Texas ER Did Not Provide Vitamin K Shot That Could Have Saved Newborn’s Life — ProPublica

The emergency room was a mile from their Texas home. Stephanie and Eric Biesenbach took comfort in that when their newborn daughter, Gwen, wouldn’t stop bleeding from her belly button. They buckled Gwen into her car seat and made the drive over. 

Medical records from that warm August evening in 2023 described her condition as a “generic problem” of a bleeding umbilical cord stump. The doctor on duty, Nicole Malouf, had treated plenty of those as an emergency room specialist. She covered Gwen’s oozing belly button with a special gauze to stanch the flow, and when it appeared to stop, she sent Stephanie, Eric and Gwen on their way. 

They made it as far as the parking lot before they noticed Gwen had bled through her footed pajamas. Eric slid his arm under the car seat handle and lifted his 11-day-old daughter out of the car. They walked back toward the glaring lights of the Lonestar 24HR ER, a freestanding emergency department in New Braunfels next to a car wash, a McDonald’s and a deli.

Stephanie told Malouf that Gwen had been bleeding a bit after the scab that replaced her umbilical cord stump fell off. The amount of blood they saw that night worried them. She ticked through Gwen’s history. No fever. No vomiting. Exclusively breastfed. She mentioned that she and Eric had declined a vitamin K shot when Gwen was born and instead had been giving Gwen oral vitamin K drops, which they trusted would protect her. 

Malouf tried another type of pretreated gauze. When that didn’t work, medical records show, she turned to silver nitrate, a chemical applied to the tip of a long matchlike stick that cauterizes blood vessels. Malouf rotated one stick after another inside Gwen’s belly button. 

Since the 1960s, the vast majority of newborns in the United States have received a vitamin K shot. The injection virtually eliminated vitamin K deficiency bleeding, a rare condition that can cause catastrophic bleeding and even death. 

But a shift in recent years has threatened to upend the unwavering protection that many doctors and hospitals had taken for granted. Families — mistrustful of medical interventions, misled by social media and devoted to a birth experience they deem natural — have begun to shun the vitamin K shot. 

A pair of studies published last week, both of which involved millions of births, found that babies who didn’t get the vitamin K shot had an increased risk of bleeding. One of the studies found that between 2017 and 2025, the rate of vitamin K deficiency bleeding increased a staggering 347%.

Without the single, inexpensive shot — which is not a vaccine — babies are dying. Autopsies reveal how babies’ systems shut down without warning and well-meaning parents who declined the vitamin K shot were left mourning the loss of their children.

Malouf kept trying to stop the bleeding. Over the course of nearly three hours, she used seven methods. At one point, she applied so much pressure to a bandage that, Stephanie said, Gwen threw up. The remedies essentially treated the symptoms and not the cause, like putting a cover on a leaking faucet. 

Malouf said she called her husband, who’s also a doctor, as well as a nurse at a local hospital, to see if she was missing something. They, too, were at a loss. The nurse’s only suggestions were the ones that Malouf had already tried. 

Malouf decided to transfer Gwen to a small, local hospital, which at least had pediatric specialists and a neonatal intensive care unit. But while she waited for a call back to confirm the hospital would accept Gwen, Stephanie walked out of the room to tell her that Gwen had bled through the latest dressing. Malouf, according to the records, quickly checked to see how long it was taking her blood vessels to refill. It was slower than when she arrived. 

Gwen’s condition was growing more dire, and Malouf had reached the limits of what she could do. What followed also wouldn’t be enough.

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Stephanie had given birth to Gwen without complications in an inflatable tub in their living room. She was perfect, with doelike eyes and a full head of brown hair that, when the light hit it, hinted at the red of her father’s beard. 

Her older brothers and sisters fussed over her like a birthday present. Her aunts from California and Louisiana came in to meet her. When the house quieted, Gwen fell asleep to the calming rhythm of Stephanie’s chest rising and falling. 

Stephanie marveled at the way Gwen seemed to study the faces of everyone who carried her. She wasn’t two weeks yet, but the corners of her mouth constantly turned up to form what her parents insisted were smiles. Even when her siblings passed her around, she rarely cried in protest. 

