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Re: IUFDFrom: ainsron@msn.comFri Apr 28 09:17:01 2000
The lay midwife who cared for this patient is a cautious practitioner and she actually did have a reasonable plan of action. She had the patient see a local FP, who did obstetrics at the community hospital, at about 34 weeks, and had the impression that the physician would handle any problems she referred to her. When the midwife called the physician at 41 1/2 weeks to request ordering a NST, the MD declined further involvement. Apparently she had caught some flack from someone at the hospital about backing up home births and opted to bow out gracefully (??), her staff wouldn't even let the midwife speak directly to her. The midwife then called the OB supervisor at the hospital and was told to contact the ER MD to order the NST. She did and the ER MD told her that he would not get involved. The patient was then told by the midwife that she would need to go to another facility, ours (She is friends with one of the CNMs that I B/U and knew that she would order the test.), to get the required testing. This all took place on Easter weekend, starting on Good Friday and the patient, for personal reasons, declined any further evaluation, even signing a waiver, until Monday when she presented to my unit with a dead fetus. The baby was moving at least through Saturday. Let me also say that I am not a fan of home births and don't actively backup home births in my practice, my malpractice carrier would turn over in its actuarial grave! I don't castigate them for what I see as a poor choice, but neither do I turn them away at the door if they call with a problem or present in L&D. My experience in this area is that most of these patients are not doing it for monetary reasons, and are motivated by strong feelings that cannot be rationalized away. Unlike what others have commented, I don't see them as high risk of suing when given the same level of care that I would give any of my patients in labor. I think the first hospital and the physicians who refused to "get involved" are in deep sh**!! I think their actions are repugnant and probably illegal. It will be reported by our hospital as a possible violation of anti-dumping laws and I don't think there is any justification for how they handled this patient.
0>On 26 Apr 2000, at 8:37, Richard Chudacoff, MD wrote:
>
-- Ronald E. Ainsworth, MD
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