Re: vbac on demand
From: Jamie (ajfields@pine-net.com)
Wed May 21 13:29:45 2008
What are the statistics for an unaugmented VBA2C vs a third c/s?
At Thu, 15 May 2008, Efrain Ramirez wrote:
>
>El-- she is not refusing treatment - she is not consenting to one of the
>treatment options .. jeopardizing her unborn child but for her,
>apparently, is of no concern. -- BTW - how did the whole drama turn
>out?
>
>Ef
>
> At Wed, 14 May 2008, Dr Eberhard W Lisse wrote:
>>
>>Lynn,
>>
>>the statute reads to me, that if a patient refuses treatment she is not
>>covered by EMTALA any more.
>>
>>I am not saying or have ever said that that one should even
>>contemplate forcing surgery. I am also not saying that an "own"
>>doctor should abandon her.
>>
>>The way I read EMTALA is that someone who does *not* have an
>>"own" physician can not be dumped, unless, and that I still
>>maintain, unless she refuses treatment, which is reasonable
>>as in this case, an ACOG recommendation.
>>
>>The statute says hospital, not physician, and I am not sure, emergency
>>treatment under the statute without payment establishes a doctor-patient
>>relationship.
>>
>>But, the idea can not be to use this statute to force an obstetrician
>>to perform a VABC against his wishes on a patient he's never
>>seen before.
>>
>>el
>>
>>On May 14, 2008, at 17:12, Lynn Montgomery wrote:
>>
>>> EL,
>>> Unfortunately, in the US, most hospitals have call schedules that all
>>> obstetricians with privileges are required to participate in call
>>> "town
>>> call" or "no-doc call", etc. When you are on that call, you are
>>> required to care for any patients who happen to drop into the hospital
>>> and don't have a physician with privileges at that hospital. If that
>>> patient is in "labor", EMTALA strictly prohibits transport of a
>>> "laboring patient". Here in Missoula, we only have one hospital that
>>> provides obstetrics and I get saddled with this type of patient all
>>> the
>>> time. If a patient with a previous cesarean section presented in this
>>> circumstance and refused repeat cesarean, other than providing
>>> informed
>>> consent, I would be stuck to abide by her wishes, unless of course I
>>> could get another physician to take care of her, which would not
>>> happen.
>>> If I assert surgery without her consent, it is felony assault, not to
>>> mention the civil liability.
>>>
>>> In addition, I must mention that I don't get paid for the vast
>>> majority
>>> of this care provided, I am liable if the patient decides to sue and I
>>> must provide care emergency care (so if she is not really in labor and
>>> is discharged, but shows up 2 weeks later in labor, she is mine) for
>>> 30
>>> days even if I fire her from my care.
>>> Lynn
>>>
>>> Lynn D. Montgomery, M.D.
>
>--
>"I can accept failure, but I can't accept not trying." - Michael Jordan
>
--
JFields, RN, BSN
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