Re: CS response time
From: art fougner, md (evsono@pipeline.com)
Tue Jul 18 07:25:10 2000
Efrain -
well -said. local standards do not determine the definition of
immediate any more than the President determines what the meaning of is
is - the dictionary does! immediate means just that - immediate.
art
At Mon, 17 Jul 2000, Efrain Ramirez wrote:
>
>Joe - I have written to Dr. Zinberg before and the answer was ambiguous
>as this one - how can an issue so important as the understanding of
>'immediate available" be left to local institutions - so in contast with
>the so called "standard of care". Lawyers will be laughing at this
>argument- I understand that the College has a terrible dilemma - trying
>to lower the C/S rate AND allowing VBAC's --BUT they should be
>completely honest and say "VBAC's should be done only in institutions
>where immediate delivery can be done' --period - problem is that they
>glued the VBAC issue with abruptio, etc, BIG mistake -
>
>Dan is absolutely right - the courts will decide all this issue -as
>always!!!
>
>Dan is absolutely right - the courts will decide all this issue -as
>always!!!
>
>BTW
>
>im·me·di·ate (ī-mź¹dź-īt) adjective
>1. Occurring at once; instant: gave me an immediate response.
>2. a. Of or near the present time: in the immediate future. b. Of or
>relating to the present time and place; current: "It is probable that,
>apart from the most immediate, pragmatic, technical revisions, the
>writer's effort to detach himself from his work is quixotic" (Joyce
>Carol Oates).
>3. Close at hand; near: in the immediate vicinity. See Synonyms at
>CLOSE.
>4. Next in line or relation: is an immediate successor to the president
>of the company.
>5. Directly apprehended or perceived: had immediate awareness of the
>scope of the crisis.
>6. Acting or occurring without the interposition of another agency or
>object; direct.
>[Middle English immediat, from Old French, from Late Latin immediātus :
>Latin in-, not. See IN-1 + mediātus, past participle of mediāre, to be
>in the middle. See MEDIATE.]
>- im·me¹di·ate·ness noun
>
>At Mon, 17 Jul 2000, Joe Cutchin wrote:
>>
>>Sometime last fall I had written to ACOG and complained about the
>>word"immediate" in terms of MD availability.I found Dr Zoinberg's
>>response and am posting for your interest.
>>Dear Dr Cutchin.
>>Your recent e-mail regarding the Practice Bulletin "Vaginal Birth after
>>Previous Cesarean Delivery"has been forwarded to me as Vice President of
>>Practice Activities.Unfortunately,Ken Heland is no longer with the
>>College and I have been asked to respond.
>>As indicated in the enclosed editorial in our newsletter ACOG Today,the
>>term "immediate" was used in this document to highlight the urgent need
>>for intervention in the event of uterine rupture.In contrast to other
>>obstetric emergencies such as placenta accreta,VBAC is a purely
>>procedure that allows for reasonable precautions in assuming this small
>>but significant risk.In addition,recognition that certain situations
>>require less than a 30 minute reponse time does not represent new
>>College policy.As explained in "Guidelines for Prenatal Care 4th Ed"
>>examples of situations mandating expeditious delivery include
>>"hemmorrhage from placenta accreta,prolapse of the umbilical cord,and
>>uterine rupture".Therefore the Practice Bullitin merely emphasizes this
>>point.
>>The definition of "immediate available" remains a local decision,based
>>on each institution's available resources and geographic location.
>>I hope this information is helpful to you.
>>Sincerely,
>>Stanley Zinbery,MD,MS,FACOG
>>Vice President,Practice Activities
>>
>>--
>> Joseph H. Cutchin MD FACOG 4105463125
>> 314 West Carroll Street 4105463128 Fax
>> Salisbury,Maryland 21801
>>
>> http://www.penobgyn.com
>>
>--
>"Do not take life too seriously. You will never get out of it alive."
>
>Marianne Williamson
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
