ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, November 17, 1996 TAG: 9611180071
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: LESLIE TAYLOR STAFF WRITER
ROGER and Diane Dulin tried for five years to have children.
They tried the natural way and they tried fertility treatments - without success.
Thousands of dollars and much heartache later, they decided to adopt.
"It didn't matter to us if we procreated," Diane Dulin said. "We wanted to be parents more than anything else."
In 1994, after moving to Roanoke from the Chicago area, the Dulins made an appointment with ABC Adoption Services Inc. in Roanoke County. Over a two-month period, they went through a series of interviews, a home study, a background check, wrote detailed eight-page biographies.
Last April, the Dulins were set to adopt the baby of one agency client, a pregnant 14-year-old. But she changed her mind after having the baby - a girl - and decided to keep her. The disappointment was devastating, Roger Dulin said.
Last month, the agency told the Dulins that another client wanted to meet them and discuss the possibility of their adopting her baby.
They met the woman Oct. 4 at Carilion Roanoke Community Hospital, where she'd been admitted with early contractions. Her name was Angela, and she was in her mid-20s. A sonogram showed she was carrying not one baby, but two.
As is common in the adoption process, Angela and the Dulins did not tell each other their last names. But they talked about themselves, their hobbies and interests. They exchanged family photos. Angela told the Dulins that the babies' father was tall, blue-eyed and dark-haired - and that he had skipped town the day after he found out she was pregnant, Roger said.
The Dulins and Angela selected names for the babies - Bryan Allen and Cameron William. Allen was Roger's middle name. William was the first name of Diane's father and of Angela's father.
"We thought the visit went very well," Diane Dulin said. "We connected. We had so much in common. She often referred to the babies as 'your babies.'''
But the twins will not become the Dulins' babies. They will not sleep in the nursery that Diane spent hours painting and wallpapering, or lie beneath the quilt that she decorated with cross-stitched Mother Goose characters.
Instead, they're being adopted by Dr. Carey Winkler - Angela's physician.
Legally, there was nothing to prevent Angela from deciding that Winkler and his wife should raise her babies. Legally, she was free to do so - without telling the adoption agency or the Dulins of her change in plans.
"We are concerned with how Angela came to change her mind," Roger Dulin said.
The Dulins are angry. They are considering filing a complaint, but with whom they are not yet sure.
"The rug was just pulled right out from underneath us," Diane Dulin said. "And we didn't even see it coming."
Winkler, a staff physician with Carilion Health System, was contacted by phone two weeks ago. He declined to speak on the record about the adoption and referred a reporter to his attorney, John Patterson. Patterson declined to discuss the matter, saying it was not "something appropriate to be written about in the newspaper."
The Dulins have raised an issue that has confounded the Medical Society of Virginia, the state Department of Health Professions and the American Medical Association - whose code of ethics is specific about many issues but does not address a physician's adopting the children of his or her patients.
But the issue concerned Carilion enough that it has begun developing a policy that, according to a statement to The Roanoke Times, "clarifies the participation of hospital employees in the adoption process."
That action followed an investigation by Carilion - after the Dulins complained to administrators - into Winkler's actions. In a letter to the Dulins after the investigation, a Carilion administrator wrote that the Dulins had raised a "very legitimate issue."
The administrator's letter emphasized, however, that Winkler had not inappropriately influenced Angela's ultimate decision.
In its statement to the newspaper, Carilion also said it found "no violations of ethical or legal standards regarding the handling of the adoption process."
"The ultimate decision of who adopts one's child," the Carilion statement said, "rests with the birth mother." And it's a decision that isn't legally binding until after the baby is born.
The Dulins said they would probably never know what made Angela, during those 20 days after meeting them, change her mind and decide to give the twins to Winkler, whose 11-year-old daughter died in October of last year. They said they would probably never know why Angela didn't let the adoption agency know she had made other plans.
Angela's attorney, Sharon Chickering, said it would not be appropriate for her client to discuss the matter with the newspaper.
"Any time you have prospective adoptive parents and disappointment, it's understandable they would feel emotional," Chickering said. "It's a risk they take. It's happened more times than one could count."
`Variety of reasons'
Angela showed up at the ABC Adoption agency in Roanoke County during her eighth month of pregnancy.
"She was no different from any other young woman faced with an unplanned pregnancy," said Anne Carpenter, the agency's executive director. "She came to the agency to explore her alternatives. Women do so for a variety of reasons.
"Oftentimes, they recognize they are not ready to be single parents and don't have the resources to provide for a child in a way they would like to."
Angela was given "letters of introduction" - brief letters that prospective adoptive parents write about themselves - on four couples. Of the four, she liked the Dulins, Carpenter said.
