The Flavor of the Month - Written by Drew

The last eighteen months have been tough for international surrogacy facilitators and agents.  In the wake of several high profile cases, India has continued to tighten its restrictions on surrogacy.   Thailand closed its doors in 2014 although the case of Baby Carmen continues to highlight the danger of surrogacy in a place where the legal framework is evolving.  An earthquake in Nepal didn't slow them down, but the Supreme Court in Nepal has put a moratorium on surrogacy.  The news from Mexico has not been encouraging. 

Of all the possible locations on the planet to descend upon for surrogacy, where are the international facilitators and agencies going now?

Cambodia.

 As a wise man once said, I'm not making this up.

Let's see what the US State Department (link) has to say about traveling to Cambodia.


On Crime:
"Cambodia has a high crime rate, including street crime. Military weapons and explosives are readily available to criminals despite authorities’ efforts to collect and destroy such weapons. Armed robberies occur frequently, and foreign residents and visitors, including U.S. citizens, are among the victims. The Embassy has also received reports that hotel rooms of U.S. citizen visitors in Phnom Penh were burglarized while the occupants were asleep."
"Local police rarely investigate reports of crime against tourists, and travelers should not expect to recover stolen items. It has also been reported that some police stations charge foreigners between $20 and $100 to file a police report."

The concept of someone breaking into my hotel room while I'm sleeping is creepy to say the least, the idea of this happening in a room where my newborn infant is sleeping is horrifying.  That's saying nothing about the military-grade weapons that are easily accessible.

On LGBT Rights:
"While there are no legal restrictions on same-sex sexual relations or the organization of LGBT events in Cambodia, public attitudes remain negative towards LBGT individuals, and same sex marriage is generally not permitted. There have been no reports of arrests or violence related to LBGT travelers."

The fact that there have not been reports of arrests or violence related to LGBT travelers may seem encouraging, however the cultural climate of negativity towards the LGBT community is  concerning.  What is more concerning is that despite several cases of LGBT parents experiencing legal issues in non tolerant countries, that facilitators and agencies continue to bring their clients to places where their rights are not recognized and protected. 


Most importantly, this is what the US State Department says on on Health:

"Medical facilities and services in Cambodia do not meet international standards. Both Phnom Penh and Siem Reap have a limited number of internationally-run clinics and hospitals that can provide basic medical care and stabilization. Medical care outside of these two cities is almost non-existent. Local pharmacies provide a limited supply of prescription and over-the-counter medications, but because the quality of locally obtained medications can vary greatly, make sure to bring a supply of your medications that is adequate for the duration of your stay in Cambodia. You should be wary of purchasing local medication. Counterfeit medication is readily available, often indiscernible from authentic medication, and potentially lethal."

Even if we were to ignore everything else, what about the above paragraph indicates that Cambodia is a safe and appropriate place to conduct a surrogacy?   By definition, surrogate pregnancies are considered high risk.  The increased risk of multiple pregnancy and prematurity make access to high quality health care critical for the safety and wellbeing of babies.

Likely, if you point this out to one of the facilitators or agents currently touting Cambodia as the next great option  for international surrogacy they will  tell you that "their" doctors and clinics are state of the art.  Given that they make thousands of dollars from IPs with absolutely zero accountability for outcomes, I suppose it's not surprising that they would minimize the risk.   Disappointing, but not surprising.  I mean really.... who cares what the State Department has to say as long as the facilitators "feel" good about it. 

Families through Surrogacy's website has the following to say about surrogacy in Cambodia:

Note:  The Cambodian surrogate retains parental rights under the law.   While facilitators may feel comfortable minimizing the risk that this poses to intended parents, one only has to look at the current Baby Carmen case to see just how dangerous ignoring the legal rights of the surrogate is.  

As always, we urge all hopeful IPs to consider the risks to everyone involved when it comes to weighing your options, no matter how desperate you may feel.  As has been said here before, where your baby will be born is the first decision you will make that could have serious and/or long-lasting repercussions on your baby's health.  As the first anniversary of my twins' birth and my son's death quickly approaches, I remember how we were reassured repeatedly that our surrogate was receiving the absolute best care possible, and that my twins would have access to the same level of healthcare as they would in a regional medical center in the United States.  My wife and I believed what we had been told repeatedly by our facilitator, and it wasn't until we received conflicting information in the wake of the premature birth that our facilitator admitted that she wasn't a medical professional.

