Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more...about consent

From: ainsron (ainsron@sbcglobal.net)
Mon Mar 14 13:40:05 2005

You can't witness the patient's signature yourself, so it doesn't make a difference whether or not you are there when she signs. "All" we have to do as physicians to protect ourselves is go through the informed consent process with the patient: Discuss the procedure, risks, benefits, alternatives, costs, etc. and document it in your notes with either a written or dictated description of the discussion and the fact that you gave the patient to ask and receive answers to any questions she has, written materials given for supplementary information, etc..

Ronald E. Ainsworth

-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod Darryl G MAJ 48 MDOS/SGOBO Sent: Monday, March 14, 2005 12:05 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more...about consent

I know this is a bit off this topic, but it brings up an interesting debate I've had with the nursing staff today. In the signing of informed consent, do all parties need to be present at the same time?

I have (probably not rightly) always talked to the patient about the procedure (c/s, pit, etc) and the nurses have signed the consent form as the witness as the patient signs. I usually am not in the room at the time. My argument with not having the patient sign in front of me is 1. I don't always have a 'witness' to the consent and 2. A consent will not likely protect me from nor help me in a lawsuit.

I'm sure this doctor had a consent form and I'm sure he signed it in front of the patient and he still got sued.

Any thoughts on obtaining informed consent?

Glen

-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Robert J. Carpenter, Jr. MD Sent: Sunday, March 13, 2005 6:05 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more...

I have avoided replying to this case, but the questions below demand it.

First yes, an obligation was breached. The MD should have reconstructed the fetus since it was a D&E and made sure that the head was removed. That is a fundamental teaching for those who do D&E.

>From the bried account the patient did not suffer a physical injury.
However, these days unless there are tort caps in place, the pleadings will almost always result is cause of action based on mental injury, dispair, anguish, etc, etc, etc. This patient had a deceased fetus. Ther MD did not cause the death.

If the patient was known to have a head inside that could not be gotten because of any number of factors - the most common being absence of an appropriate instrument to allow crushing of the head with its subsequent extraction, then that information can be given to the family and appropriate things done

1. Do nothing, allow nature to prevail. Nature is very efficient. 2. Acquire the services of a person who is expert in D&E to extract the head (or do it in the first place). 3. Use cytotec to initiate contractile activity.

The above are predicated on knowledge that the head remains inside. In this case if I were a judge hearing the case - specialty medical court - the judgment would be that breach of standard of care had occurred, no physical injury had occurred, and unless there is EVIDENCE that severe mental anguish (like with intentional tort of infliction of mental anguish) has caused a physiological process requiring medical care, then no damages would be awarded.

Since I have no more information than the rest of you I can only speculate to the facts of the case.

As a well trained MFM, knowledgeable expert, and near JD, the lawsuit craze in the entire US has to come to a screeching halt. That is not going to happen in my life time since everyone feels a sense of entitlement from society.

I am sure that there are those who will rebut my presumption, but that is what this list is for! Thanks RJC On 12 Mar 2005 at 14:33, Brickster0@aol.com wrote:

>
> In a message dated 3/12/2005 2:28:15 PM Eastern Standard Time,
> tdrcaste@yahoo.com writes:
>
> I know, I am stepping out. Please correct me if I am wrong, I'm in
> it to learn.
>
> Was there an obligation? was the obligation breached? Did the patient
> suffer an injury? and can the injury be directly attributed to the
> breached duty?
>
> The obligation in my eyes is the Standard of Care. Does standard of
> care require ultrasound?
>
> Physicians doing thier own U/S is very scary.
> Just to think about it:
> I encouraged a Co-worker of mine (hirsute, obese, with irregular
> menses) to get eval for PCOS. The doctor was from out of town who
> actually works up PCOS. She ordered lab and tests, which she had
> done locally (mid size town). the Ultrasonographer found uterine
> stripe...but didn't note size. DID NOT FIND THE OVARIES. The
> physician re-ordered and had done near her office. She underwent
> evaluation received dx and tx PCOS. The woman could not afford to
> continue travelling out of town for treatment, asked the doctors
> locally if they would follow her while on treatment with
> Avandia....nobody would. One time she was actually hospitalized and
> the doctor did q 2 hr blood sugars just to prove to this woman, she
> didn't have diabetes. 2 years later she just couldn't stand it
> anymore, and had a Hyst. She never stopped bleeding after surgery,
> they went back in. She had two tumors. and what the physicia! n
> called Primary peritoneal cancer. She went to Tx. it is Primary
> ovarian cancer.
> Do you really want to do ultrasounds in your office?
>
> So, back to the original question...Was it standard of care to perform
> an ultrasound in this situation? Isn't Standard of Care, the minimum
> requirements for safe care, that all practitioners can do in any
> size town? Are all physicians SAFE in ultrasonography?
>
> Diane Castellanos RN,C/WHNP
>
> Ms Castellanos
>
> The physician you're describing is not necessarily an idiot for doing
> sonography, but may be an idiot for missing an ovarian cancer
> intraoperativily. A patient being treated with Avandia for insulin
> resistance leading to PCOS is well within acceptable clinical
> standards (and yes she will have normal BG and HgbA1C's which leads
> me to question the clinical fund of knowledge of physicians in you
> community). The Standard of Care is location dependent. It is the
> standard of care in your community. A family practice doc in Wyoming
> is held to a lower standard than a physician practicing at the
> largest ob hospital in the country if they encounter something like
> an amniotic fluid embolism. The response in both situations is
> maternal stabilization and fetal delivery (usually at the same time).
> In a rural hospital I would expect both mother and child would die
> and that would be within the standard of care. At Northside the
> standard of care would include intubation by the anesthesiologist
> assigned to L&D (and nowhere else) immediate delivery. Support by a
> pulmonlogist and perinatologist and/or hematologist for the ensuing
> DIC. (If I failed to do any of those things Tuesday, I would be ripe
> for a lawsuit)
>
> Brick Bills MD
> Atlanta, GA
>

Robert J. Carpenter, Jr. MD 6624 Fannin, #2720 St. Luke's Medical Tower Houston,TX 77030-2339 713-795-4600



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