OHSU's Response

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Following Dr. Julie Andrews' instructions, Karellen and Renee sought follow-up care for Qadira at the OHSU Primary Care Clinic at Gabriel Park in Southwest Portland. Records indicate that Qadira was addressed by OHSU personnel a total of six times, including one instance via phone call.

It is crucial to note, however, that we are only focusing on six of these records. There are additional visits to OHSU that are not reflected in the documents we have, which were obtained by the law firm Vangelisti Kocher in the scope of their representation of Qadira, and then discovered by the Stephens years later.

Key concerns regarding Qadira's treatment at OHSU, based on the available records, include:

• Referral Oversight: Qadira was not referred to a specialized burn center, contrary to standard referral recommendations.

• Misclassification of Injury: OHSU personnel incorrectly labeled Qadira’s injury as an accident, without proper authority or adherence to the ORS Statutes of 2005.

• Failure to Notify Authorities: Consistent with the ORS statutes, neither the police nor the Department of Human Services (DHS) were notified about the injury.

In the following sections, we will delve into the details of each hospital visit, review the medical records, and examine Karellen's accounts of each interaction.

The day after Qadira was treated at St. Providence Vincent, Karellen and Renee realized they needed additional help because Qadira's wound was extensive, and she was still unable to walk. 

"I was going to have to take Qadira back to the doctor by myself because obviously nothing was resolved. Renee called Todd and Aimee early that morning to get their Homeowners insurance in case they asked for it at Qadira’s next visit. 

We all know how insurance works. Our insurance wasn’t going to cover something that was somebody else’s responsibility. Renee informed Aimee that Qadira’s burns were bad and that he needed their insurance to make sure everything was covered. Aimee hemmed and hawed and told Renee she would call him back. 

Eventually Todd called back with the information but he still couldn’t seem to understand why we were taking Qadira back to the doctor." (Pg. 39)

"I took Qadira to Oregon Health Science University otherwise known as OHSU where she was seen by a Doctor Sarah Tubbesing. We had recently established care with the Gabriel Park OHSU Family Clinic and Qadira hadn’t even met her new doctor yet. I had chosen Nancy Gorden-Zwerling because when I first met her she claimed that she knew and had worked with our kids’ old pediatrician Mariah Taylor." (Pg. 39)

"Nancy Gorden-Zwerling wasn’t available that day which is why we saw Sarah. She was a tall thin pretty young blonde lady with a pleasant smile. But she looked just as confused as I felt when she took off Qadira’s bandages. It was a MASSIVE wound and for some time Sarah just sat there and stared at it.

The diagnosis from the Emergency Room doctor was a 2nd degree burn on 10 to 20 percent of her body. Sarah said she thought that maybe there were areas that were 3rd degree and she ran out of the room to grab a colleague to come look. Another doctor came into the room and behind her came several more. 

I didn’t understand what was going on. Was Qadira okay? After a few minutes they all left and I was left all alone staring at my daughter’s open wound." (Pg. 40)

"Sarah came back after a while with some supplies and bandaged Qadira’s leg back up. She calmly instructed me to go to the medical store and buy bandages and silvadene and to change Qadira’s bandages 3 times a day. SLAP, KICK, PUNCH! She didn’t show me how to change her bandages as if watching her that one time was supposed to be enough. 

She pretended like everything was fine even though Qadira couldn’t walk and had a huge open wound on her leg. I was standing there in the office feeling a little stunned and unsure of what I was experiencing. So Qadira was fine?" (Pg. 40)

"Sarah kept smiling at me as if this was just a routine visit. She kept telling me over and over again that everything was going to be just fine. She reminded me again to go to the medical store and buy bandages and silvadene and further instructed me not to bring Qadira back to the hospital. 

I had now been told by a second doctor that my daughter was perfectly fine. Nobody even offered me the use of a wheelchair when I carried my daughter out of the clinic that day." (Pg. 40)

During Qadira's visit, Dr. Sarah Tubbesing took measures to diagnose and assess her burn. According to her assessment and plan (A/P), she noted that the burn covered less than 5% of Qadira's total body surface area (TBSA) and classified the injury as minor. However, this contradicts the official diagnosis, which states that the injury covers 10-19% of the TBSA and refers to the severity as variable.

Dr. Tubbesing's recommendations included:

• Referral to a plastic surgeon for further evaluation.
• Instructions to return to the clinic if signs of infection, fever, or chills developed.
• Continued application of Silvadene cream and regular bandage changes.

