Re: Too Few C-sects, Dr. Sandland Responds
From: art fougner, md (evsono@pipeline.com)
Wed Jun 29 11:52:07 2005
Anna
i think the article may have missed a possible link to clavicular
fractures as an adverse outcome monitor. would be worth checking.
art
At Wed, 29 Jun 2005, Anna Meenan, MD wrote:
>
>Your point?
>
>--
> Anna Meenan, MD
>
>At Wed, 29 Jun 2005, art fougner, md wrote:
>>
>>All newborn clavicular fractures are reported to the NY State Health
>>Dept as an adverse outcome ...
>>
>>art
>>
>>At Tue, 28 Jun 2005, Stmidwife@aol.com wrote:
>>>
>>>I was given permission by Dr. Helen Sandland to post her response, which w s
>>>originally posted on a blog sight to the recent circulated newspaper
>>>article. The original article is below her response, I know it was posted on this
>>>list. Thought you might be interested.
>>>
>>>Sue
>>>
>>>Just for clarification--my babies were most likely to be born at 39
>>>weeks--none were born "post-mature", there was no increase in macrosomia or diabetes.
>>>I have had NO permanent brachial plexus injuries--a couple of transient on s
>>>that healed completely--over 17 years.
>>>I get one or 2 more clavicle fractures a year but they are not deemed
>>>significant unless there is a brachial plexus injury and there wasn't in t ese. I
>>>was well within published norms for clavicle fracture but the reason I fee I
>>>had one or tow more a year than thte other OB's is that I as doing 3 times
>>>the average percentage vaginal births. That is the only issue--there is no
>>>increase in REAL problems--actually less since I didn't have to deal with ost
>>>-op complications!!
>>>I have had no brain damaged babies and hope to keep it that way!
>>>It is the position of WHO and MArch of Dimes that low birth weigth and
>>>prematurity are the biggest problem faced by newborns--they have allocated ver 7
>>>million dollars this year to study the problem. I was very proud of my low
>>>prematurity rate --never thinking for a nano sceond that I would be cited
>>>because my babies were more likely to be TERM (not post term) and heavier(N T
>>>MACROSOMIC)
>>>Oh well--life is forever a mystery---but I will continue to do my thing in
>>>Mississippi. It was very important that I send my children a clear message n
>>>this---how could I cut women open just so they could keep kayaking on the C pe
>>> Fear River???
>>>My soul is very much at peace with my decision to leave--I would have lost
>>>all my self-respect and sleep had I caved.
>>>Posted by: _Helen Sandland_ (mailto:drsandland@yahoo.com)
>>>
>>>Original article
>>>
>>>Dr. Sandland – known for the past decade as the doctor local women ent to
>>>if they desired natural, vaginal deliveries – moved to Mississippi ast week
>>>after being told by New Hanover Regional Medical Center administrators to o
>>>more c-sections.
>>>She refused.
>>>“I leave NHRMC with my morals and backbone absolutely uncorrupted � Dr.
>>>Sandland wrote in her resignation letter dated May 15. “I am going o practice
>>>with a long-time friend, whose scruples I admire, and in a place where
>>>unnecessary surgery is not encouraged.�
>>>During a time when national health officials have sounded the alarm that t e
>>>cesarean section rate is at an all-time high and needs to be sliced, Dr.
>>>Sandland’s case raises questions about what factors are pushing the numbers
>>>higher.
>>>The rate doubled in five years and continued to increase until 1990, when t
>>>peaked at 22.7 percent. It held steady and slightly declined through the
>>>1990s before picking up again in 1998. The rate now sits at 26.1 percent of
>>>4,021,726 births nationally. North Carolina’s rate is 26.4 percent.
>>>“I don’t see any end in sight right now,� said Dr. ruce Flamm, regional
>>>chairman of The American College of Obstetricians and Gynecologists, saying
>>>there’s little concrete data on how many c-sections are unnecessary “All of
>>>the current pressures seem to be going in the direction of more c-sections, not
>>>less.�
>>>He and other national medical experts are concerned with the trend; a trend
>>>they believe is pushed by medical liability issues, convenience for both
>>>doctors and patients, and perhaps hospitals’ financial and staffing pressures.
>>>“There are some doctors who say the only cesarean section I have ev r been
>>>sued for is the one I didn’t do,� Dr. Flamm said. “ t’s a sad but true
>>>situation.�
>>>Not only is there a decreased chance of getting sued if a c-section is
>>>performed, but it’s less time consuming to perform c-sections inste d of waiting
>>>out long and sometimes difficult labor.
>>>But, as many obstetricians will point out, pressure by doctors or hospitals
>>>is only part of the equation. Some women, they say, really are looking for
>>>c-section because they fear the pains of labor or want to schedule it when
>>>grandparents are in town or around holidays.
