Re: Too Few C-sects, Dr. Sandland Responds
From: Anna Meenan, MD (annam@uic.edu)
Wed Jun 29 11:36:31 2005
Your point?
--
Anna Meenan, MD
At Wed, 29 Jun 2005, art fougner, md wrote:
>
>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
>
