Re: VBAC
From: R. Daniel Braun (rd.braun@gmail.com)
Wed Apr 13 22:10:54 2005
So why did you join this group that has such a diferent philosopphy
from you? Didn't you talk about these things first?
On 4/13/05, Efrain Ramirez <eramirezt@coqui.net> wrote:
> Rich - I don't know if that will suffice if a really bad outcome occurs
> (Dios no lo quiera) – I think you acknowledged that your facilty does
> not meet ACOG's criterias? you have to get your act together .. it is
> not a "simple" disagreement on management - contact YOUR lawyer...
>
> >At Wed, 13 Apr 2005, Richard Chudacoff, MD wrote:
> >
> >I don't know, since I just joined the group two weeks ago. However, I have made it known that I don't do them (neither does the senior partner) and I guess if I cannot convince them to have a repeat c-section I will labor them under protest. Documenting into the chart my disagreement with the course of management, and how legally to force the surgery will be assault and battery
> >
> >--
> >Richard Chudacoff, MD
> >
> >-----Original Message-----
> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron
> >Sent: Wednesday, April 13, 2005 11:38 AM
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Re: VBAC
> >
> >So what happens to them when you are on call and they refuse a RCS?
> >
> >Ronald E. Ainsworth
> >
> >-----Original Message-----
> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD
> >Sent: Wednesday, April 13, 2005 7:11 AM
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Re: VBAC
> >
> >What if you are covering your group and you are the only one of 5 who does not do VBACs? I'm considering buying a video camera for those patients so that when I say I do not do them, and highly suggest a repeat c-section but if you refuse the c-section you understand that legally I cannot operate without your permission.
> >
> >Richard Chudacoff, MD
> >
> >-----Original Message-----
> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain Ramirez
> >Sent: Monday, April 11, 2005 6:46 PM
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Re: VBAC
> >
> >It is soooooo simple not to offer VBAC...!!! How many patients would
> >walk away -??? very few - and I would be glad if they do!!
> >
> >>At Mon, 11 Apr 2005, RModugno@aol.com wrote:
> >>
> >>This guest editorial from OB/GYN News says it all.
> >>
> >>Robert Modugno MD MBA FACOG
> >>
> >>Guest Editorial
> >>Informed Consent for Attempted VBAC
> >>
> >>Dennis J. Sinclitico, J.D.
> >>
> >>MR. SINCLITICO is an attorney specializing in medical malpractice law in
> >>Long Beach, Calif.
> >>There are certain topics that we just can't discuss enough, and attempted
> >>vaginal birth after a previous cesarean section is one of those. VBAC and
> >>informed consent for VBAC seem to be the topics du jour in every obstetrics
> >>program.
> >>The number of VBACs seems to have declined following concerns about the ris
> >>for uterine rupture. Some physicians prefer elective C-sections to VBAC
> >>because of large monetary awards in medical malpractice lawsuits dealing w th
> >>VBAC, such as a $30 million judgment in Philadelphia.
> >>Is there life after this death for VBAC? As your friendly defense lawyer, I
> >>can tell you those are hard cases to defend.
> >>A recent prospective, multicenter study that provides the first solid data n
> >> the risks of VBAC showed that only (0.7%) of 17,898 women who attempted VB C
> >>for a term singleton developed uterine rupture. Only 12 term infants in th
> >>VBAC group developed hypoxic-ischemic encephalopathy, 7 of them in the
> >>uterine-rupture subgroup. The absolute risk for hypoxic ischemic encephalop thy
> >>was approximately 1 case per 2,000 women attempting VBAC at term (N. Engl. .
> >>Med. 2004;351:2647-9).
> >>Even though the risks of a bad outcome are smallâ€â€and ongoing statis ics
> >>support thatâ€â€those statistics take flight when you're in the witnes chair and a
> >>catastrophically affected infant is with a parent in another witness chair.
> >>You'll notice that when speakers at meetings present statistics about the
> >>risks or benefits of VBAC, there are no photographs of a catastrophically
> >>affected infant. But the jurors will see that. When a case goes to trial, t e
> >>focus is on the care and treatment provided by a specific physician for a
> >>specific patient with a specific kind of outcome. In that setting, the risk seem
> >>much different than they do in studies.
> >>That's why most obstetricians are voting to do cesarean section instead of
> >>VBAC. They've seen the results in accounts from their peers, in discussions in
> >>the literature, and in the media.
> >>While there were only 12 cases of hypoxic ischemic encephalopathy in the
> >>recent multicenter study, if we assume that each of those cases went to tri l
> >>and the plaintiffs won only 10% of the large award in the Philadelphia case
> >>that totals $36 million, plus untold millions of dollars spent defending th se
> >>cases.
> >>If you choose to provide VBAC, I suggest getting informed consent in the
> >>patient's handwriting. Most informed-consent documents are forms, and that' a
> >>problem. They're not individualized to any degree and to any specificity. E en
> >>though your consent process might be substantial, the extent to which you a d
> >> your staff provided informed consent is poorly documented in a form.
> >>Absent an individualized, specified consent document, what happens is that
> >>the mother says in court, â€Å"I don't know. …He shoved it in f ont of me and I
> >>just signed.†That's what the plaintiff will say in almost every s tuation.
> >>Having the mother write out her informed consent is a lot better for your
> >>defense. Better yetâ€â€pull out the video camera and document the cons nt process.
> >>Simply having a form with a signature acknowledging that the consent proces
> >>has taken place is a prescription for disaster. That won't fly in court.
> >
> >--
> > I think I will do nothing for a long time but listen,
> > And accrue what I hear into myself...and let sounds
> > contribute toward me.
> >
> > ~walt whitman~
> >
>
> --
> I think I will do nothing for a long time but listen,
> And accrue what I hear into myself...and let sounds
> contribute toward me.
>
> ~walt whitman~
>
--
R. Daniel Braun
Kinky for Governor
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