Re: Informed Refusal - VBAC
From: Joe (forcep@intercom.net)
Wed Mar 15 19:38:03 2006
Don't ever ,ever believe the hospital is with you at any time. Joe C
RModugno@aol.com wrote:
> In a message dated 3/15/2006 3:41:39 P.M. Eastern Standard Time,
> eramirezt@coqui.net writes:
>
> At Wed, 15 Mar 2006, Dr. Ainsworth wrote:
> >The above is from the recent ACOG Committee Opinion on Informed
> Refusal.
> >How does that relate to our discussion on the availability of VBAC
> in a
> >small hospital? If we tell the patient that we do not have the
> >recommended capability for immediate availability ...
> yada...yada, and
> >they signed an informed refusal for repeat cesarean section, how
> >effectively would that protect us from the lawyers in case of a bad
> >outcome? I know many of you would say, if the patient refuses a C/S,
> >discharge her from your practice and send her somewhere else.
> However,
> >in rural locales, there are no suitable alternatives and "St.
> Elsewhere"
> >is over an hour and a half away. I also don't think patient
> refusal of
> >recommended care is always a reason to discharge a patient. We
> >sometimes have to agree to disagree.
>
> Ron... I strongly believe that if you do not have the facilities to
> comply with the strict standards set by our College – you cannot offer
> VBAC – period – it does not matter if the next suitable alternative is
> across the street or in the moon – if there is a bad outcome everyone
> will get sued and most probably evryone will have to pay...
>
> You know what I would like to see? – a written opinion – from the
> College – addressing this specific issue – but I doubt very much it
> will..
>
> Good luck..
>
> Ef
>
> I think that the hospital should support the physician, and make it
> hospital policy - if one cannot maintain the standard outlined in the
> ACOG guideline.Some rural hospitals have done this. To paraphrase
> "George in the Bush" : The hospital's either with us or against us.
>
> We are having similar angst at present with videotaping of deliveries.
> BTW Ashley what was the decision taken by your hospital group on
> videotaping?
>
> Robert Modugno MD MBA FACOG
> Marietta, GA
|
|
