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That operation would place metal rods, known as Harrington rods, in Tammy's back in order to straighten her spine. The surgery could have enabled Tammy to live until she was 30 or 40 years old, if not longer.
The Gentrys knew the surgery was dangerous. But they also knew that to improve Tammy's life, indeed, for her to have a life at all, it had to be done.
@body:Luann Gentry was an insurance rater with Fireman's Fund Insurance in the mid-1980s when her company began to offer the CIGNA Healthplan to its employees. Luann says she switched her family's coverage from Aetna to CIGNA because it paid for substantially more services.
While the Gentrys' lawsuit did not find fault with CIGNA's coverage, the parents did cite problems. At first, Luann says, CIGNA allowed Tammy to continue seeing the specialists at the spina bifida center, then called Arizona Children's Hospital.
For Tammy's routine care, however, she began seeing Dr. F. Gerald Figgs, chief of staff at CIGNA's office in Maryvale.
But eventually, Luann says, CIGNA would pay only for visits to specialists within the organization. "All of a sudden, they told me Tammy could not see her doctors that she had since birth," Luann says.
Then, in February 1988, CIGNA sent a letter saying it was canceling the Gentrys' coverage because Jerry Gentry allegedly refused to get treatment for an alcohol problem.
While it is unclear whether CIGNA planned to cancel the whole family's coverage or just Jerry Gentry's, the letter came months after Luann began discussing her daughter's need for the costly surgery with CIGNA staff.
"Every inch of the way I fought them over the surgery," Luann claims.
Upon appeal, CIGNA agreed to continue coverage. (CIGNA officials declined repeated requests for an interview.)
CIGNA did finally recommend that Phoenix surgeon Jack Mayfield perform the operation to straighten Tammy's spine.
Mayfield began practicing regularly in Phoenix in 1982 and later opened the Papago Medical Park on Seventh Street, just south of McDowell Road. In 1987, he published a book, Surgical Management of Kyphosis, the medical term for Tammy's curved spine.
He was one of a handful of surgeons in the Valley capable of performing the delicate surgery Tammy needed.
Tammy and Luann first saw Mayfield in April 1988. The doctor carefully explained the two-step procedure. During the first surgery, Mayfield would open Tammy's back and place the metal rods inside her body. During the second surgery, he would cut in anteriorly to fuse the spine.
Mayfield cautioned Luann and Tammy about the difficulty of the procedure. He later gave Luann a "teaching check list" that outlined the possible complications. Number one on the list was "infection: wound."
But Mayfield's nurse reassured the mother and daughter. She showed them photos of other children who had successfully undergone the operation at Mayfield's hands.
Having gone through nearly 40 operations together, mom and daughter felt ready for the most intense surgery of Tammy's young life.
"I felt really confident," Luann says. "Tammy was scared, but she knew she wanted it done."
@body:On August 14, 1988, four days before her surgery, Tammy was admitted to Phoenix Children's Hospital at 11th Street and McDowell.
The surgery had originally been scheduled weeks earlier, but getting authorizations and coordinating the schedules of the other specialists delayed Tammy's hospitalization.
The date was just a few weeks before Mayfield was leaving the country to attend a medical conference in Yugoslavia.
Because of Tammy's chronic urinary tract infections, a urologist under contract with CIGNA had recommended Tammy enter the hospital 10 to 14 days ahead of time for antibiotic treatment; Mayfield said he expected Tammy would be admitted seven days beforehand.
CIGNA, however, would only authorize four days of the treatment. The Gentrys theoretically could have paid for the extra days out of their own pockets, but the cost would have been prohibitive.
While doctors knew it was extremely difficult to completely sterilize a patient like Tammy--because of abundant bacteria in both her skin and body--she appeared to be ready for the first and more complex operation on August 18.
Luann Gentry remembers that first surgery lasting 10 to 15 hours. Between the first and second surgeries, while her daughter was in intensive care, Luann slept in the same room with Tammy.
The second surgery two weeks later was shorter, but still lasted several hours. Again, Luann stayed with her daughter as much as possible.
"She did real well," says Luann. "Within a couple of days, she was giggling, talking on the phone, acting like Tammy."
Indeed, no one disputes the success of either surgery. Tammy, it seemed, would become another smiling picture on Mayfield's wall.
But that was contingent on the care Tammy received in the critical recovery period after her second surgery on August 29.
@body:After any surgery, protecting against wound infections within the body is the most critical part of a patient's postoperative care. These infections, known as subfascial deep-wound infections, can lead to death.
According to Mayfield's own testimony, the risk for deep-wound infection is highest seven to 14 days after surgery.