In a patient like Tammy--who had just had a foreign object placed in her body and had a history of urinary tract infections--the chances of contracting any infection were particularly high, anywhere from 8 to 30 percent.

Coupled with the fact that Tammy had no control of her bladder or bowel and had diarrhea, constant monitoring of her wound was essential.

But during those critical days, the Gentrys say, Tammy's care was inadequate.
Luann and her husband say that on several occasions, they arrived at the hospital to find Tammy lying in her own excrement. "I'd go up there and find her in horrible condition," Luann says. "She'd tell me she hadn't seen a nurse for an hour."

"It stunk," remembers her father. "Her wound bandages and sheets would be soiled."
One family friend who visited Tammy frequently said she witnessed the same thing. What's worse, both parents and the family friend say, is that Tammy's call light--the button she could push to summon the nurse--was often out of her very limited reach.

Even Mayfield complained that he observed "soilage in the sheets" close to Tammy's surgical incision.

"That upset me," he said. "That's standard nursing care. . . . If they needed more nursing staff, get it."
Nursing records from the time show that nurses checked Tammy approximately every hour, and usually checked off a box on the records indicating that Tammy could reach the call light. Attorneys for the hospital say at times nurses may have checked Tammy as frequently as every 15 minutes.

"Tammy received excellent care by excellent nurses," said Joyce Niemec in a court deposition. Niemec is a registered nurse who treated Tammy.

Still, she said, at times the wound did become contaminated. "There are certain days that you probably are not able to do as many things for every patient as you would like to be able to do. That is reality."

It was also critical that Tammy maintain high levels of fluid and food intake. Mayfield ordered Tammy to receive between 1,300 and 1,500 cc of fluid a day--about 45 ounces. In the days after her surgery, however, nurses charted her intake at levels as low as 600 cc. They also said that Tammy frequently skipped meals.

Attorneys for the hospital, however, point to the fact that Tammy didn't show signs of being clinically dehydrated, and that Tammy often ate food brought in by a friend of the family.

"Every time [the friend] visited Tammy, she brought food and drink from McDonald's," attorneys argued, "of which Tammy partook. There is simply no evidence that she was dehydrated or malnourished while at Phoenix Children's Hospital."
Tammy was still in the hospital a week after her second surgery--when Mayfield said an infection was most likely to develop--when a nurse noted that part of Tammy's surgical incision wasn't healing properly. The area, which she described as "gaping," was about a quarter-inch in size. She documented that she observed a "purulent drainage"--pus--coming from the wound.

On a later check, a hospital intern also noted purulent drainage coming from the same part of Tammy's wound.

While without tests it was impossible to tell whether it came from a surface infection or a deep-wound infection, the drainage was a potentially ominous sign.

But preparation for Tammy's discharge from the hospital was already under way. And by the following day, September 7, after three weeks in the hospital, Tammy was eager to go home.

@body:Mayfield, too, was eager to get Tammy home. He was leaving the country the next day.

In Mayfield's judgment, the area was not healing properly in part because Tammy had poor skin. He did not believe it was serious.

"Sort of like when you cut your finger a little bit or scratch your finger, you may have developed a little purulence on the top," he said.

Mayfield prescribed Betadine, a topical surgical dressing, to help prevent infection. He planned to see Tammy in two or three weeks to check her progress. He ordered a home-health evaluation. And then he signed Tammy's discharge papers.

But, "in his zeal to get out of the country," the Gentrys' attorney Ray Slomski charges, "Mayfield left before his job was done."

The surgeon never asked either the nurse or intern why they described the drainage as "purulent," or how much pus they had observed coming out of the wound. He didn't order a wound culture to determine what, if any, bacteria were inside.

He didn't order a follow-up visit during his absence to determine if the drainage was the body's normal healing process or a sign of an infection, or to see if the Betadine was working.

Tammy left the hospital late that evening. CIGNA had an ambulance waiting to take her home. No one in Tammy's family spoke with Mayfield that day; Luann says she didn't even know the surgeon was leaving town.

"It was a shock," she says of the discharge. Tammy's home-health nurse would later record that Tammy was "discharged unexpectedly."
From then on, Tammy's condition would get much, much worse.

@body:When Mayfield ordered the home-health evaluation, he later said he expected a nurse to visit Tammy every other day, if not every day.

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