Baby Boom

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.