Trail of Infant Deaths Leads to Alabama Clinic for Poor Women

MONTGOMERY, Ala. —  Word of mouth and fliers distributed in mostly poor, mostly black areas brought Gladys Mae Hinson and a lot of women like her to the clinic where Dr. Jesse James Howard delivered babies for $350.

Hinson, 23 and the youngest of a family of 18, came from Mosses, an impoverished backwater, to have her second child. Antoinette was born at 6:55 p.m. on Aug. 20, 1986, and Howard sent mother and baby home at 7:30, even though Antoinette was having trouble breathing. Soon her breathing stopped.

Gladys Mae gave her baby mouth-to-mouth resuscitation during the 30-minute race to a hospital, but lack of oxygen already had taken its toll. “She can’t walk, she can’t talk, she can’t take care of herself,” the mother says.

A month later, Howard sent Janice Peterson home 2 1/2 hours after she gave birth to Willie Jr. Willie began having trouble breathing the next day, and before he reached the hospital he was dead from inhaling meconium, or fetal feces, a treatable birth complication.

Investigation Asked

Medical Examiner James R. Lauridson believed Willie should not have died and asked the state Board of Medical Examiners to investigate. Right away, board Director Larry Dixon said, six more doctors urged action against Howard.

The board investigated 11 of Howard’s deliveries over an 18-month period--including those of Willie, Antoinette, another baby who suffered brain damage and three others who died--and asked the Alabama Medical Licensure Commission to revoke his license. It took until July, 1987, for the commission to suspend Howard’s license, and until the following March to revoke it.

“We should have done something a little sooner, maybe,” said Dixon, a state senator. But he said the circumstances--a black doctor delivering the babies of poor women who had had little prenatal care--prevented the board and the commission from moving faster than they did.

“He was dealing with a patient population that has a much higher infant mortality rate than the rest of the state. We didn’t know at first whether we were dealing with gross malpractice or a phenomenon of the population.”

Worst Mortality Rate

Alabama’s infant mortality rate in 1986 was 13.3 per 1,000 live births, the worst in the nation. The nationwide rate was 10.4. In 1987, Alabama fell to fourth place, with 12.2; complete nationwide statistics were unavailable.

Howard, who says he has delivered at least 2,000 babies, contends that the white-controlled medical community has been “on his case” for years, in part because his deliveries took business away from hospitals and other doctors. There is a double standard of medicine in Alabama, he says: Whites get quality care from well-paid doctors; poor blacks get whatever they can.

Because of that double standard, Howard should be praised for his work, his attorney, Robert Turner, said. “It’s a miracle more of his patients didn’t die. It’s a testament to his skill that they didn’t.”

Howard was “as much a missionary as a medical doctor,” J. L. Chestnut, another of his lawyers, argued in appealing the March 23, 1988, license revocation before Montgomery County Circuit Judge Joseph Phelps.

Board officials “knew we were going to be charged with racial discrimination when we got into it,” Dixon said, adding that such claims have been standard whenever action is taken against nonwhite member.

The board accused Howard of sending babies home minutes after problem deliveries, of performing risky deliveries in an ill-equipped office, of failure to keeping newborns warm and of “repeated failure . . . to recognize and treat significant and substantial life-threatening medical conditions.”

“The standards of medicine nowadays dictate that if you’re going to provide the care, there’s a minimum standard of care you’ve got to meet,” said Dr. Earl Fox, head of the Alabama Department of Public Health.

Howard, a 1972 graduate of Meharry Medical College in Nashville, Tenn., says he met that standard in obstetrics, which accounted for 10% of his practice. “Many of those babies had problems from the get-go. I didn’t do anything to those mothers.”

Howard was no stranger to the authorities, however.

The board had investigated him before, in 1976, but took no action, citing lack of evidence of irregularities in his prescription practices. Howard said he also was investigated twice for problems with deliveries similar to those that ultimately cost him his license.

In Selma, where Howard set up a clinic in 1973, he lost his hospital privileges after he stabbed Dr. Chudy Okoye during a scuffle in a ditch. Howard also was convicted of assault, fined $500 and sentenced to 30 days in jail, which he served on weekends. (No charges had been filed after an earlier fight took place in an operating room where Okoye’s surgery took longer than scheduled.)

Howard also assaulted a woman employee who had been living with him. He was fined $50 and given a 30-day suspended sentence and six months’ probation. In 1979, he was fined and given a suspended sentence for petty larceny, and in 1980 he was convicted of failing to file birth and death certificates. The death-certificate charge was dropped on appeal; he pleaded guilty to the birth-records charge and was fined $1.

When Howard moved his clinic to Montgomery in 1985, members of the medical community there already had seen some of his babies in emergency rooms.

“We’d get a (dead) baby born to a low-income family, and the first thing we’d ask is ‘Did it come from Dr. Howard?’ ” said Ike Moss, a former investigator with the state’s Department of Forensic Sciences. “I started hollering, ‘Let’s get his license!’ when I worked the second one.”

Still, about 100 people showed up at a license hearing in support of Howard, who is living in Tuscaloosa pending Phelps’ decision.

“He was a neighborhood hero,” said Dr. Thomas C. Nolan, a member of the license commission.

Sharon Jones, 18, of Ft. Deposit, whose daughter died less than a day after she was born on June 9, 1987, said, “Dr. Howard treated me very nice.”

“It’s just in God’s hands,” her mother, Annie Pearl Jones, said. “I never felt like he killed the baby.”

Febie Ann Crum’s baby suffered brain damage during delivery June 5, 1987. “He is not really the age he’s supposed to be. He has not got the growth a 2-year-old has supposed to get,” said her mother-in-law, Plummie Mae Crum of Greenville. “He don’t do nothing much.”

Gladys Mae Hinson describes Antoinette, now 2 1/2, in similar terms.

“They say she will always be with me,” Hinson said. “I’ve accepted the fact that this child will be with me until I die or she dies.”

Hinson, who had a son before Antoinette and has had a daughter since, says she can’t work because of the danger that Antoinette could suffer a seizure and the numerous doses of medicine the child must be given daily.

She said she now believes Howard was wrong to send her home so soon after Antoinette was born, particularly since the baby was in trouble.

“I trusted him,” she said. “He was my doctor.”