Re: Too Few C-sects, Dr. Sandland Responds
From: art fougner, md (evsono@pipeline.com)
Wed Jun 29 11:01:15 2005
All newborn clavicular fractures are reported to the NY State Health
Dept as an adverse outcome ...
art
At Tue, 28 Jun 2005, Stmidwife@aol.com wrote:
>
>I was given permission by Dr. Helen Sandland to post her response, which w s
>originally posted on a blog sight to the recent circulated newspaper
>article. The original article is below her response, I know it was posted on this
>list. Thought you might be interested.
>
>Sue
>
>Just for clarification--my babies were most likely to be born at 39
>weeks--none were born "post-mature", there was no increase in macrosomia or diabetes.
>I have had NO permanent brachial plexus injuries--a couple of transient on s
>that healed completely--over 17 years.
>I get one or 2 more clavicle fractures a year but they are not deemed
>significant unless there is a brachial plexus injury and there wasn't in t ese. I
>was well within published norms for clavicle fracture but the reason I fee I
>had one or tow more a year than thte other OB's is that I as doing 3 times
>the average percentage vaginal births. That is the only issue--there is no
>increase in REAL problems--actually less since I didn't have to deal with ost
>-op complications!!
>I have had no brain damaged babies and hope to keep it that way!
>It is the position of WHO and MArch of Dimes that low birth weigth and
>prematurity are the biggest problem faced by newborns--they have allocated ver 7
>million dollars this year to study the problem. I was very proud of my low
>prematurity rate --never thinking for a nano sceond that I would be cited
>because my babies were more likely to be TERM (not post term) and heavier(N T
>MACROSOMIC)
>Oh well--life is forever a mystery---but I will continue to do my thing in
>Mississippi. It was very important that I send my children a clear message n
>this---how could I cut women open just so they could keep kayaking on the C pe
> Fear River???
>My soul is very much at peace with my decision to leave--I would have lost
>all my self-respect and sleep had I caved.
>Posted by: _Helen Sandland_ (mailto:drsandland@yahoo.com)
>
>Original article
>
>Dr. Sandland – known for the past decade as the doctor local women ent to
>if they desired natural, vaginal deliveries – moved to Mississippi ast week
>after being told by New Hanover Regional Medical Center administrators to o
>more c-sections.
>She refused.
>“I leave NHRMC with my morals and backbone absolutely uncorrupted � Dr.
>Sandland wrote in her resignation letter dated May 15. “I am going o practice
>with a long-time friend, whose scruples I admire, and in a place where
>unnecessary surgery is not encouraged.�
>During a time when national health officials have sounded the alarm that t e
>cesarean section rate is at an all-time high and needs to be sliced, Dr.
>Sandland’s case raises questions about what factors are pushing the numbers
>higher.
>The rate doubled in five years and continued to increase until 1990, when t
>peaked at 22.7 percent. It held steady and slightly declined through the
>1990s before picking up again in 1998. The rate now sits at 26.1 percent of
>4,021,726 births nationally. North Carolina’s rate is 26.4 percent.
>“I don’t see any end in sight right now,� said Dr. ruce Flamm, regional
>chairman of The American College of Obstetricians and Gynecologists, saying
>there’s little concrete data on how many c-sections are unnecessary “All of
>the current pressures seem to be going in the direction of more c-sections, not
>less.�
>He and other national medical experts are concerned with the trend; a trend
>they believe is pushed by medical liability issues, convenience for both
>doctors and patients, and perhaps hospitals’ financial and staffing pressures.
>“There are some doctors who say the only cesarean section I have ev r been
>sued for is the one I didn’t do,� Dr. Flamm said. “ t’s a sad but true
>situation.�
>Not only is there a decreased chance of getting sued if a c-section is
>performed, but it’s less time consuming to perform c-sections inste d of waiting
>out long and sometimes difficult labor.
>But, as many obstetricians will point out, pressure by doctors or hospitals
>is only part of the equation. Some women, they say, really are looking for
>c-section because they fear the pains of labor or want to schedule it when
>grandparents are in town or around holidays.
