Few medical stories are as horrific as that of Janet Warren, a vibrant, driven career woman who was sent on a 20-year spiral to her death by a doctor's hubris and incompetence. Before it ended Janet had gone through 25 major surgeries, her spine had shattered as she slept, and her life had become constant torture.
California's MICRA law helped shove her down the fatal slope and, after she was gone, poked a finger in the eye of her husband and son, who not only had to endure the pain and suffering of losing the woman they loved, but still are paying the bills for the ineptitude and gross and reckless actions of some doctors.
Janet's husband, John Warren, met her in 1969; they married in 1976. An active businesswoman who worked hard and traveled often, she began developing ulcers in the mid-1970s and went on medication.
The ulcers persisted. Janet went through four endoscopies. In 1981, her doctor told her she had intractable, non-healing ulcers. Medication would not solve her problem, he told her. He advised experimental surgery, telling her it would amount to little more than an appendectomy.
Janet trusted him, so, at 32, she went ahead. He performed the surgery in front of residents, and photographed it. It was only the fifth time he had done it, and the first time on a woman.
The doctor removed the part of her stomach that had the ulcers, but left her unable to eat normally. "Never again was she able to take a bite of food or drink of water without a reaction," John says.
It also is important to note what the doctor did not do: He did not tell Janet she was at extreme risk for osteoporosis. The operation caused major malabsorption, which led to osteoporosis.
The next 20 years were a futile attempt to get Janet back to where she had been before the experimental surgery. She was shunted from doctor to doctor, went to Florida, Louisiana, all over southern California trying to find specialists who could help. At one stop she had her entire stomach removed.
During this time, the Warrens learned that many doctors, especially those they encountered in southern California, knew - and protected - one another, sometimes because they had shared a joint residency.
Over time, Janet underwent 25 procedures of seven to 10 hours each. She had to leave her job. In 1991, "she woke up screaming at 3 a.m.," John, his voice shaking, recalls. "She was lying on the floor, writhing, in excruciating pain." Janet's bones had lost their density and her spine literally fractured in her sleep. Her son, at home, was six years old.
By now, the Warrens had decided to sue. But "big name attorneys wouldn't touch it because of (MICRA's) statute of limitations": The experimental surgery had taken place a decade earlier. The Warrens used the spine fracture, and the doctor's failure to talk with Janet about osteoporosis, as a cause of action; she could not, however, introduce testimony about the experimental surgery.
A jury awarded $20 million - $12 million after adjusted for inflation. But MICRA struck again: It allows insurers to dole out "periodic payments." The actual payout amounted to roughly $2.3 million, John estimates - not much compensation for 20 years of agony.
Even those payments, however, stopped when Janet, her final years wracked by pain, her weight down to 95 pounds, died in 2001. Under MICRA, when the victim dies, the payments stop. It is a clear gift to insurers. The provision was yet another blow to John, who had lost his business and nearly his home because of medical bills. "If I'm liable for her debts, why not her assets?" he asks.
None of this begins to compensate for the emotional pain Janet and her son and husband suffered for 20 years. "You become numb at a certain point because it doesn't stop," John says. "There is no high or low, because it's constant. Janet said many times 'I wish I could just go to sleep and not wake up.'"
It is a pain made all the more acute because everything that happened could have been prevented. Eighty percent of ulcers are caused by bacteria: antibiotics can fix them.
John Warren stresses that many doctors worked heroically to help his wife. But he remains both angry and disgusted at the rest. "They're not accountable," he says of the many doctors who had a hand in his wife's decline and death. "The shenanigans, the conspiracy to cover up."
He wants the system reworked. "What did anyone learn from this? Nothing." There are still people who, like Janet, "innocently put their lives in the hands of a doctor" who might make a mistake, or lie about it afterwards, and not be held to answer.
The lesson, John says: "We're all going to have to come way up the ladder, consumer-wise, and not count on their medical expertise."