Re: vbac on demand
From: Jamie (ajfields@pine-net.com)
Sun May 25 19:54:17 2008
Admitting this is theoretical for me. An induced VBA3C is terrifying
and I would advise her more strongly that a RCS is safer (although a 4th
c/s is also increasingly riskier). As to the risk of induction vs.
carrying past 42 weeks vs. RCS, I probably would bring in legal
counsel, bluntly outline all the risks of her options, and record her
decision. As much as I think she needs a RCS at that point, you can't
do surgery without consent. I would also record the conversation, with
her knowledge.
At Sat, 24 May 2008, Efrain Ramirez wrote:
>
>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
>
--
JFields, RN, BSN
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