>>>Regardless of the reason, health officials across the country are concerned
>>>with the rates.
>>>Leading medical groups such as the Centers for Disease Control and
>>>Prevention, National Institutes of Health and the World Health Organization have all
>>>spoken out against the increase, demanding the medical community investiga e
>>>ways to lower the rate to 15 percent or below.
>>>
>>>Dr. Sandland thought she was doing just that.
>>>
>>>In the decade she has delivered babies and cared for their mothers in New
>>>Hanover County, she has always had a rate below 10 percent.
>>>
>>>“I’ve always maintained I’m a midwife with a MD beh nd my name,� she said
>>>from her two-story Pine Valley home last week while preparing to move. â €œIt’s
>>>better for Mother Nature to decide when it’s time, not the doctor. y
>>>philosophy is you don’t interfere unless you really have to.†?
>>>Her philosophy, admittedly different from the mainstream, attracted many
>>>patients who wanted the best chance of having a vaginal delivery. Dr. Sandl nd
>>>became known as one of the few doctors in the area who would try to deliver
>>>breech babies naturally or pursue a vaginal birth with a woman who already ad
>>>one child with a c-section. Her solo practice boomed.
>>>If her lack of medical malpractice lawsuits and gratitude of patients are f
>>>any account, she was not only popular, but also successful.
>>>Fellow Wilmington obstetrician Dr. Joshua Vogel said though she was
>>>considered too set in her ways or a renegade by some doctors, he admired he talents
>>>to deliver naturally in situations when other doctors would have
>>>automatically pushed for a c-section. “She was a valuable asset fo patients,� he said.
>>>Dr. Sandland said she became the target of the hospital’s professio al
>>>review and credentials committees. Because it is confidential by law, she ould
>>>not legally discuss the peer review process.
>>>But the Star-News viewed two letters addressed to her from committee
>>>members. Written on New Hanover Regional letterhead dated July 6 and July 7 2004,
>>>the letters discuss the conversation committee members had with her.
>>>The first letter, written by Dr. Cobern Peterson, chairman of the
>>>Professional Review Committee, stated “concerns� regarding er practice. They include
>>>higher than average infant birth weights, much lower than average c-sectio
>>>rates and later than average gestational age of neonates at delivery.
>>>The letter states “the main concern reiterated several times was an overall
>>>practice attitude rather than any individual case.�
>>>The next letter, written by Dr. Janelle Rhyne, acting chairman of the
>>>Credentials Committee, states Dr. Sandland’s privileges at the hosp tal would be
>>>reappointed for a period of six months but monitoring would continue.
>>>It reads, “Your c-section rate is to be within an acceptable range s
>>>determined by the NHRMC OB/GYN Department with a plus or minus deviation of two.�
>>>No reason was given in the letters, other than adding the committee would e
>>>watching other outcomes like collarbone fracture – something expe ts say is
>>>a minor, common complication of vaginal deliveries.
>>>New Hanover Regional spokeswoman Kendra Gerlach said two standard deviatio s
>>>equates to five or six percentage points above or below the average.
>>>The c-section rate at New Hanover Regional is 27.9 percent. At the time, D .
>>>Sandland said, it was about 26 percent. That meant the committee was
>>>requiring her to reach at least a 20 percent c-section rate. To do so, sh ’d have to
>>>more than double her current rate.
>>>“It’s just not something I could see happening,� sh said. “You just don’t
>>>change your practices overnight. I certainly wasn’t going to change them to
>>>meet some arbitrary quota.�
>>>Jack Barto, chief executive officer of New Hanover Regional, said he was n t
>>>familiar with the letters but that it sounded to him more like a “ uideline�
>>> than a “quota.�
>>>But Dr. Sandland said that in a March conversation with Mr. Barto, part of
>>>the reason became clear.
>>>“Barto said in a separate meeting that a c-section rate of 25 perce t would
>>>reduce the likelihood of getting sued,� she recalled.
>>>Mr. Barto confirms he had a meeting with Dr. Sandland but would not discuss
>>>the conversation.
>>>“I had a private conversation with one of my physicians,� h said,
>>>asserting he did not recall discussing liability issues. “I talked ith her about a
>>>variety of topics.�
>>>The hospital’s chairman of the OB/GYN department, Dr. Bora Duruman, declined
>>>to comment on Dr. Sandland but said doctors are not pressured to do
>>>c-sections nor do they pressure patients toward c-sections unless the proc dure is
>>>medically necessary.
>>
>>--
>>art fougner, md
>>
>> "If you don't know where you are going, you will wind up somewhere else."
>>Lawrence Peter Berra
>>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
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