As a matter of fact, none of them are.

None of them are legal experts in any of the numerous countries they have churned through over the last almost two years, either.   There is no possible way any of them could become legal experts on surrogacy in country after country after country.  

None of them are fluent in the local language, and I find it implausible that any of them could have become experts in the local customs and cultural practices in the very limited amount of time that they spend there before declaring a program "open for business." 


Yet they routinely present themselves to desperate intended parents as being experts who are able to determine whether a hospital, clinic, or even an entire country is an appropriate and safe place to bring a newborn into the world.  

Commenting on this blog is not a right.

This is my blog.

I am not obligated to post abusive, inappropriate ugly comments.

I am not obliged to justify what I do and do not post here.

I am not obliged to give anyone a platform to attack and shame intended parents for speaking out about their experiences.

I am not obliged to promote anyone's business.

It is not my responsibility to promote international surrogacy.

If as an industry professional you feel that I am a big meanie head for demanding that people who charge thousands of dollars for their services be accountable?

International Surrogacy Risks/ Danger of International Surrogacy: Eleven months.

Eleven months ago tomorrow our long awaited, much loved twins arrived.

Eleven months ago our hearts filled with joy and then shattered with sorrow.

People who we thought were our friends turned on us when  they realized  we were unwilling to allow them to treat the death of our son as an inconvenience to their business.

People who we mistakenly assumed would blame us for our son's death have surrounded us with love and support.

A lot has changed in the last eleven months.

Our beautiful, vivacious daughter has blossomed as the health issues related to the medical neglect of her surrogate and the consequences of her premature birth have slowly begun to resolve.    She starts every morning with a smile.   Her first word was "Yay!"   She now says, momma, daddy-ji and didi (sister).   She loves music, adores jewelry and waves to everyone we meet.  

Mr. Q has flourished in his role as big brother.   Having a little sister has helped him in ways that we never envisioned.   

I no longer feel as alone as I did in the first few months after losing Johnny.   Some incredibly wise, strong and beautiful women (I'm looking at you, JT and CR) have allowed me to rage when I needed to, cry when I needed to and have never told me to "get over" it.  

Some things remain the same:

We are just as devastated by Johnny's death as we were  the day  he died.   Perhaps even more so as the truth about his life and death has become more clear.  To anyone thinking of commenting   that it's time for us to "get over it",   I truly hope you never have are in the position to know just how wrong you are to say this to parents who have lost a child. 

We are still being threatened, harassed and defamed by people within the international surrogacy community for speaking out about the dangers that this unregulated multi-million dollar industry presents to babies, to surrogates and to intended parents.

The organization which purports itself as advocating for best practices in international surrogacy still promotes agents/agencies, facilitators and clinics with well documented and known problems.  

Despite story after story of devastated intended parents, suffering surrogates and babies put in harm's way, agents and facilitators continue to promote themselves as experts in the legal and medical  systems of countries they have only visited briefly.  

How many babies will have to die?  How many families will be left bankrupted and devastated, their dreams of a family shattered?  How many surrogates will have to  suffer immeasurably?  When will these   "surrogacy cowboys" recognize that while they may not be legally accountable for the suffering they profit from,  the reality is that they are morally and ethically complicit in it continuing.   

Lauren Hill said it best, "Never underestimate those who you scar, cause karma, karma comes back to you hard."

"Everything is fine"

http://www.worldcrunch.com/culture-society/surrogate-mother-industry-carries-on-after-nepal-quake-/surrogacy-fertilization-modernity-poverty-trafficking/c3s18992/#.VXjw00Z8NKh

Surrogacy in Nepal: International Surrogacy Disaster

One of the families currently stranded in Nepal with their newborns

Today our thoughts and prayers are with the surrogates, babies and intended parents who have been impacted by the terrible earthquake in Nepal.   There are reports of several Israeli families with premature babies who are trying to get out of the country.   I can only imagine how scared and worried they are as they try to keep their fragile babies safe.

