Re: IUFD
From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com)
Fri Apr 28 13:56:04 2000
While that clarifies some of the inconsistencies in this case, why wasn't
the involvement issue with the FP evaluated fully at 30 or even 40 weeks? Or
at the latest 41+0. It still seems the responsibility of the midwife was to
make sure she had adequate back-up.
As for the impending lawsuit (whether valid or frivolous) it will occur
since rarely do patients take responsibility for their own actions, and
since God cannot be held responsible for His actions (read: except in
instance of an act of God), that leaves the care-givers. Now the case
reverts to the basic elementary school game of tag, where the last person
touched is it. In Latin : Tagus, urus itum (ahhh, it has been one of those
days :-) )
Rick
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of
>ainsron@msn.com
>Sent: Friday, April 28, 2000 9:19 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: IUFD
>
>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:
>>
>>> Just to play the devil's advocate, suppose an OB or FP agreed
>to do the NST.
>>> Significant late decelerations are noted; emergent c-section is
>performed
>>> and a significantly injured baby is born (say with CP.)
>>>
>>> Who becomes the responsible party? Who is going to get sued?
>>
>>Why should anyone get sued? Who has been negligent or been
>>responsible for this? It seems to me that the original practitioner
>>(?CNM) who failed to arrange for ongoing antenatal care is the
>>responsible one. Everyone else would have done only what they
>>could under the circumstances. The responsible parties include
>>the patient for opting for an antenatal "carer" who didn't have
>>access to all the tools that she needs to do her job - and the lay
>>midwife who didn't have a plan of action of how to deal with the
>>need for a NST.
>>
>>Steve Raymond
>
>--
>Ronald E. Ainsworth, MD