It's crucial to note that by the end of this visit, Qadira was still unable to walk, her wounds were openly painful, and she remained in significant pain and shock. This underscores the critical nature of burns, which can worsen from mild to severe if not properly managed, suggesting that the initial ER care may have been inadequate, potentially allowing the burn to deepen further.

Regarding mandatory reporting, Dr. Tubbesing's conclusions raise concerns:

• She noted that Qadira was burned at the home of Todd and Aimee, an hour before Karellen's arrival, suggesting the burn occurred under questionable circumstances involving cold bath water and the application of ice and cold water.

• She labeled the burn as an accident, a determination made without an official investigation or confirmation of the events she described. This is problematic because Dr. Tubbesing, not being a law enforcement official or a child abuse pediatrician, did not have the authority to confirm these events independently.

• Additionally, another doctor, Candice Tong, amended the report three days later to also state the injury was accidental, again without any law enforcement or DHS investigation, perpetuating a pattern of inadequate unsubstantiated medical reporting.

This ongoing mischaracterization of the injury as accidental, without proper investigative backing, reflects a concerning disregard for mandatory reporting laws and casts doubt on the transparency and accuracy of the medical reporting at OHSU.

Karellen was sent home to facilitate bandage changes with the advice given to her by doctors. Here is her account of returning home to carry out the doctors instructions:

"When I arrived home I was relieved that Qadira’s bandages had been changed and I thanked my brother Uranus for watching the kids. For once I was really glad he was staying with us. Kymani, Kamaya, and Qayden still all needed looking after and I hadn’t had time to get anybody to school that day.

I called Renee at work and told him what they had said. We were just both so relieved that the doctor had told us that Qadira was going to be okay." (Pg. 40)

"Renee said he knew where the medical store was and when he got home he would go buy the supplies and we could change Qadira’s bandage together. I tucked Qadira safely away in our bed away from her brother and sister. 

I gave her some Tylenol with codeine the only prescription the doctor had prescribed and watched anxiously over her. She had to be carried back and forth to the bathroom and she was in a lot of pain but they had told us she was going to be okay." (Pg. 40)

"Two days into the bandage changes I had a bad feeling. The wound was red and weeping and I just felt that something was wrong. I called the number on the discharge papers and spoke to a doctor David Solondz. I told him that I thought Qadira’s wound might be infected but he told me that I was doing everything right and he firmly instructed me not to come back to the hospital.

This was the 3rd time I had been told by a medical professional that Qadira was fine so I resigned myself to the task at hand. My feelings must be wrong I told myself. It must be true that Qadira was fine even though she didn’t look fine. But I still felt that something was wrong." (Pg. 41)

"I decided to go ask my neighbor Alexander what he thought about the situation. Alexander had been a nurse in the military and maybe he could help. What if we weren’t changing the bandages right? It’s not like anyone had showed us how.

I knew from my knowledge as a caregiver to use chucks pads and gloves but I still worried that we might be doing something wrong. Alexander came over and watched us do a bandage change.

He said he thought we were doing a good job. Nobody ever asked us why Qadira wasn’t in the hospital" (Pg. 41)

The phone consultation with Doctor David K. Solondz corroborates Karellen's account of the encounter. However, it's crucial to note that Qadira was still unable to walk at this time, preventing any possibility of bathing.

A key point of discrepancy arises in Dr. Solondz's report, where he states that Qadira sustained both second and third-degree burns—a finding that conflicts with Dr. Tubbesing’s earlier assessment. Additionally, it was inappropriate for Dr. Solondz to address Karellen’s concerns over the phone without physically examining the wound.

Following Dr. Sarah Tubbesing's referral, Karellen consulted with Dr. Randall Nacamuli. His report contrasts with Dr. Tubbesing’s earlier assessment by categorizing Qadira’s burn solely as a superficial partial-thickness burn, despite previous indications of deeper tissue damage.

Additionally, despite Karellen's concerns about a potential infection in Qadira's leg, Dr. Nacamuli reassured her that everything appeared normal.

"On April 16th I took Qadira back to OHSU to see a Doctor Randall Nacamuli.  At this point I was absolutely convinced her leg was infected.  He once again assured me everything was fine.  After this visit we stopped trying to take Qadira back to the hospital." (Pg. 41)

Dr. Nacamuli’s report describes Qadira’s injury as an accident and that she slipped under hot water from a bath faucet, though he does not cite any investigative source for this claim. Interestingly, he mentions that Qadira was given xeroform in the ER, a detail that is not corroborated by any other medical report. It’s noteworthy that Qadira later received xeroform, but this was a decision made independently by the Stephens family, not based on medical advice received at that time.

