Fallbrook woman denied accommodation request for IUD removal

REGION — A Fallbrook sexual assault victim is pushing back against Kaiser Permanente after the health care provider’s San Diego Medical center twice denied requests to allow her husband in the operating room for emotional support during a procedure to remove her birth control device.

Cassie Sanderson, whose real name will remain anonymous for the protection of privacy, learned that something had gone wrong with her intrauterine device, or IUD, a T-shaped device that is inserted into the uterus as a form of birth control.

Sanderson first had the device inserted in Nov. 2020. The following summer doctors were unable to find the strings that would be used to pull out the IUD but the device itself was still intact.

Doctors later found the device’s strings in December, but pulling on it hurt Sanderson too badly so they stopped. Now, she must get the birth control implement removed another way.

Because of Sanderson’s past history of sexual trauma, her remaining options on how to remove the birth control device are limited.

“I cannot have any procedure to remove it under general anesthesia,” Sanderson said, “It’s a non-starter for me.”

Under general anesthesia, patients are completely unconscious.

One of Sanderson’s limited, alternative options is to have a hysteroscopic IUD removal in-office, which would require a paracervical block. In this method, a local anesthetic is injected into the cervix to numb the area for the procedure.

During a paracervical block, a device called a tenaculum is used to stabilize the cervix for the injection. The device pierces the cervix, often causing pain and bleeding.

“With this option, they will allow my husband to be with me for support, however, the idea of needles going into my cervix makes me nauseous and keeps me up at night,” Sanderson said.

The other option is the same procedure but with a spinal block instead of a paracervical block for pain management, but her husband couldn’t be with her for this procedure because it must be done in an operating room. As per hospital policy, any companions cannot be in operating rooms during procedures.

“I’ve spoken with the perioperative services department and they denied me,” Sanderson said.

She also submitted two requests for accommodation for the IUD removal procedure that would allow her husband to be in the room, but both were denied.

“They’re claiming it’s for my safety and infection risk control, which is a crock,” Sanderson said.

A spokesperson with Kaiser Permanente told The Coast News that “patient privacy laws prohibit providing comment related to this matter.”

Gynecological exams have always been difficult for Sanderson. Between the ages of 5 and 22, she was sexually abused and assaulted on three separate occasions.

Now, things are made easier with the presence of her husband who accompanies her for emotional support for any new procedure she would experience, including an IUD removal.

Sanderson’s husband had been with her during two cesarean sections, which also required spinal blocks and were performed in operating rooms. During a c-section operation, the abdomen and uterus are cut open to remove the baby, which also requires the bladder and intestines to be moved aside.

Given these details, she doesn’t understand how her husband was allowed to be in a room where all of that was going on without risk of infection but not for an IUD removal.

“It’s sickening to me that they would deny me this, especially given that it’s April, sexual assault awareness month,” Sanderson said last month. “The infection risk is astronomically lower than the c-sections were.”

In the first letter from Kaiser Permanente’s California Grievance and Appeals Operations, the medical group explains the “longstanding policy” is to prevent surgical site infections and protect the patient, support person and staff.

“A spouse attending the birth of their child is a special circumstance that does carry all the same risks but has over time been determined to be acceptable,” the first letter dated March 24 states. “This is not a policy foreseen to change for operating rooms outside of labor and delivery; an exception will not be made at this time.”

The second letter also explains that c-sections have special operating rooms, and even support persons are limited from those procedures. According to hospital policy, support persons are not allowed in operating rooms where general anesthesia is provided.

Sanderson has recently filed a complaint to the California Department of Managed Health Care. Along with it, she submitted a letter of support from Thomas Ventimiglia, professor of counseling at Palomar College, who previously counseled Sanderson regarding her rape and sexual trauma history.

“Since [Cassie] has severe anxiety from her past and her husband is such a great support for her, I am respectfully recommending to Kaiser that [Cassie] be able to have her husband in the operating room so she can manage her anxiety and pain,” Ventimiglia wrote to Kaiser Permanente. “Women who have been raped can be triggered quite easily even under normal circumstances and I would hope your staff could grant this accommodation to be made despite the policies.”

Sanderson is running out of options now that she has been denied twice. Her current plan is to wait until the IUD completely punctures her uterus so she can have it laparoscopically removed through an abdominal incision. She has also considered going out of state as far as Oregon to have it removed if elsewhere would accommodate her, but the long journey would be hard.

“It doesn’t cost Kaiser Permanente a penny to allow my husband to support me, and it doesn’t change a single aspect of the procedure,” Sanderson said.

Sanderson added that her experience with Kaiser through all of this has “completely retraumatized” her and destroyed her progress with managing her post-traumatic stress disorder (PTSD) symptoms.