The agency arranged for Angela to meet the couple Oct. 4. The meeting took place in the hospital, where Angela had been admitted after experiencing early contractions. She had been placed under the care of Winkler - a perinatologist, an obstetrician who specializes in caring for mother and baby in the late stages of pregnancy and early days after birth.
Angela discovered during that hospital stay that she was having twins, the Dulins said.
The Dulins said they were nervous and apprehensive at the meeting, having already had one adoption fall through this year. But they said Angela was very talkative, very open. She put them at ease, Diane Dulin said.
"She said she wanted the parents not to have any other children, to be young and to have been married for a while," Roger Dulin said. The Dulins, who have been married 11 years, qualified on all counts. Roger, 33, is a manufacturing engineer. Diane, 32, is a social worker with an agency that works with physically and mentally handicapped people.
"We got to talking about family," Diane Dulin said. "We talked about different things we like to do. She talked about school and her job.
"We talked about the kind of relationship we wanted with her after the babies were born, how it was important for them to know who their birth parents were and how much she loved them."
The Dulins told Angela how they had been set to adopt a baby in April and how the mother changed her mind and decided to keep the baby.
"I begged her, 'Don't hurt us,''' Diane Dulin said.
The meeting lasted two hours. The Dulins said they left in a state of elation at the prospect of raising twins. The next day, Diane Dulin picked up a few items of baby clothing - in doubles - at a big yard sale held by members of the Roanoke Valley Parents of Multiples Club, a support and education group for parents of twins and triplets.
Angela, having been treated with medication to stop her contractions, was discharged from the hospital Oct. 6, the Dulins said. On Oct. 7, they called the adoption agency and asked about Angela's impressions of them.
"We were told that she loved us, that she thought we were great," Diane Dulin said. "We were told that she was real comfortable with her decision."
Diane Dulin said that every time she called the agency in the following weeks to ask how Angela was doing and whether she was still comfortable with her decision, "I was always told, 'Yes.'''
"There was never any hint that she didn't want us to be the parents of these babies," Diane Dulin said.
The Dulins gave notice at their jobs that they would need to take leave. They picked out car safety seats. They called a pediatrician and put him on standby.
On Oct. 23, Diane Dulin received a call from Carpenter. She asked if Diane could meet her for lunch.
Carpenter told her that Angela had delivered twin boys that morning.
"I said 'She's decided to keep them, hasn't she?''' Diane Dulin said. "And [Carpenter] says, 'No. She has placed them with somebody else.'''
Several days later, the Dulins found out that the somebody else was Angela's physician.
"Through the 22nd, we were still thinking that they were coming home, because we hadn't been told differently," Diane Dulin said. "She never told the agency that she'd made other plans."
The Dulins said they do not believe ABC Adoption misled them.
Agency records show that staff had frequent contact with Angela between Oct. 6, the day she was first discharged from the hospital, and Oct. 23, the day the twins were born, Carpenter said.
Angela "was still receiving services from the agency up until we got a call from the hospital that she'd delivered," Carpenter said. "We were absolutely flabbergasted when we learned she had placed the babies" with the Winklers.
Carilion administrators, after meeting with the Dulins at the couple's request, conducted an investigation.
Dr. Kellogg Hunt, executive vice president and medical director for Carilion, wrote in a letter to the Dulins on Nov. 5 that a member of the nursing staff confirmed the Dulins' perception that Angela had selected them as the couple to adopt her babies.
"However, Dr. Winkler was not aware of this initial decision by Angela," Hunt wrote.
Winkler called Angela at home after her release from the hospital Oct. 6 after being treated for early contractions, according to Hunt. "Dr. Winkler asked her if she had made a decision about anyone adopting her children and if she had made any verbal or written commitments," Hunt wrote.
"Angela replied to him that she had met you and thought you were a very nice couple but she had not decided to place the babies with you or any other couple at that time," Hunt wrote to the Dulins. Winkler asked Angela to consider him and his wife "as the adoptive parents and Angela replied that she would be 'ecstatic' if the [physician and his wife] would adopt her babies."
Winkler subsequently hired a lawyer to make sure the legal details were properly handled, Hunt wrote. Angela started weekly prenatal visits with the physician's partner.
"Obviously by October 6, Angela had waivered [sic] from her initial decision regarding you and sometime during that following week she consolidated her feelings which culminated in her decision to allow the Winklers to adopt her children," Hunt wrote.
"We are truly sorry that this had to affect you in the way that it did and we are setting in motion a group of professionals to form a policy so that henceforth no couple working with a patient in our hospitals will be similarly hurt."
In an interview last week, Hunt said he didn't know how the policy would be structured or what it would prohibit, discourage or permit.
That Carilion was taking steps to develop a policy was some consolation to the Dulins. But it did little to ease their pain.
Initially, they asked Carilion to take action to stop Winkler from adopting the babies, but now they do not intend to fight for them.
