least.

If you have reviewed my chart, which I doubt, you would have learned that I am pregnant with my 5th child, and that my other children are aged 7, 3 and 1 year old (my twins.) I have been ill for over a month and have done everything in my power to get well. I have rested, I have taken approved medications, I have consulted doctors. You would have also learned that I have a history of HELLP syndrome, which I experienced with my second child. In my previous pregnancy with the twins and with this pregnancy, I was warned by my maternal fetal medicine specialists to be especially aware of any time I was ill, since bacterial infections and illness can increase the risk of an occurrence or reccurence of HELLP. At my most recent appointment with Dr. Middleton, I was prescribed Augmentin (my second course of antiobiotics, the first was Zithromax just 2 ½ weeks earlier) for a sinus infection. By the time of my visit with Dr. Wright 12 days later, I was still not well and had finished my course of Augmentin. Dr. Wright told me that I needed to get my sinus issues under control and recommended I get a referral for ENT. He also told me that I should be vigilant for signs of HELLP. While I had a few days where I thought I was on the road to recovery, by Saturday of last week, I was back to feeling terrible again. I spent all day Sunday and most of Monday sick in bed. On Tuesday my husband put in for leave so that I could see the doctor and hopefully find a solution to put me on the road to recovery. I called your office to make an appointment and was told that I could not be seen in the office because I might “contaminate” it. I explained to both the receptionist and the nurse that I did not think I had the flu, but that I was continuing to have issues with my sinuses. I was told again that I could not be seen in the office and that I was to go to either the urgent care clinic or the ER/L&D. I finally just gave up and said I would go to the ER/L&D. I wished to be seen by my OB to ensure that everything was still ok with the baby and that my body was not having any adverse reactions to my extended illness. Due to my history of HELLP and my 3 miscarriages, I tend to be a bit on the skittish side. If you had made any effort to communicate with me prior to the letter you sent, you would have been aware of this.

As this is my 5th child and 7th pregnancy (in 3 different states and 1 foreign country), I have seen several different Obstetricians both on and off base. Each of those physicians has been caring, concerned, thorough and patient. After my first visit to your office and with Dr. Middleton, I was under the impression that I had again found a good fit for my situation. I came to your office from the Crist Clinic, which I left for 2 reasons. They are not child friendly and abortions are performed in office, which I am uncomfortable with. I did not leave due to any conflict or lack of acceptable medical care. Especially with my limited options here in Jacksonville, I am distressed that you would take this action without having spoken with me or researched this matter any further. If Tanya or Peggy was offended that I was so upset, I apologize. However, I think you have to understand that I have been extremely ill and by now, quite concerned about my health. I was very sick in much this same fashion during my pregnancy with Charley and that was when I developed the HELLP syndrome. To add to my stress and concern, I was refused an appointment because your staff was told they could be fired for allowing a patient with flu symptoms to come into the office (which I tried to tell them I did NOT have), I was sent to L/D where I was told to go home, rest and “get a babysitter,” then given misinformation regarding follow up care. (I was told that Hazel would try to get my referral pushed through and that she would try to see if she could help me get an ENT appointment right away.) In addition, during my visit to L/D Peggy told me she didn’t understand why I was even refused the appointment and that if I was not better by Friday, I should come back in to the office. I called your office on Friday to find out that status of the referral request and ENT appointment, as I was told when I spoke with TriCare that they had no record of a request. When I called I was informed that Hazel was not there, that there was no record of any of this in my chart and that there was nothing that could be done to help me. I asked why I was not called and told that they could not help me with the referral or ENT and was told that no one in the office knew what the situation was and that they could not help me as they were just “stuck in the middle.”
I am sure that I could continue to address this issue further, as I am quite upset with this situation, but I feel that I have made my point. Your actions and the actions of your office were irresponsible and unacceptable. I will be sending a copy of this letter to TriCare, Onslow County Memorial, the State Board and to the Naval Hospital. At the very least, I feel that I deserve an apology for your unwillingness to research this issue before you took it upon yourself to terminate my care. As my chart should have told you, I am high risk for several reasons and your actions only served to exacerbate my stress. Although pregnancy is a wonderful and joyous celebration, there are times when it can cause or increase levels of stress. As a physician, you and your staff should be aware of and understanding of situations that increase or contribute to those factors. As a physician, I thought you took an oath to “first do no harm.” You may want to reread that oath when dealing with patients already under great stress.
And just in case you were wondering, I got rest and a babysitter, as well as my husband taking almost a week off of work. And I am still sick. Do you suppose an ENT referral and a visit with a doctor who actually addressed my symptoms might have been helpful had I been afforded that opportunity? And just for your information, my OB in previous pregnancies addressed any and all illnesses that arose that might lead to an issue with myself or my unborn child.

Sincerely,

Tiffany M. McCawley