Re: vbac on demand
From: Efrain Ramirez (eramirezt@coqui.net)
Sat May 24 18:35:43 2008
Jamie - let's push this issue a bit further to see how would you react..
the patient has 3 previous C/S.. she is 42 weeks - she demands a TOL ..
induction that is.. she refuses another C/S...
Ef
At Fri, 23 May 2008, 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
>
--
"I can accept failure, but I can't accept not trying." - Michael Jordan
