The Dr. Brewer Pregnancy Diet
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Pre-eclampsia Precedent-Setting Lawsuit 1977

OCTOBER 19, 1973, LETTER TO SPUN [Society for the Protection of the Unborn through Nutrition] FROM CORA SMITH STANINGER, NORA'S MOTHER

This will probably seem unbelievable to you, but every bit is the bitter truth. When I became pregnant, I went to the "in" obstetrician in Gary at that time.

I was doing well and felt wonderful during my seventh month of pregnancy. At that time, I went to the doctor for a checkup, and he informed me that my blood pressure was normal and that I was doing fine. Also, I only weighed 119 pounds at that time. Just before leaving the office, I mentioned that I had recently begun to get headaches, which was a new experience for me. The doctor said, "Oh! In that case, sit down," and he wrote on a prescription blank, "Nothing but rice, fruit, and water three times a day." I asked if I could have milk or vitamins, and he stated, "Absolutely not."

After several weeks on the diet, I felt terrible and started to get sick and hungry, and I began to experience swelling in my ankles. It was then that the doctor ordered daily diuretics, or water pills, and visits to his office three times a week for a fluid shot. He also had me take large doses of Epsom salt (which is both a laxative and a purgative) nightly for two months. As I look back now, I can see how he kept my system completely drained of fluid, even with the small amount of rice and fruit that he allowed me to eat for the final wo months of pregnancy. It is a wonder that my daughter lived.

I kept asking the doctor if I could go off the diet and whether this was hurting the baby. He said, "No, you must stay on it and it will not hurt the baby; the baby will take what it needs from your body." Many times I was going to go off the diet, but my husband and relatives said, "He is a doctor and knows what he is doing." It was not a question of money, as we could afford the proper food, and I had attended a prenatal class and knew what to eat. The doctor told me I should forget what I had learned at the prenatal class and stay on his diet.

Thank you again for your wonderful work. My daughter, my family, and I have had to pay a very high price for the prenatal diet that my physician ordered, but it is gratifying for me to know that you are so diligently trying to spare others such a terrible fate.

Chicago Tribune, Sunday, September 18, 1977

Retarded before birth, she's awarded $50,000

by Bill Grady

A mentally retarded Lake County, Ind., woman was awarded $50,000 Saturday by an Indiana jury in a medical malpractice suit that charged her retardation was linked to a protein-deficient diet prescribed for her mother shortly before her birth.

In what could be a precedent-setting decision, the jury agreed with medical experts who testified on behalf of the 23-year-old woman that there is a connection between a mother's prenatal nutrition and mental development in the fetus.

The suit was brought by the woman's mother, Mrs. Cora Smith Staninger, against Dr. Joseph Kopcha, a Gary-area physician.

IN THE SUIT, Mrs. Staninger charged that she was placed on a rice and fruit diet during the last two months of her pregnancy in late 1953 by Dr. Kopcha.

She also was required to take 1 1/2 tablespoons of epsom salts every night. Epsom salts act as a laxative.

Byron M. Chudon--the Schererville, Ind., attorney who filed the suit--said the diet deprived the mother of the proteins needed for normal brain development of the fetus.

Dr. Benjamin Pasamanick, a specialist asked to testify on behalf of the woman by the Society for the Protection of the Unborn through Nutrition, called the jury's decision "precedent shattering."

IT'S GOING to make physicians think twice about what they do. This decision is going to make physicians exceedingly careful about the diets they prescribe for their pregnant patients," said Pasamanick, who has done research into the causes and prevention of mental disorders.

The society, a 5-year-old activist group based at 17 N. Wabash Av., has waged a campaign to convince the public and doctors of the importance of good nutrition during pregnancy.

The rice diet, which was supposed to prevent a complication of pregnancy called pre-eclampsia, consisted of a cup of rice and two pear halves or other fruit three times a day, Chudon said.

Pre-eclampsia, sometimes called high blood pressure of pregnancy, is not uncommon in poor women and can be fatal to either the mother or the fetus, Pasamanick said.

CHUDOM SAID the mother contended she stayed on the diet with no vitamin or iron supplement. He said the Dr. Kopcha apparently based the diet he prescribed for Mrs. Staninger on a then-experimental diet being tested at Duke University for treatment of extreme high-blood pressure. However, that diet was used only under hospital supervision supplemented with sugar, honey, and massive doses of vitamins and was not used for pregnant women, he said.

At the time, the textbook treatment for pre-eclampsia was bedrest and an adequate diet, Pasamanick said.

A Porter County Superior Court jury in Valparaiso, Ind., returned the verdict after deliberating about 12 hours.