One of the primary reservations I had when people first began touting Nepal as the next location for international surrogacy was the fragility of  infrastructure in the country.  For years experts have been warning about the danger to the area from earthquake,   especially given that in recent years construction has been largely unregulated.   Even prior to the quake, Nepal's medical infrastructure was fragile, not a single hospital in the country was accredited by the International Joint Commission on patient safety.   Now those facilities are overcrowded and running short on emergency supplies, and morgues are running out of space. BIR hospital is reported to be treating people in the streets.

Hours after the quake, the death toll is already above 1500.   However, surviving the initial quake and its  aftershocks is only the first hurdle that must be overcome.   The country is highly dependent on hydroelectric power plants, it's not yet clear what damage they have sustained.  Interruptions to the power grid are not unusual in Katmandu,  so many people and businesses have generators, however, given the significant damage to roads moving fuel to where it is needed is going to be very difficult.

I doubt that fertility clinics are going to be given first priority for allocation of what is likely going to be a scarce commodity.  This could have grave consequences not only for surrogates in housing, but for the thousands of embryos imported there in recent months.  

Cholera is a regular problem in Nepal, one which could easily become epidemic given the difficulty in maintaining clean water and adequate sanitation after a disaster of this magnitude.

When people advertise they are experts at surrogacy in a third world country the implication they are giving to intended parents is that they are prepared for the worst.   Unfortunately, as has been seen repeatedly, many of the so called "experts" are little more than expensive glorified travel agents with little to know understanding of the challenges that may be faced even under the best of conditions.  I have zero faith have the ability to truly help intended parents under conditions like these.

Families Through Surrogacy: Consumer Advocacy Group or Trade Show?

"Families Through Surrogacy is a consumer-based non-profit organization focused on bringing together surrogates, intended parents and families through surrogacy to network, share their stories and stay informed about best practices in surrogacy arrangements" 

In March 2014, I spoke at the West Coast Families Through Surrogacy Conference held in San Francisco, California.  I was also a member of the conference committee from the fall of 2013 to the summer of 2014.

I was very excited when I first joined the FTS conference committee .  I felt honored to be part of a group that promoted transparency, ethics and best practices in international surrogacy.  It wasn't very long though before  I began questioning how the conference's policy on sponsorship could be reconciled with its mission statement.   

While I understand the financial reality of doing conferences around the world, I am disheartened by the way the financial need for sponsorship appears to be overshadowing FTS's stated mission.   When I was on the committee one of the very difficult conversations we had regarded a set of sponsors who had ties to a medical tourism company currently under FBI investigation.   When I expressed concern about promoting players with a history that was at the  least problematic,  Sam responded with something along the lines of "Well they are being investigated, but they aren't indicted yet."

Surely there is a better measure of best practices than "Not yet indicted." Allowing people with long histories of questionable behavior the opportunity to promote themselves at Families through Surrogacy conferences not only makes vulnerable IPs a captive audience to providers with known issues, it undermines the credibility that the conference has with the wider surrogacy community.  Whether the committee realizes it or not, allowing someone to present at the conference is an endorsement of their services.

Unfortunately, the conference has been used by more than one provider in this manner.   Speaking at the conference legitimizes providers, allowing them to present themselves as recognized "authorities" when that is often not be the reality.  It grants them a veneer of respectability and allows them them not only a captive audience, but they can later refer to their "speaking engagement" as a way to recruit new clients.  

The year  I spoke at the West Coast Families through Surrogacy conference Kim Waters Hendrix of Complete Surrogacy Solutions also spoke.    It was very clear the conference was used as a platform  to promote her business.   This pattern was repeated later that same year in Australia, where many people complained of Kim's "grandstanding."  Kim  used the forum not only to promote her own services, but also to denigrate her competitors.

Last year, Megan Sainsbury was "banned" from the Families through Surrogacy conference in Australia.   This year, Kim Hendrix is banned while Megan is attending under the umbrella of the clinic she promotes in Mexico.  What changed during this time?  To my knowledge,  no one from Families Through Surrogacy has explained why Kim went from being actively promoted to being banned and what Meg did that resolved the issues that caused her to not be allowed at the conference one year and then allowed to return the next.