Stephanie and Eric met in 2010, when they both worked at Chili’s. Texas natives, they had just returned home after spending time in Florida, where Stephanie spent a semester interning at Walt Disney World Resort. 

“I was doing lawn care work and maintenance on restaurants,” Eric said before Stephanie interjected. “He moved there for a girl,” she said as the two erupted in laughter.

He proposed to Stephanie on Christmas Eve. They married at a vineyard on Halloween. The venue capped off the night with fireworks. 

Life moved quickly after that. They had a daughter and two sons, then adopted the daughter of a relative who was too young to care for the child herself. Just when they thought their family was complete, Stephanie got pregnant with Gwen. 

Overjoyed, they decided to name her after Stephanie’s grandmother, Gwendolyn, who passed down her flowered baby blanket with “Gwen” embroidered in the corner. 

There were no signs something could be wrong with Gwen until the day her parents took her to the ER. Stephanie had texted her midwife first. 

“So sorry to bother you,” she typed into her phone, writing that Gwen’s belly button had been bleeding most of the day and they couldn’t get it to stop. 

“How much blood is too much blood,” she asked. 

The midwife told her to send a photo. Stephanie sent two, one of dried blood on Gwen’s stomach and the other of a pile of bloodied tissues. The midwife instructed Stephanie to tape some gauze over Gwen’s belly button. About 90 minutes later, just before going to bed, she checked on Gwen again. She snapped another picture, this one with bright red blood soaking through the gauze and diaper, and texted it to the midwife. “Are you sure this is fine?”

The midwife told her to go to the emergency room. 

In many states, all emergency rooms are in hospitals, where patients can be transferred to other units for more care. Not so in Texas, where more than 200 ERs are freestanding, separate and distinct from a hospital. At the ER, Gwen grew increasingly pale. Her heart raced at 177 beats a minute. Around 1:40 a.m., Stephanie and Eric received their first piece of good news: Malouf was transferring Gwen. She had scrapped her plan to send Gwen to the local hospital and would instead transfer her to North Central Baptist, a larger hospital in nearby San Antonio with more specialists. North Central was only about half an hour away, and it was sending a NICU transport team to get Gwen. 

Eric’s eyes fixated on the large clock hanging in the room. Ten minutes passed, then 20, then 30, then an hour. He couldn’t understand what was taking so long. He stepped into the hallway and asked if he could just drive Gwen to the hospital. 

But, he said, Malouf told him he couldn’t because it would be too dangerous. Malouf, however, said she told him that if he did leave, he would have to sign paperwork acknowledging he was doing so against medical advice. The transport team, she told him, would have blood and IVs. Besides, she said, Gwen was stable. Malouf called to check on the status of the ambulance; she was told they were on their way. 

Stephanie and Eric said that was the last time they spoke to Malouf that night. 

By the time the ambulance arrived, it had been nearly two hours since Malouf had requested it. One of the team’s first questions was whether Gwen had received a vitamin K shot. 

The ER nurse told them they didn’t have the shot on hand.

It was the first time since walking into the ER, Stephanie said, that anyone suggested that vitamin K may be the culprit — and the cure. 

At 3:45 a.m., within minutes of the ambulance team’s arrival, they gave Gwen a vitamin K shot in her left thigh. They spent the next two hours at her bedside, hooking her up to an IV, drawing blood for lab tests and giving her antibiotics — all things that, the records show, hadn’t been done yet. Malouf didn’t respond to questions about why not.

Stephanie and Eric observed the ambulance team as they worked, bantering, discussing another call that had come in and, just as they were about to leave, waiting for one of them to go to the bathroom. Between what they viewed as the team’s laidback pace and Malouf’s reassurances that Gwen was stable, Stephanie and Eric were encouraged enough to split up. Eric went home to the kids, who had been with his mom all night, to get them ready for their first day of school. Stephanie stayed and planned to ride with Gwen in the ambulance.

“Grab me a change of clothes and coffee,” Stephanie called to him as he was leaving. 

The team transferred Gwen to a temperature-controlled enclosed incubator. As they packed up to leave, Gwen began to whimper. With each breath, Stephanie said, she let out a weak, high-pitched sound. It was unnatural. Stephanie reached through the incubator’s opening and ran her hands back and forth across her daughter’s chest.