Chicago Tribune September 20, 1977

A victory for nutrition

A jury in Lake County, Indiana, has returned a $50,000 malpractice verdict against a doctor on the ground that he prescribed an inadequate diet to a pregnant woman 23 years ago and that this caused her daughter to be mentally retarded.

This is a precedent-setting case; not because it is likely to be repeated [it became possible through a temporary fluke in Indiana law] but because it gives judicial recognition to the importance of proper nutrition during pregnancy.

The daughter's suit against the doctor became possible only because of an earlier court decision invalidating Indiana's previous statute of limitations in cases involving childbirth. Since then, Indiana has passed a new law generally restricting malpractice suits and providing that cases involving childbirth must be brought before the child becomes eight. Other states, seeking to curb the costly effects of malpractice suits, are moving in the same direction.

But the fact that malpractice suits have become a plague in no way justifies malpractice--which quite properly should include the somewhat casual attitude which many doctors show toward nutrition during pregnancy. The mother in this case was put on a diet of rice and fruit during the last two months of her pregnancy on the basis of experiments showing that such a diet could prevent high blood pressure. But it was clear even at the time that this diet was inadequate for pregnant women.

The Society for the Protection of the Unborn through Nutrition helped to bring the Indiana case to court. The jury's message is an urgent one to the medical profession. We hope that it will heed the warning rather than invite new malpractice suits of a nature which, despite the limitations imposed on them, could be very difficult to adjudicate.

American Medical News, September 26, 1977

Pregancy diet suit is upheld

An Indiana jury awarded a mentally retarded woman $50,000 in a malpractice suit that charged her mother's prescribed diet during pregnancy caused her retardation.

The suit was brought by 23-Nora Smith's mother, Cora Smith Staninger, against Joseph Kopcha, MD, an obstetrician-gynecologist.

A diet of polished white rice, fruit, and a daily dose of one-and-one-half tablespoons of Epsom salts was prescribed in May, 1954, for Staninger by Dr. Kopcha during the last two months of her pregnancy for treatment of pre-eclampsia, said Stephen Meyer, Staninger's attorney.

Expert witnesses for Staninger testified that the diet, because of its low protein content, caused Nora Smith's retardation. By prescribing it, Dr. Kopcha also breached the standards of care for the community and for 1954 Meyer said.

"The diet was developed at Duke U. as a last-ditch effort to treat chronic hypertension and (severe) renal disease," Meyer said. "It was never supposed to be used during pregnancy because of the low protein." Meyer added that during the trial "We got Dr. Kopcha to admit he made a misdiagnosis," and that instead of pre-eclampsia, Staninger suffered from "pre-pre-eclampsia or insipient pre-eclampsia."

Meyer was able to bring suit for Staninger at this time because of a 1973 Indiana court case which changed the statute of limitations.

Prior to 1973, malpractice suits in Indiana had to be brought within two years from the date of the incident.

Because of a state supreme court decision in a 1973 case, the statute was changed so that a suit could be brought up to two years after a "disability is removed," or anytime in the case of mental retardation.

According to Meyer, Dr. Kopcha "fought vigorously on three fronts. He said that he didn't breach the standards of care for the community, that malnutrition can not cause mental retardation, and that the diet he prescribed was adequate."

Dr. Kopcha was unavailable to AMN for comment.

Chicago Tribune, October 2, 1977

Feeding the unborn

CHICAGO--The Tribune is to be applauded for its timely editorial "A victory for nutrition" [Sept. 20]. The malpractice case referred to may have far greater significance than many of your readers recognize, as it established a precedent that obstetricians can be held liable for imposing dietary restrictions which lead to reproductive casualty. Many studies link inadequate prenatal diet to a wide range of newborn and childhood diseases and disorders.

There is a general agreement that anyone practicing obstetrics has a serious responsibility to prevent a lifetime of affliction and to ensure that future generations are able to attain their full potential. Certainly, then, obstetricians should follow the highest standards of medical care, especially with regard to the profession's basic principle "First, do no harm."

The paucity of nutrition education in medical training by no means, the Indiana jury decided, relieves those obstetricians who impose inadequate diets upon expectant mothers from liability. The most significant outcome of the trial [and one whose implication is likely to reverberate throughout the medical community] is that malpractice may be construed to include, as The Tribune succinctly stated, obstetricians' "casual attitudes toward nutrition during pregnancy."

While medical practices should be determined in medical schools, physician training, and continuing education and not in court, malpractice litigation remains the last resort of those victimized by iatrogenic [physician-induced] prenatal malnutrition. The medical profession should adopt scientific standards for the nutritional management of pregnant women, an action which is the main requisite for improved maternal and infant health.

Jay Hodin
Executive director,
Society for the Protection
of the Unborn through Nutrition

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