"We now know we don't have any legal rights to the boys," Roger Dulin said.
The questions
When medical ethics experts and medical professional organizations were asked about this case, they wanted to know:
Did Winkler deliver Angela's babies?
No, his partner did.
Was Winkler with Angela immediately before or after the delivery?
The Dulins said Carilion administrators told them Winkler was in a waiting area near the delivery room.
Did Winkler know that Angela had been working with an adoption agency?
He did.
The latter troubled Dr. Edwin Harvie of Danville, chairman of the Medical Society of Virginia's biomedical ethics committee.
"I can't cite you specific ethical criteria that has been breached here, unless the doctor really did know all of these circumstances and just went ahead," Harvie said. "I would sort of be troubled if that were the case."
In his letter to the Dulins, however, Carilion's Hunt assured the couple that the doctor had done nothing inappropriate.
The Winklers, Angela and Angela's mother, Hunt wrote, were "adamant in their denial that Angela was inappropriately influenced by Dr. Winkler and they are all adamant in their view that Dr. Winkler knew nothing of Angela's initial decision on October 4 to consider placement of her babies with you."
The problem is in the adoption system, said John Fletcher, professor of biomedical ethics at the University of Virginia School of Medicine.
"We have two worlds - the official world of adoption agencies, and the private world," he said.
In the private world, there has been a long-standing tradition where physicians, particularly obstetricians, may know couples who would be good parents but are infertile and recommend them to a patient who is interested in finding parents for her baby, Fletcher said.
"That tradition has worked pretty well in the past, and I think that's why the medical organizations haven't done much to reflect on the issue," Fletcher said. "Generally, the baby ends up in good hands. This is legally and ethically acceptable."
When the physician is the adoptive parent, "you want to build in safeguards so they don't abuse their influence and authority," Fletcher said "Obviously, the profession needs to pay attention to how its members interact with society in particular social issues. And adoption is a social issue."
Earlier this year, one hospital in Carilion's chain developed a policy that deals with the issue. Carilion Radford Community Hospital's policy prohibits hospital employees from using their position to adopt a baby born at the hospital.
Using their position could mean simple knowledge of a baby's birth, said the Rev. Jonathan Webster, hospital chaplain and a member of the hospital's ethics committee.
Webster said the hospital developed the policy because "on one hand we were trying to be proactive. On the other hand, we had requests from folks who were part of the hospital family who wondered if they could adopt babies born in the hospital."
When told of the Dulins' complaints, Lynne Austin, a complaint intake analyst with the state Department of Health Professions, would not comment on the specifics.
If a complaint were filed with the state Board of Medicine, "We'd put it through the complaint process," Austin said. The board can take disciplinary action if it finds a doctor has been unprofessional, she said.
ABC Adoption already has notified the state Division of Licensing, a branch of the Virginia Department of Social Services. Anne Carpenter, executive director, said licensed child placement agencies must let the division know of "any kind of irregularity in the process of a child being placed for adoption."
The Dulins said they plan to file a complaint. But they have not decided with which agency or medical entity.
A closed door
The room is color-coordinated - with seafoam green walls that match the Mother Goose wallpaper border that matches the crib comforter that matches the quilted headboard cover.
A dark brown wooden dresser's drawers are stuffed with clothes, some in sets of two - two sleepers, two bibs, two rompers with the words "Play Me or Trade Me."
A framed work of needlepoint hangs on the wall above the dresser. "A baby outgrows a lot of things but never the need to be loved," it reads.
This was to be the twins' nursery.
Diane Dulin prefers to keep the door closed.
"When she's in an emotional state, she takes everything down and puts it away," Roger Dulin said. "The door stays shut."
Diane wrote a letter to Angela the day after she found out Angela had decided to give the babies to another couple. Diane didn't know then that the other couple were Angela's physician and his wife.
The first draft was harsh, Diane said. She trashed it and wrote another one, with a softened tone. She sent it to Angela through the adoption agency.
"We write this letter to you with great pain and sorrow," Diane wrote. "Our hearts are aching more than anyone can describe.
"We were so excited when we found out about you and the boys. We opened our hearts to you and the boys. Together, we all picked out names. We made a commitment to raise Bryan and Cameron the way you wanted them raised; in a loving home with two parents who wanted them so much and who already loved them.
"How our hearts ache for them now. We can only imagine what they look like.
"For twenty days we believed we were going to be parents of two wonderful boys. We had the nursery ready for Bryan and Cameron. Do you remember the pictures of the nursery? Now, the blinds are drawn, items packed away and the door closed.
"We do not know when or if the door will ever be opened again."
LENGTH: Long : 293 lines ILLUSTRATION: PHOTO: NHAT MEYER/Staff. Roger and Diane Dulin got the nurseryby CNBready for the twin boys they thought they'd be adopting last month.
color.