The team loaded Gwen onto the ambulance and flipped on the sirens and lights. At 5:55 a.m., they headed down Interstate 35. It had been seven hours since Gwen was first admitted to the ER.

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Stephanie appreciated the importance of vitamin K. All of her other children got the vitamin K shot shortly after they were born. But over the years, she and her husband had grown wary of medical intervention. When their youngest son was nearly 2, they fell behind on his vaccines. After getting several vaccines at one appointment, they said, he developed a high fever and suddenly stopped talking for about a year. He was later diagnosed with autism.

“I think that they just gave him too much at once,” Eric said.

Research studies from numerous sources have found that multiple vaccines taken at once do not overwhelm or weaken a child’s immune system. They also do not increase the risk of serious or long-term adverse effects. 

Still, seeing their son struggle to speak, Stephanie and Eric were convinced there was a connection. They stopped vaccinating their children after that. 

Before Gwen’s birth, Stephanie’s midwife gave her a five-page handout on newborn vitamin K. It covered why babies need vitamin K to help their blood clot and cautioned that babies who don’t have enough of it can start to bleed without warning.

The handout compared the pros and cons of the vitamin K shot with oral vitamin K drops, noting that the drawbacks of the drops are that some babies may not be able to absorb them or may spit them up. They also don’t eliminate the risk of bleeding entirely. Stephanie initially signed the document agreeing to the shot, but as her due date neared, she and Eric changed their minds. If both are effective, they reasoned, why not go for the option that didn’t involve sticking their baby with a needle? 

“We did our own research. I don’t remember feeling like there were red flags,” Stephanie said. “I felt like the information we had was sufficient.”

She doesn’t recall exactly what sources she consulted, but she read articles online and spoke to some people who worked in the medical field. No one, she said, warned her against the drops. But she didn’t ask her mother, Lauren Hoel, a longtime family nurse practitioner. Stephanie knew exactly what her mom would say. 

Many medical experts consider the drops inferior for several reasons, including those mentioned in the handout. There are also concerns about harried parents of a newborn forgetting a dose and the fact that cases of vitamin K deficiency bleeding have been reported even when drops are used. 

Only limited data exists about vitamin K drops, and much of it is from Europe, where the drops are more common. In the U.S., the Food and Drug Administration does not provide oversight of the drops. Instead, parents can simply add them to their Amazon carts without any verification of what’s in them, or whether they’re safe or effective.

A single vitamin K shot acts quickly, and then the liver stores the rest of the vitamin K to slowly release into the baby’s system over months. 

For decades, the recommendation from doctors, hospitals and medical organizations has been the shot. The Centers for Disease Control and Prevention, the American Academy of Pediatrics and the World Health Organization call for giving the shot to all newborns. 

“While some countries outside of the U.S. sometimes administer vitamin K orally, it has not been approved by the Food and Drug Administration,” the American Academy of Pediatrics wrote in May, reiterating its longstanding position, “and it is less effective than an intramuscular injection.”

Stephanie and Eric’s choice to opt for the drops reflects a broader trend. Vaccine skepticism grew after the COVID-19 pandemic, and under the direction of Health and Human Services Secretary Robert F. Kennedy Jr., a fierce vaccine critic and champion of the Make America Healthy Again movement, the federal government has fed those doubts. Stephanie and Eric, who voted for President Donald Trump and are ardent supporters of both Kennedy and MAHA, welcomed the change. 

In December, the CDC stopped recommending that all newborns get the hepatitis B vaccine. In January, the agency revised its childhood vaccination schedule, reducing the number of routinely recommended shots by six. A federal judge temporarily blocked that move in March, but the CDC’s decisions appear to have caused a ripple effect beyond vaccines. 

After the January change to the vaccine schedule, an analysis of more than a million newborns found a rise in the rate of babies not receiving the vitamin K shot so sharp that it resembled a hockey stick. Between January and June of this year, the analysis found, the rate jumped from 5.2% to 8.1%. Despite being asked multiple times at a congressional hearing to assure parents that the vitamin K shot is safe, Kennedy responded by declaring that he has not said anything publicly about the shot. An HHS spokesperson did not answer ProPublica’s questions but said that the CDC recommends that parents give newborns the vitamin K shot within six hours of their birth to prevent vitamin K deficiency bleeding.

