Re: vbac on demand
From: forcep@intercom.net
Fri May 23 10:33:34 2008
The relation between patient and physician is a contract agreed to by both.
Each has right to agree or disagree to it. By joining a hospital staff , under
medical staff by-laws , you might as a physician, lose your ability to disagree
to that contract. In 2008 it is a contract as a hospital member alot of us have
simply opted out of , ie no more deliveries in such an environment.The
relative risks are important to this woman - more commonly as each day passes
in this country she must find an obstetrician who is willing to stand in the
middle of the road and risk his license and career. Not very attractive to the
best and brightest of our youth who enter medicine. Joe C
> 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
>
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