At the very least, if a concern is brought to a provider, and it's serious enough to warrant not allowing them to attend the conference,  and then they take the time and energy to resolve those issues so that you feel comfortable bringing them back, it seems like it would be in everyone's best interest to give them credit for making those changes.

If the conference wants to grant sponsorships to anyone willing to pay the fee,  in much the same way that vendors at a trade show are selected, that is clearly their prerogative.   However, it's my opinion that if you want to maintain credibility as a non profit IP focused advocacy group, "not yet indicted" and "not popular at this time" is an incredibly low standard for professional participants.

When Families through Surrogacy allows agents to abuse intended parents publicly and says nothing?  They are giving their tacit approval of the behavior.  They are in fact contributing to the climate of fear and intimidation that permeates the international surrogacy community.   When Families through Surrogacy is not transparent about how they choose sponsors, they are not modeling the transparency that intended parents should expect from ALL parties who work in this field.  

I know that I am not the first person, nor am I likely to be the last,  to bring these issues to their attention.

Consumer driven advocacy groups have a responsibility to advocate.   If they do not want to take on that responsibility then truth in advertising demands that they notify attendees that they are a trade group for agents and clinics.   This would all them to continue to provide information to consumers, but would give those intended parents the proper context for that information.

If you aren't part of the solution, you're part of the problem.  

Kim Waters Hendrix & Complete Surrogacy Solutions Review and Complaint: Client Confidentiality

As I’ve written before, client confidentiality is a fundamental part of any professional surrogacy agency, facilitator, etc…     Surrogacy facilitators have access to financial information, medical information and are frequently given significant amounts of personal information by their clients.   

There were many times during my relationship with Kim where she shared information with me, that in retrospect was inappropriate.  I should not know about the couple who had to terminate their much wanted pregnancy at 13 weeks due to fetal abnormality, nor should I know anything about the sperm quality of several of my Facebook friends.  

That’s why when I found out that Kim was sharing my information with other people I wasn’t surprised.  Hurt, yes.  Surprised?  No.  One of the first people to let me know that this was going on was Paul McDavy.  Frankly, if he had been the only one and it had been an isolated issue, I probably would not be writing this post today. 

Posting information (and inaccurate information at that) about our struggle to get records  on my Facebook wall?  Not appropriate.  Sharing even more information with a prospective client?  Not professional.  

I confronted her about this in January:

One would have thought that this would have ended the matter.  However, it's very clear now that this pattern-  which was going on throughout our pregnancy and after our son died has continued.

She admits that she knew John wasn't well, although she and Bakshi repeatedly assured Drew and I that no oxygen deprivation had taken place.   Additionally, she fails to share that while she offered to go to Delhi it was with the understanding that Drew and I were footing the bill. 

Sharing details of our financial situation is not appropriate.   Additionally, we were being told that Adiva was a good hospital, there was no oxygen deprivation and no reason to move him unless we wanted to do so for the sake of doing it.  Given the information we had at time we made the decision to leave John where he was until I got there.  Had we been told that Adiva was not qualified to care for him, we would have moved him, regardless of cost.

Kim had absolutely no right to share the ongoing issues we were having in terms of getting the records or my other concerns. 

John died of HIE and Klebsiella pneumonia.  HIE is not genetic, nor is pneumonia.  HIE is caused by oxygen deprivation at birth.  Secondly, the genetic issue that our six year old has is not carried on the Y chromosome, it's maternally inherited...which is why we used an egg donor.  Lastly,  it is absolutely unfathomable that any person calling themselves a professional would feel this kind of disclosure is appropriate. 

I am also aware that Kim has also emailed clients, sharing her version of our tragedy and requesting that those clients give her positive reviews.   The fact that she has recruited other "professionals" not involved with our case to help her do this is even more disturbing.  While it's certainly her right to ask people for testimonials, the fact that she is continuing to share our personal, private information, despite our repeated requests that she not do so is disgusting.   

It has come to my attention that this blog does "not paint me in a very positive light".  



Allow me to clarify.  Because I trusted the wrong people my youngest son died alone, in a filthy hospital of a bacteria transmitted by human shit.  I wake up every morning and have to confront that fact.  It is the last thing I think about at night.  Regardless of what strangers on the internet think of me, it is NOTHING compared to how I feel about my failure to protect my son.