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In the ambulance, Gwen’s blood pressure dropped.

“Infant looks much more lethargic,” the team wrote in their notes. 

They placed a mask on Gwen to increase her oxygen and gave her an infusion of saline in hopes of improving her blood volume. 

Gwen’s condition continued to deteriorate. Almost immediately after they arrived at the hospital, her heart stopped. Doctors inserted a breathing tube then began pressing down on her chest with two fingers to manually pump blood through her body. They pushed epinephrine into her IV to stimulate her heart. That appeared to work. 

Stephanie couldn’t comprehend what was happening. All night, she said, no one had acted like Gwen’s life was in danger. Suddenly, her daughter was covered in tubes and doctors were performing CPR. 

Stephanie said she heard someone yelling into a phone, “Where is the blood?”

She texted her family. “I need you to pray for Gwen like her life depends on it,” she wrote.

She called Eric. “You need to get here now,” she told him. 

Eric pressed on the gas pedal of Stephanie’s Honda and sped to the hospital. There, he pushed through a clutch of doctors to find Stephanie crying in the corner of the room. The same wave of shock that had washed over his wife minutes earlier crashed over him. For the first time, he worried he might lose his daughter. 

They prayed together, and the chaplain stopped by the room to check on them. He noted, according to records, that they were anxious but hopeful.

Less than two hours after she was admitted, Gwen crashed again. The medical team called a code blue. Doctors performed CPR for the next 34 minutes. They gave her epinephrine four more times. She had lost so much blood. Her heart was barely pumping. Doctors told Stephanie and Eric that they could keep trying to resuscitate Gwen or they could take her off the machines for her parents to hold her.  

Stephanie sobbed. Eric collapsed at her knees. She told him she couldn’t make the call. Eric said they wanted to spend the final moments with their daughter. The doctors unhooked Gwen from the beeping machines and handed her to him. Stephanie and Eric told Gwen how much they loved her and how much they were going to miss her. 

Shortly after 9 a.m., nearly 11 hours after they’d first brought her to the ER, Gwen took her last breath. The team ushered them to another room where families can mourn in private. They spent hours there. They gave Gwen a bath. Family stopped by. Stephanie’s sister picked up their kids from school so they could say goodbye to their baby sister. Two nurses came in to create molds of Gwen’s hands and feet. 

When Eric and Stephanie finally left the hospital, Gwen’s car seat was empty. Their two youngest children slept in their bed that night. At one point, Stephanie jolted awake. She turned to Eric. The look in his eyes told her that it hadn’t been a dream. Without making a sound that could wake their kids, they cried themselves back to sleep. 

Eric’s grief soon morphed into anger. His brother-in-law drove him to the Lonestar ER to ask for Gwen’s medical records. He didn’t trust himself to go in, so he asked his brother-in-law to retrieve them. 

The file was just 15 pages with the payment and registration forms. They searched for any clue that could explain what happened to their daughter. 

“I was constantly assured that it wasn’t that bad,” Eric said. “I can’t tell you how many times they said, ‘Don’t worry, babies are very resilient.’”

They planned Gwen’s funeral. When they couldn’t find a coffin small enough to fit her tiny 8-pound body, Eric’s brother, who makes custom cabinets, built one. They wrapped Gwen in the flowered baby blanket from Stephanie’s grandmother for the viewing.  

Stephanie and Eric operated on parallel tracks those next several months: mourning their daughter and trying to understand what led to her death. The family attended a grief camp put on by a local hospice group. They painted a garden pole with things that reminded them of Gwen. When Thanksgiving approached, they escaped to Stephanie’s sister’s house in Colorado to avoid questions about how they were doing. 

Eric got Gwen’s handprints tattooed on his chest, the last place he felt them before she died. Stephanie picked Gwen’s footprints, but the tattoo artist had to size them down to fit. 

“She had such big feet,” Eric said. “She was gonna be a tall girl.”

“Or clown,” Stephanie said, half laughing, half crying. “One of the two.”

