OB-GYN-L Messages for March, 2006: Re: Informed Refusal

Re: Informed Refusal - VBAC

From: Efrain Ramirez

eramirezt@coqui.net

Wed Mar 15 15:10:48 2006

The problem that ACOG has is the selection of words in their recommendations – “Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”

That statement does not provide any leeway… immediate is only that - immediate…

At Wed, 15 Mar 2006, ainsron wrote: >
>I think we do also. I'll pose the question on ACOG.net.
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
>Ramirez
>Sent: Wednesday, March 15, 2006 12:42 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Informed Refusal - VBAC
>
>At Wed, 15 Mar 2006, Dr. Ainsworth wrote:
>>The above is from the recent ACOG Committee Opinion on Informed Refusal.
>>How does that relate to our discussion on the availability of VBAC in a
>>small hospital? If we tell the patient that we do not have the
>>recommended capability for immediate availability ... yada...yada, and
>>they signed an informed refusal for repeat cesarean section, how
>>effectively would that protect us from the lawyers in case of a bad
>>outcome? I know many of you would say, if the patient refuses a C/S,
>>discharge her from your practice and send her somewhere else. However,
>>in rural locales, there are no suitable alternatives and "St. Elsewhere"
>>is over an hour and a half away. I also don't think patient refusal of
>>recommended care is always a reason to discharge a patient. We
>>sometimes have to agree to disagree.
>
>Ron... I strongly believe that if you do not have the facilities to
>comply with the strict standards set by our College - you cannot offer
>VBAC - period - it does not matter if the next suitable alternative is
>across the street or in the moon - if there is a bad outcome everyone
>will get sued and most probably evryone will have to pay...
>
>You know what I would like to see? - a written opinion - from the
>College - addressing this specific issue - but I doubt very much it
>will..
>
>Good luck..
>
>Ef
>
>--
>" The greatest obstacle to knowledge is not ignorance,
>it is the illusion of knowledge." Daniel J. Boorstin - Historian
>

-- “ The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge.” Daniel J. Boorstin - Historian

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