Re: vbac on demand
From: Dr Eberhard W Lisse (el@lisse.na)
Fri May 23 10:10:59 2008
No, it would be that this is a list for Obstetricians and Gynaecologists
and not for witches having fallen off the broomstick warming up old
threads ad nauseam.
el
On May 23, 2008, at 15:53, Jamie wrote:
> Would that be that the physician's right to do whatever he wants
> trumps
> the patient's right to informed consent? Or that the physician's legal
> and financial risk are more important than the patient's physical
> risk?
> Because I really can't see how the relative risks aren't important to
> this woman's decision about her body.
>
> At Thu, 22 May 2008, Efrain Ramirez wrote:
>>
>> 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
>>
>
> --
> JFields, RN, BSN
>