In his assessment and plan, Dr. Nacamuli recommended that Karellen continue with the existing burn-care regimen and additionally recommended using a sunblock cream for Qadira.

Per the guidance of medical personnel from OHSU and St. Providence, Karellen and Renee Stephens diligently followed the prescribed procedures for changing Qadira’s bandages. The upcoming excerpts from Karellen's book detail how these bandage changes were conducted.

Before you proceed, it’s crucial to understand that Karellen and Renee were acting on the advice of trained professionals, who repeatedly assured them that their care methods were appropriate. As a reader, you may already possess some basic knowledge of burn injuries and might sense that something in Qadira’s treatment was amiss due to the context provided.

Additionally, it's important to note that burn injuries in children typically require comprehensive care and are often reported to authorities—facts that the Stephens' were not aware of at the time.

Therefore, as you read these excerpts about the bandage changes for Qadira, please temporarily set aside any prior knowledge or judgments you may have formed:

"The bandage changes were horrible.  Her wound looked so HORRIFIC we were compelled to take pictures. We thought about calling the police but what could they do? They weren't going to help us change Qadira's bandages and we couldn't see anything beyond getting Qadira well.  

The doctors didn't tell us to call the police they told us that it was our job to take care of Qadira. We didn't have any reason to distrust the doctors. We had to listen to what the doctors had said and do as we were told if we wanted Qadira to get better." (Pg. 41)

"It was terrible to watch. Sometimes the bandages would get stuck to her open flesh and she would cry out in pain as we tried to carefully remove them and clean the open wound. It was HORRIFIC for everybody in the house but for her it must have felt like TORTURE. 

Little did we know that every time we had to change the bandage we were being further traumatized and we did this over and over and over and over again watching our little daughter grit her teeth and cry as we tried our best to help heal the gigantic burn on her leg. We had been told over and over by the authorities that is was OUR job to take care of Qadira." (Pg. 42)

"After about a week she was able to get around on some crutches but every time she moved the bandage would slip down below the knee and sometimes the wound would get dirty. The burn was located right over her left knee joint in a difficult to keep bandaged spot but we did the best we could do under the circumstances." (Pg. 42)

"We did our best to care for Qadira and in about three weeks the burn had been replaced with mottled patchy looking skin. Her leg looked like it belonged to Frankenstein and at times she had trouble breathing." (Pg. 44)

Karellen’s accounts of changing Qadira’s bandages reveal shocking truths about the events that transpired. Unfortunately, the doctors' responsibilities were not fully met. Specifically, they failed to direct the Stephens to a burn specialist and crucially, did not report Qadira's injury to the police as mandated—oversights by OHSU that had significant implications.

The image below, dated April 18th, 2007, shows the healing stage of Qadira's burn. Next to it, you can view an image of the initial wound. The differences in depth and borders between the two images suggest that the burn may have worsened over time because it was not properly managed initially, allowing the injury to deepen.

Karellen and Renee took Qadira to see Dr. Joel Solomon on April 30th, 2007. Dr. Solomon's report indicated that Qadira's wound had fully epithelialized, meaning that the skin was healing and beginning to regenerate.

Dr. Solomon recommended that Karellen continue with the care regimen that had been previously instructed. He specifically noted the use of moisturizer and sunscreen as needed.

Additionally, he advised Karellen to schedule a follow-up appointment in one to two years or pro re nata (PRN), which translates to "as needed."

Karellen initiated an appointment with Dr. Nancy Gordon-Zwerling due to Qadira experiencing frequent bouts of difficulty breathing. Dr. Gordon-Zwerling diagnosed Qadira with anxiety and prescribed her Albuterol. Here are Karellen's accounts:

"I took her to see Nancy Gorden-Zwerling where she was given an inhaler and referred to a Plastic surgeon. We took her to the plastic surgeon and he told us that Qadira was healing up just fine and that there was nothing he could do to make her leg look any better. That’s just the way burns looked." (Pg. 44)

"But Qadira was so disfigured I just couldn’t understand how everything was fine? He told me to make sure to keep the area covered with sunblock so it didn’t get sunburned. I felt like someone had kicked me in the stomach.