They also reached out to Byron Miller, a medical malpractice attorney, who sought records from Malouf, the ER, the ambulance company and the hospital. Miller investigated whether negligence in Gwen’s care resulted in her death. But the medical expert hired to review the case homed in on Stephanie and Eric’s decision to give Gwen the vitamin K drops instead of the shot. Without an expert’s supporting opinion, which Miller said was a state requirement, his office was unable to continue pursuing a case. Miller recommended that Stephanie and Eric follow up with the Texas Medical Board.

The ER, the ambulance company and the hospital did not respond to multiple requests for comment. The nurse on duty at Lonestar that night also did not respond to requests for comment.

Stephanie had several conversations with her mother, who remembers learning in the 1980s, while in nursing school, that all babies need a vitamin K shot at birth. Hoel didn’t know that Stephanie and Eric didn’t get the vitamin K shot for Gwen. 

“It never occurred to me that people would refuse the vitamin K shot,” she said.

Even with that, Hoel couldn’t look past Malouf’s actions that night. 

“She should have said, ‘That’s a newborn. Take it to a NICU,’” Hoel said. “And by not doing that, the fate was sealed.”

That next December, Stephanie sat down at the kitchen table and pulled out her laptop. Someone, she said, had to hold Malouf accountable. She found the website for the Texas Medical Board and followed the instructions to file a complaint. 

“When Dr Malouf decided to provide medical care to our daughter, despite her lack of training in neonatal emergency care, and lack of appropriate monitoring equipment,” Stephanie wrote to the board, “Gwen was deprived of any potential life saving intervention.”

The seven hours they spent at the ER that night, she continued, could have been used to save Gwen’s life. And she stressed that the ER nurse said the facility didn’t carry the vitamin K injection.

“If Vitamin K was a vital part of the evening,” she wrote, “then we should have been pointed to another location that was fully equipped sooner.”

Malouf became the target of her anger and her anguish. She described how painful it was to drive by the Lonestar billboard with Malouf’s giant photo near her house every day. She wrote that Malouf failed to recognize that her daughter’s life was in danger. “I just don’t understand how it can go from a calm relaxed environment to all of a sudden your child is dead,” she wrote to the board. She recounted feeling intimidated when Eric asked if they could leave when Gwen’s color began to change and Malouf advised against it.

“To this date,” she wrote, “Dr Nicole Malouf does not even know that my daughter died under her care.”

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After Gwen died, Malouf said, a doctor from the hospital called. The news, she said, came as a surprise.  

Sitting in her home office, her framed degrees hanging on the wall behind her, Malouf spoke to ProPublica for nearly three hours about what happened. Malouf and her husband have three daughters, for whom she is team mom for cheerleading and president of the Fine Arts Boosters. Racks of uniforms filled her home’s entryway in preparation for an upcoming sale. 

She said she repeatedly relived the details of that night with her therapist. The first few sessions, she said, were just the two of them crying. She said they discussed what was in her control and what wasn’t. Every life is precious, she said, but it’s one thing to lose a 95-year-old grandmother with a long list of medical problems. It’s another to lose a baby. 

“I still have my three daughters,” Malouf said, pushing back her long, dark hair, “and now she has lost hers.”

Malouf said the doctor who called said the hospital would conduct its own review. Malouf said the doctor mentioned that they had already identified some issues, including questions about the transport team. 

The hospital wasn’t the only one probing the night’s events. The state Medical Board also launched an investigation. The board subpoenaed records and reviewed the medical documents. 

In September 2025, the board held a virtual hearing, which was closed to the public. Stephanie and Eric appeared, as did Malouf and her attorney. The board staff attorney charged that Malouf did not meet the standard of care in her treatment of Gwen and that she failed to halt or limit Gwen’s bleeding. Her lack of timely care, the board’s attorney alleged, ultimately resulted in Gwen’s death. Citing confidentiality, the board would not release a recording or transcript of the hearing.

The next month, the board issued its decision. It found that Malouf failed to recognize that Gwen had a life-threatening vitamin K-dependent bleeding disorder. The ER did not have vitamin K shots on site, and Malouf failed to immediately transfer Gwen to a regional pediatric referral hospital better equipped to handle Gwen’s condition. Finally, the board found that Malouf had failed to quantify the amount of blood lost by Gwen.

