When Heather Giammaria arrived at Hillcrest Hospital in April 2006 to have her third child, she knew she had reached her limit.
She was a nursing assistant in Willoughby; her husband, Daniel, worked in security and maintenance for the Hospice of the Western Reserve. Their little house in Mentor-on-the-Lake was cozy and clean, but the mortgage left no money to spare. Leaving the size of their brood to chance was a luxury they simply couldn't afford.
Then there were the health risks. Heather developed high blood pressure and had to be hospitalized during two of her pregnancies. Each new life she ushered into the world required slicing her abdomen open for a C-section. Tempting fate a fourth time didn't seem wise.
After speaking with Dr. Dinkar Rao, the Giammarias decided that Heather would have her tubes tied immediately after this C-section. That April day, before heading to surgery, Heather signed the necessary paperwork. When she emerged from the operating room with new daughter Alexis, she assumed her childbearing days were over.
The next few months passed in a blur. Even though Heather's oldest daughter doesn't live with them, caring for the other two children — an infant and a two-year-old son — was enough to keep any young couple busy. But the Giammarias' son, Hunter, had developed behavioral problems. He was prone to violent outbursts, couldn't speak in full sentences or learn to use the toilet, and almost never slept.
In the rare moments Heather had for herself, she noticed that something was amiss. She hadn't had a period since the baby was born, and she didn't seem to be dropping the extra weight. This wasn't entirely unusual: Thyroid problems typically make her period abnormal. So when she suggested to Daniel that she might be pregnant, he brushed it off. The surgery was supposed to make that nearly impossible, right?
About eight months after Alexis was born, they were strolling through a dollar store when they noticed pregnancy tests on sale. They bought a couple as a joke, Daniel remembers. But the results weren't funny.
Frantic phone calls to Dr. Rao followed. If Heather was pregnant, the baby could be growing inside a tied fallopian tube instead of her womb, putting both mother and baby at risk. Rao rushed to his office late that night to find her file.
He called back with some stunning news: Yes, Heather might be pregnant. But her tubes had never been tied.
Rao told the Giammarias that he never received the papers for the surgery. In fact, the nurse should have never even provided them, he added. Expectant mothers are not allowed to make such decisions on the day of delivery, because they might not be thinking clearly.
But it was now too late. Heather was more than five months pregnant.
Once again her blood pressure problems flared up; she would need another early delivery and C-section. But when she posed her dilemma to bosses at the Breckenridge Village nursing home, saying she would need six to eight weeks off to recover from major surgery, they weren't particularly empathetic. Heather had already used her annual three months of family leave when she gave birth to Alexis. Breckenridge was in no mood to provide more.
After 10 years on the job, Heather was forced to leave.
By the time little Haylie was born, the stress was becoming unbearable. Heather's Breckenridge health insurance was about to end, and they couldn't afford continued benefits. Daniel tried to talk to Rao about the mounting medical bills. "Doctor, I don't make your kind of money," he told him. "We're in a tough situation here."
Rao referred him to a hospital administrator and promised to help. But he "didn't do anything more," Daniel says.
Swallowing her pride, Heather signed the kids up for free health insurance and a program for kids with disabilities. Having worked her whole life, she suddenly found herself a stay-at-home mom chasing after three kids under the age of four, all still in diapers.
Daniel picked up double shifts. But it was never enough to cover the bills. They had to buy a new car to fit three car seats. Hunter had to stop seeing their favorite speech therapist because she wasn't covered by the free program. "When you don't pay for nothing, you take what you can get," Heather notes ruefully.
In May, she got a letter from Elizabeth Vaci, a regional claims director for the Cleveland Clinic, which owns Hillcrest. Vaci admitted that the hospital received the paperwork Heather signed to get her tubes tied. But she argued that it wasn't the hospital's fault the surgery wasn't done. Heather didn't discuss it with the doctor in advance — or at least his records "do not indicate any discussions.
"There was no discussion with Dr. Rao of your desire for a tubal ligation, and appropriately, no such procedure was performed," Vaci wrote. But she neglected to mention why no one bothered to inform the Giammarias.
Rao refuses to talk about the incident. Vaci referred Scene to Clinic spokeswoman Heather Phillips, who says she can't comment due to "patient confidentiality."
Meanwhile, the Giammarias asked Daniel's sister, lawyer Melanie GiaMaria, to prepare a lawsuit alleging breach of contract and unwanted pregnancy. GiaMaria wrote Vaci in September requesting the matter be settled out of court. But she never got an answer until Scene called Vaci a month and a half later.
The next day Vicky Vance, a hospital lawyer, called GiaMaria, wondering how much money her clients desired. She requested about $53,000 — half to cover the cost of Haylie's delivery and Heather's lost wages, the other half for the emotional distress.
The Giammarias say they are not trying to smear Dr. Rao or exploit what was clearly a mistake. Heather admits that she's partly to blame for not asking more questions after the baby was born.
"I'm not looking to get millions of dollars," she says. "I'm just looking for some kind of justice here."
On a recent rainy morning, the desperation is palpable in their living room. Hunter keeps trying to tackle Alexis, who is wailing in her playpen. Heather is cradling baby Haylie and trying to talk to a reporter, while Daniel struggles to get his son ready for school. It seems like someone is crying all the time.
"The stress level is real thick in here," Heather says as she collapses in a chair at the kitchen table.
She worries that Alexis lost out on important mothering time because the new baby came so fast. She worries that the financial strain is taking a toll on her husband's health. She worries that Haylie will feel unwanted if they go public with the story of her birth.
The dulled exhaustion of her pale skin, the anxiety in her eyes, make her seem like a distant cousin of the glowing woman in the wedding photo on the wall behind her. But she scarcely has time to complain. Her daughter is crying again.