This is what her leg was going to look like? All patchy and mottled? From her lower thigh to down past her knee her leg looked like a patchwork quilt. It was like someone had taken several different legs and sewn them all together. Every time I saw it all I could think was that it looked like dead flesh." (Pg. 45) 

Critically, it's important to note that despite the severity of Qadira’s previous burn injury, Dr. Gordon-Zwerling did not refer her to a burn center. She also did not evaluate whether the breathing issues could be a complication related to the burn.

Recall that at the time of her initial injury, Qadira was unable to walk, indicating severe trauma. This suggests that the effects of the burn might have been more extensive than what was addressed by the doctors at OHSU.

In Karellen's book, Justice For Qadira, she provides insights into what Qadira was experiencing at the time.  

"Qadira was really not well.  Her tongue had turned a strawberry red and a dark rash around her mouth continued to persist and there were still times when she struggled to breath.  

On January 22nd 2008 I took her back to OHSU afraid that she was also coming down with the dreaded Kawasaki’s syndrome.  They ran a comprehensive metabolic test and came back to us a couple of days later insisting she just had the flu.  

But she didn’t get any better.  With nothing to really go on I began to change the family diet by pulling all of the wheat out of our diet. Maybe she was suffering from allergies?  

With no answers from the doctor’s I decided to try something to help everyone be a little healthier. I needed something to focus on besides doom and gloom." (Pg. 59)

 Notably, during an appointment with Dr. Dahra Perkins, it is recorded that Qadira, then nine years old, was presenting with a fever and several other symptoms detailed in Dr. Perkins' report. Particularly alarming is Qadira’s blood pressure reading of 86/58, which is unusually low for an eight-year-old child.

Dr. Perkins responded by ordering a lab test, the results of which are included in the medical records dated January 25th.

Karellen returned to OHSU with Qadira after noticing further unusual symptoms for which she had few explanations. Qadira still had a fever, swollen lymph nodes and reddish, cracked lips. 

  
The comparison of blood test results on January 22, 2008, and January 25, 2008, reveals a concerning trend in the Qadira's health. The white blood cell count (WBC) decreased further from 3.5 to 2.6 K/cu mm, indicating a worsening immune system. Neutrophil count also decreased from 1.8 to 1.0 K/cu mm, increasing vulnerability to infections. While the monocyte percentage slightly improved from 16% to 15%, it remained high, suggesting ongoing inflammation or infection. Blood urea nitrogen (BUN) and aspartate aminotransferase (AST) levels remained low and high, respectively, indicating continued liver stress and potential nutritional issues. These deteriorating results underscored a significant decline in Qadira's health, necessitating urgent medical attention and further investigation. The failure to communicate these abnormalities to her parents delayed crucial interventions, contributing to subsequent severe health issues. 

 Before continuing, it's essential to clarify that while we are not medical professionals specializing in burns or child abuse, burns are universally recognized as complex injuries. Our role as activists compels us to highlight that neither OHSU nor St. Providence Vincent adhered to the required procedures for reporting or treating Qadira’s injury, particularly the related systemic trauma.

These records reveal potential medical malpractice and, more gravely, child neglect. All involved doctors were aware of the necessary practices to ensure proper care, yet failed to implement them. This oversight not only tasked Karellen and Renee with managing painful and inadequate treatment for their daughter but also exposed their other children to these distressing scenes.

Burn injuries of this severity, especially in children, typically require coordinated care from multidisciplinary teams at specialized burn centers. The blood tests from OHSU confirm that Qadira suffered further complications due to this lack of appropriate care.

The disclosure of these records aims to demonstrate unequivocally that mandatory reporting laws for child neglect and abuse are not foolproof and can themselves be overlooked or misused.

While we acknowledge that only qualified professionals can fully assess the implications of a burn, it is clear that Qadira experiences ongoing morbidity, which remains unexplained likely due to the initial mismanagement of her injury. This pattern began with the first responders to her burn, who prematurely labeled it an accident without proper investigation.

We cannot identify which officials decided to categorize Qadira's injury as accidental without further inquiry. Proper reporting could have recognized her situation as criminal, potentially providing her access to the victim's assistance she deserves.

This story extends beyond these records. As Qadira was recovering, the Stephens' pursued restitution through insurance to cover her medical costs and sought legal representation to navigate the insurance claims process. The full narrative continues in the next section.