Secondly, you are welcome to call me culturally intolerant because I have an issue with the quality of health care my child received.  Rest assured I have spoken to several doctors in India.  All of them were horrified by the conditions at the hospital, etc....    This is an example of derailing.  It's used as a way to deflect attention away from the topic at hand. 

Prior to threatening someone with a libel or slander suit, I would suggest that you familiarize yourself with protected speech.  For those who have not yet mastered the art of Goggle-fu  

negative review/ tos

https://www.techdirt.com/articles/20140924/16444828628/roca-labs-sues-customer-posting-negative-review.shtml

Complete Surrogacy Solutions/ Kim Hendrix. Review and Complaint #1

There is one issue I want to talk about today.   The first is that Kim seems to be telling people that Drew and I were not her clients.

It is true that Drew and I did not pay Kim her 8000.00 client fee.  When we first connected with Kim, she told us that she would waive this fee because as a new facilitator, it would be helpful to her to have us as clients.  We had received quite a lot of media exposure as a result of the issues with Planet Hospital and therefore would be in a position to make referrals to her.    I made numerous referrals to Kim throughout our surrogacy.  She introduced me to several people at the Families through Surrogacy conference as her client and frequently asked me to write references for her to prospective clients.

Additionally, I am aware that she was given a 10% referral fee from Dr. Bakshi.

Therefore she was paid both monetarily and in kind.

If Kim was NOT my facilitator, why did Dr. Bakshi only communicate with her when my children were being born?  Why was she given our medical records?   Why was she involved in invoicing payments to the clinic?

Kim, you can't only take credit for the successes.  That's not how this works.  It's not how it works at all.

What made John disposable and Maizy ignorable?

I'm seeing a parade of cute babies who were born as a result of surrogacy in India and Thailand.  Babies whose parents were helped by Kim Waters Hendrix.

They are really darling.   

Looking at them made me sad though.   What made those parents and those babies more valuable than mine?   Does their existence somehow negate my children and their suffering?   Understand, I am very very glad that those families did not experience what we did.  But there experience does not negate ours.  

John deserved better than this.  He was loved and cherished by his family.  

Mae deserved to have appropriate medical care.  She deserved a relationship with her brother.

Surrogate medical care matters..

Drew and I choose to have a "facilitator" involved not once, but twice because we knew we didn't have the ability to effectively vet and monitor a clinic on the other side of the planet.  Our facilitator told us that she traveled to India frequently to check on surrogates and make that they were being well taken care of.   During the entire year we were involved with her, she made trips to Thailand and Mexico.  She did not travel to India during our surrogate's pregnancy. When she finally went there after one of her trips to Thailand, we were appalled to find out that it was the first time she had been since the birth of her nephews-  who were almost two years old.  

Prenatal care is absolutely critical to the health and safety of babies.  We were assured repeatedly that our surrogate would have the absolute best care.   Unfortunately, it doesn't appear that was the case. 

A cursory look at our surrogate's medical records indicates that she was tested for iron deficiency on four different occasions.  On three of those occasions, she tested as anemic.  Despite those test results and despite the fact that she was complaining of dizziness and fatigue, there is no evidence in the chart that this was ever treated.  Anemia  in pregnancy increases the risk of post-partum hemorrhage  which can be fatal.  It's also dangerous to the developing fetus and increases the risk of developmental delay.  

Despite supplementation,  which started when I arrived in India,  Maizy was  anemic at her first pediatrician appointment in the US.  Our pediatrician says this is an indication of just how anemic she was at birth.   Her pediatrician believes that her anemia may have contributed to her seizure.  Only time will tell if she will experience  developmental delay as a result.  This was entirely preventable.

In the beginning of the pregnancy, our surrogate had low to normal blood pressure.  However, from twenty weeks on it appears that her blood pressure rose steadily at each appointment.  By the time she delivered the twins, the hospital records indicate that she had pre-eclampsia.  The chart indicates that Mrs. S was complaining of dizziness, headache and visual disturbance.  Despite these clear indications, the clinic did not do a 24 hour urine collection, which would have confirmed the diagnosis.   While she was observed in the hospital overnight at one point there is no indication that they did anything other than give her some fluids.    Pre-clampsia is a very serious medical condition -  left untreated it can result in seizures, stroke and even death.  It seems that they did nothing other than record the fact that this was happening.  The fact that our surrogate survived appears to be a result of luck more than anything else.  When we confronted our facilitator and the doctor about this, they  denied that it was a problem.

