Re: Family practice and OB
From: Dr Eberhard W Lisse (el@lisse.na)
Sun Dec 30 22:09:25 2007
Glen,
call your carrier(s)! *NOW*
Because you might get into a liability they would not be happy about.
I guarantee
you that they will not be happy to cover this situation. Or any
situation where you
can show them an out from coverage :-))-O. Let them fax it to you or
whatever, but
in writing, and you then request an appropriate meeting, where you
raise the issue.
If they call you at night, you say: ""Sorry, can't help you, I am on
EMTALA duty,
and what would happen if someone comes in to the ER while I am busy
attending
to an admitted patient? I would be de-relicting. Why don't you have
the Chief of Staff
relieve me of my EMTALA duties" :-)-O
If the Chief of Staff phones you, and relieves you, you tell him:
"Thank you,
but I don't know this admitted patient, so I can't help." :-)-O
(because now
they can't attempt EMTALA any longer :-)-O) If you get instructed to
go, you
can ask: "Have you been to the hospital to see this patient, whom I
don't know?"
And when he starts shouting, you tell him that you go under protest and
that this issue must be put on the agenda of the next meeting.
Have you thought f introducing yourself to the FPs?
el
On Dec 31, 2007, at 02:43, Glen Elrod wrote:
> Garry,
>
> A hand shake would be fine, and better than what I've gotten so
> far. I have only had one FP doc introduce themself to me so far and
> no one has come forward to say anything other than, if they call you
> have to come.
>
> Granted, I'm pretty flexible and easy going and won't ever say no if
> asked to come in. But to me there is a huge difference between the
> patients we get (I hear) dropped off from the local at home
> midwifery centers where there is no doc or priveleged provider at
> the hospital to consult with and ones that are engaged with FP,
> could have been discussed at any given time during labor. But to
> get the call, like my office partner did last week...'I need to you
> do a c-section" Period. Not I have a 29 yo G...at 39 wks with x
> problem that we pitted and she is stuck at 6. I just have a problem
> with it. But, maybe once I get to know the FP docs it won't seem so
> irritating.
>
> Glen
>
>> ----- Original Message ----
> From: "Garry E. Siegel, M.D." <garrys@mindspring.com>
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> Sent: Saturday, December 29, 2007 9:48:14 AM
> Subject: Re: Family practice and OB
>
> FWIW, Robert and others have made most excellent points about your
> situation.
>
> Unless I'm missing something, the FPs who don't do sections are going
> to
> rely on the Ob docs on staff, regardless of any pre-arrangement.
>
> What would be wrong with a multi-disciplinary meeting among the
> involved
> Ob and FP docs to figure out how to best work it (for your
> circumstances), and then create bylaws that are appropriate to your
> situation and that make the hospital/JCAHO happy. If there are docs
> who
> won't agree, then the medical staff may be obliged to set up bylaws
> that
> address the situation clearly.
>
> Obviously, you (and others) are going to be called in as consultants
> for
> difficult cases, forceps, sections, etc. It seems like a good idea to
> set up a mechanism, which could be a handshake among the various docs,
> perhaps backed up by medical staff policy.
>
> Garry
>
> At Sat, 29 Dec 2007, rmodugno@aol.com wrote:
>>
>> Welcome back Glen!
>>
>> As Joe says, EMTALA has nothing to do with the transfer of care from
> a
>> FP to an OB in the same hospital.
>>
>> What is the structure of your medical staff vis-vis ob/gyn? Is the
>> ob/gyn dept a separate enitity or part of the dept of surgery?
>>
>> There should be protocols/guidelines set up by your medical staff
>> regarding consultations/transfers of care similar to ones for
>> providers such as CNMs.
>> The Joint Commission wants to have these in place as part of their
>> patient safety initiative.
>>
>> At our hospital , OB/GYN dept is part of the surgery dept. It is a
>> 90+
>> bed hospital.FPs doing deliveries has dwindled down to one - mainly
>> because of rising malpractice premiuims.
>>
>> We have an ad hoc committee - the perinatal committee - consisting of
>> ob/gyn, FP and peds which meets on a monthly basis to discuss issues
>> pertinent to all 3 specialties.
>>
>> My advice - makes waves! Be a change agent!
>>
>> Robert Modugno MD MBA FACOG
>> Sylva, NC
>>
>> -----Original Message-----
>> From: Glen Elrod <dr99645@yahoo.com>
>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> Sent: Fri, 28 Dec 2007 6:00 pm
>> Subject: Family practice and OB
>>
>> #AOLMsgPart_2_36b80125-7aa6-44a8-8d58-72e4537906fa
>>
>> Greetings all! I have been away while separating from the service
> and
>> moving back to Alaska to start a private practice. So far so good,
> but
>> one thing I've run across at our hospital is with regards to Family
>> Practice and OB.
>>
>> We have several FP docs that are doing OB. We even have one that is
>> credentialled for c-sections. I'm OK with that bit, mostly. What
> I
>> have found out is that the FP docs do not have any set OB doc backup
>> that they use/consult/etc. When the time rolls around that a patient
>> of theirs needs a c/s, they simply call the EMTALA OB call doc and
>> ask
>> them to 'do a c/s'
>>
>> My question to the group is, is that standard of care across the
>> country? Is that what EMTALA call is meant for? If I were to try
> and
>> make a change, what sort of legal legal (Joe) do I have to justify
> them
>> picking an OB and consulting them.
>>
>> Its good to be back.
>>
>> Glen
>>
>> D. Glen Elrod, MD
>> Obstetrician/Gynecologist
>> Sleeping Lady Women's Health Care, LLC
>>
>> Looking for last minute shopping deals?
>> Find them fast with Yahoo! Search.
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
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