>Regardless of the reason, health officials across the country are concerned
>with the rates.
>Leading medical groups such as the Centers for Disease Control and
>Prevention, National Institutes of Health and the World Health Organization have all
>spoken out against the increase, demanding the medical community investiga e
>ways to lower the rate to 15 percent or below.
>
>Dr. Sandland thought she was doing just that.
>
>In the decade she has delivered babies and cared for their mothers in New
>Hanover County, she has always had a rate below 10 percent.
>
>“I’ve always maintained I’m a midwife with a MD beh nd my name,� she said
>from her two-story Pine Valley home last week while preparing to move. â €œIt’s
>better for Mother Nature to decide when it’s time, not the doctor. y
>philosophy is you don’t interfere unless you really have to.†�
>Her philosophy, admittedly different from the mainstream, attracted many
>patients who wanted the best chance of having a vaginal delivery. Dr. Sandl nd
>became known as one of the few doctors in the area who would try to deliver
>breech babies naturally or pursue a vaginal birth with a woman who already ad
>one child with a c-section. Her solo practice boomed.
>If her lack of medical malpractice lawsuits and gratitude of patients are f
>any account, she was not only popular, but also successful.
>Fellow Wilmington obstetrician Dr. Joshua Vogel said though she was
>considered too set in her ways or a renegade by some doctors, he admired he talents
>to deliver naturally in situations when other doctors would have
>automatically pushed for a c-section. “She was a valuable asset fo patients,� he said.
>Dr. Sandland said she became the target of the hospital’s professio al
>review and credentials committees. Because it is confidential by law, she ould
>not legally discuss the peer review process.
>But the Star-News viewed two letters addressed to her from committee
>members. Written on New Hanover Regional letterhead dated July 6 and July 7 2004,
>the letters discuss the conversation committee members had with her.
>The first letter, written by Dr. Cobern Peterson, chairman of the
>Professional Review Committee, stated “concerns� regarding er practice. They include
>higher than average infant birth weights, much lower than average c-sectio
>rates and later than average gestational age of neonates at delivery.
>The letter states “the main concern reiterated several times was an overall
>practice attitude rather than any individual case.�
>The next letter, written by Dr. Janelle Rhyne, acting chairman of the
>Credentials Committee, states Dr. Sandland’s privileges at the hosp tal would be
>reappointed for a period of six months but monitoring would continue.
>It reads, “Your c-section rate is to be within an acceptable range s
>determined by the NHRMC OB/GYN Department with a plus or minus deviation of two.�
>No reason was given in the letters, other than adding the committee would e
>watching other outcomes like collarbone fracture – something expe ts say is
>a minor, common complication of vaginal deliveries.
>New Hanover Regional spokeswoman Kendra Gerlach said two standard deviatio s
>equates to five or six percentage points above or below the average.
>The c-section rate at New Hanover Regional is 27.9 percent. At the time, D .
>Sandland said, it was about 26 percent. That meant the committee was
>requiring her to reach at least a 20 percent c-section rate. To do so, sh ’d have to
>more than double her current rate.
>“It’s just not something I could see happening,� sh said. “You just don’t
>change your practices overnight. I certainly wasn’t going to change them to
>meet some arbitrary quota.�
>Jack Barto, chief executive officer of New Hanover Regional, said he was n t
>familiar with the letters but that it sounded to him more like a “ uideline�
> than a “quota.�
>But Dr. Sandland said that in a March conversation with Mr. Barto, part of
>the reason became clear.
>“Barto said in a separate meeting that a c-section rate of 25 perce t would
>reduce the likelihood of getting sued,� she recalled.
>Mr. Barto confirms he had a meeting with Dr. Sandland but would not discuss
>the conversation.
>“I had a private conversation with one of my physicians,� h said,
>asserting he did not recall discussing liability issues. “I talked ith her about a
>variety of topics.�
>The hospital’s chairman of the OB/GYN department, Dr. Bora Duruman, declined
>to comment on Dr. Sandland but said doctors are not pressured to do
>c-sections nor do they pressure patients toward c-sections unless the proc dure is
>medically necessary.
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
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