We were not the only clients who were concerned that our facilitator had not made the promised trips to India for surrogate monitoring.  When these concerns were brought up to her, she became very defensive and angry and talked about how she needed to make her family a priority.   

If Mrs. S was the only surrogate whose health and safety was put into jeopardy,  I could understand why someone  might think that our situation was an aberration.  Unfortunately, I know that this is not the case.  I can't speculate as to why a facilitator  would continue to refer clients to a clinic where two clients in three months experienced serious complications for their surrogates and their babies.  I don't want to believe that the referral fees are what motivated her,  perhaps she genuinely believes that this care was appropriate.  

We wanted an independent facilitator because we wanted someone to advocate not only for our family, but also for our surrogate.  Our facilitator and our doctor likely feel very differently about our journey than we do.  Regardless of how anyone feels the facts are this:  

•My surrogate had more than one health condition that was not managed appropriately

•My daughter has ongoing health issues directly related to those issues, her prematurity and the facility where she was born.

•My son died.

As an aside,  another surrogacy facilitator, not the one we used,  threatened to take legal action against me because she didn't like what I've said on this blog.  For the record, nothing I have said here constitutes libel or slander.  

She also told me "Your blog does NOT paint you in a positive light."

My child died.  The last thing on my mind is what other people think of me.  Lastly-  bullying a grieving mother says a hell of a lot more about you than it does her.  

Professional Standards for International Surrogacy Professionals: Part 2 Qualifications and Conflict of Interest

My husband and I chose to use a surrogacy facilitator not once, but twice.  One of the primary reasons we made that choice was the recognition of our limitations in terms of evaluating a medical facility on the other side of the planet.  In retrospect, we should have recognized that those same limitations applied to the facilitator.

Most international surrogacy agents do not have degrees in the health care field; it’s probably not reasonable to expect them to.  However,  absent accreditation by a credible third party like the International Joint Commission, it seems unlikely that the average layperson  has the ability to evaluate doctors or facilities in a foreign country.   Given our experience,  a hospital that does not adhere to the standards set by the joint commission is not a hospital I would feel comfortable using for high risk pregnancies or infants.  To find out if a hospital meets these standards,  click here.

The fact that a medical facility has a nice website or that it “looks” clean doesn’t mean that it adheres to international standards for patient safety.  

At the same time, if a facility cannot maintain the most basic standards for cleanliness, it seems extremely unlikely they would have the capacity to prevent the spread of infection.  In a country like India, where antibiotic resistant bacteria kill fifty-eight thousand babies  every year it should be obvious why this is critically important. 

The second and equally concerning issue is the conflict of interest in the relationship between facilitators and clinics.  Facilitators frequently receive referral fees from the doctor/clinic.  This is problematic for reasons that I think are pretty clear. At the very least, transparency would seem to require that this relationship be disclosed.

There are hospitals in New Delhi that meet the standards set by the Joint Commission. Again, you can find them here.  I would not feel safe using a doctor who delivered at a hospital that did not meet these standards.    If my agency or facilitator was recommending that I go forward with surrogacy in a country where there were no facilities accredited by the International Joint Commission, knowing what I know now,  I would not be comfortable taking that risk with my baby.

Losing a child is one of the single most devastating things that has ever happened to my family.   Sharing our experience has opened me up to vitriol from strangers and from people I used to call friends. I’ve been threatened with legal retaliation and told that this blog “does not paint me in a positive light.”  What those people don’t seem to understand is this:  My beloved son died.  The last thing I’m worried about is other people’s opinions.  Frankly, I don't deserve to be painted in a positive light because I failed  my son by being arrogant enough to think that I had the ability to protect him from half a world away.  Telling my story isn’t easy.  It shouldn't be, but it’s the only way I can think of to say this:

“Johnny, Mommy is so very, very sorry.”