Re: vbac on demand
From: Efrain Ramirez (eramirezt@coqui.net)
Thu May 22 20:58:12 2008
You missed the central, fundamental issue of the discussion..
Ef
> At Wed, 21 May 2008, Jamie wrote:
>
>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
>
--
"I can accept failure, but I can't accept not trying." - Michael Jordan
|
|