The board required her to take 24 hours of continuing medical education; she said she completed her hours in courses on pediatric advanced life support, communicating with patients and vitamin K deficiency bleeding. She also had to inform her employers that she had been disciplined. Malouf neither admitted nor denied the allegations but agreed to abide by the board’s final order. 

A board spokesperson would not answer specific questions about Gwen’s case but said the board expects all licensees “to provide appropriate treatment and, if the necessary supplies are not available, to make arrangements for transport to a higher level of care.”

“I felt that I had done everything that I could with the resources I had,” Malouf told ProPublica.

She said she did know that Gwen had vitamin K deficiency bleeding, even though she did not immediately give Gwen a vitamin K shot. Malouf said she thinks the board didn’t believe that she knew because she didn’t act “in a panicked manner.” It remains unclear, even to her, whether the ER carried the vitamin K shot at the time or if it was just in a spot where the nurse couldn’t find it. But she said she asked the nurse for it. 

Either way, she believed that giving Gwen vitamin K at that point would just be to make her chart look good. 

“It’s really not even going to take effect at that stage,” Malouf said. “As soon as you give vitamin K, the earliest it’s even going to start working is 10 to 12 hours.”

But several doctors told ProPublica that vitamin K should be given immediately if there’s even a suspicion that a baby has vitamin K deficiency bleeding. It’s so vital to stopping the bleeding that they don’t even need to wait for a confirmation. There is no downside, they said, to giving it. Vitamin K, they said, may need to be followed up by blood or blood products, such as fresh frozen plasma, which is rich in the proteins that help the blood clot.

While vitamin K can quickly help to halt the bleeding, it can’t reverse the bleeding that’s already occurred. It also has to be given in time, and some babies need more than one dose of vitamin K to recover. Gwen, as one doctor who reviewed her medical records put it, needed vitamin K, blood and blood products much sooner than she got them. 

Malouf said she had learned about vitamin K deficiency bleeding in medical school and during her residency, but she doesn’t recall ever seeing it in practice. Nearly every medical student learns about the coagulation cascade, but not all doctors know or remember how to diagnose and treat an infant who shows up in an ER bleeding, often in the brain and invisible to the eye. Some completed their training at a time when vitamin K deficiency bleeding was still considered a historic condition, much like measles. 

The ER staff, Malouf said, has been subsequently trained on the importance of vitamin K, and the ER keeps it in stock. All ERs, she said, should carry vitamin K.

“I still gravely regret that the outcome was still the same,” she said, “even after again assuming that, ‘Hey, I’m putting this baby in y’all’s hands. You guys are the experts. Fix her.’”

Malouf doesn’t understand how the board found that her care that night fell short. She didn’t intentionally harm her patient. 

“I can state my whole case and literally one of the board members goes, ‘Well, I just don’t believe you,’” Malouf recalled. “I said, ‘Well, then I don’t know what more to tell you.’” 

In addition to working at the ER, she had a part-time job doing telehealth. The telehealth company that employed her, she said, fired her once she disclosed the board’s action. As of August, she was still working some shifts at Lonestar ER; the board’s decision didn’t affect her ability to practice. Following the interview with ProPublica, she declined further comment. 

“I feel like the only way to change the outcome is to go back to the beginning, that fork in the road,” Malouf said. “And go, ‘OK, well let’s give vitamin K after birth.”

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Stephanie and Eric also have asked themselves what they would have done differently. They wished they had left the ER that night and driven Gwen to a hospital. 

“We were just trusting that the person who went to school their whole life for this would know more than us,” Eric said.

In their minds, the role of vitamin K has overshadowed the medical mistakes they believe are most responsible for their daughter’s death. By the time Gwen had arrived at the hospital, her organs were already starting to shut down. The autopsy found that she had tiny spots of bleeding in her kidneys and small intestine and a small scrape on her chest where doctors pushed down for CPR. The medical examiner noted Gwen’s precipitous decline and listed her cause of death as vitamin K deficiency bleeding.

If they could go back, both agreed they would get the vitamin K shot for Gwen. 

“I don’t trust a lot of things,” Stephanie said, “but get peace of mind and get the vitamin K shot.” 

A few months after Gwen’s death, Stephanie found out she was pregnant with a little girl. They were so ready to love a baby again. She gave birth to her in 2024. This summer, they welcomed another baby girl. 

Both got vitamin K shots.