Re: Insurance 'recommendations' for practice FRI
From: art fougner, md (evsono@pipeline.com)
Thu Jul 20 07:16:33 2006
What will they do - put the carrier on 'Double Secret Probation'?
Art
At Wed, 19 Jul 2006, Efrain Ramirez wrote:
>
>I sure hope ACOG will take a strong stance against this policy..
>
>Ef
>
>>At Wed, 19 Jul 2006, Lynn Montgomery, MD wrote:
>>
>>Ef,
>>I sent an e-mail briefly outlining the issue and asked for direction on who
>>to contact in an "official" capacity at ACOG. Haven't heard anything back
>>yet.
>>Lynn
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
>>Ramirez
>>Sent: Wednesday, July 19, 2006 5:26 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Insurance 'recommendations' for practice
>>
>>Amazing..
>>
>>Lynn may I forward this to ACOG's Liability Forum?
>>
>>Ef
>>
>>>At Wed, 19 Jul 2006, Lynn Montgomery, MD wrote:
>>>
>>>Listers,
>>>I am pissed and I apologize in advance because y'all are my closest
>>>sounding board...
>>>
>>>I received a booklet in the mail from the medical malpractice insurance
>>>company that covers most of us in Montana. The booklet is titled,
>>>"Insurance Recommendations for Obstetrical Practice". Under the title
>>>on the cover page is says, "There are only two options for delivery: An
>>>easy vaginal delivery or an easy cesarean section".
>>>
>>>The booklets starts off by making the following statement, "Failure to
>>>abide by the insurance recommendations in the absence of the patient's
>>>written consent will not affect coverage provided under a policy then
>>>in effect, but may result in non-renewal of the policy or renewal with
>>>an exclusion of the coverage for obstetrical care".
>>>
>>>The booklet then lists basically all types of obstetric management and
>>>situations and provides very matter of fact direction on how each of
>>>these situations should be managed. Dictums are provided - no
>>>acceptable alternative, one way, period. Further, the booklet contains
>>>NO references or bibliography.
>>>
>>>Some examples of the "recommendations"
>>> -"it is inappropriate to discuss serum screening in terms of "false
>>>positives". Rather this should be offered to all pregnant women in
>>>order to determine whether or not they are at increased risk for Down's
>>>syndrome, and the absolute magnitude of this risk."
>>>
>>> -"cesarean section is almost always the appropriate route of
>>>delivery for lack of progress in labor, unless criteria for outlet forceps
>>are met."
>>>
>>> -"all singleton breech fetuses (24+ weeks gestational age) should
>>>be delivered by cesarean section."
>>>
>>> -"VBAC - Elective induction is contraindicated. The only
>>>acceptable oxytocin regimen is a starting dose of 1mU/min, increasing
>>>by 1 mU every 30 minutes."
>>> The following quote is included, "Remember that most cases of
>>>uterine rupture will be heralded by the appearance of new, significant
>>>variable decelerations. A low threshold for intervention in the
>>>presence of such decelerations, even with good variability and
>>>accelerations, in mandatory in the VBAC patient".
>>>
>>> -"When misoprotol is used with a living fetus, which is potentially
>>>viable exutero, the following precautions are mandatory:
>>> The dose is 0.25 mcg vaginally
>>> The dose cannot be repeated more frequently than every 4 hours
>>> Elective induction with misoprotol is contraindicated"
>>>
>>>These are only a very few examples of the mandates listed on 25 pages.
>>>I am personally offended by the fact that an insurance organization, to
>>>whom I pay thousands of dollars in premiums is providing mandates, not
>>>suggestions, on the management of patients that I trained to care for
>>>over many years of residency, fellowship and practice. Further, it has
>>>been beat into me by every mentor worth his/her salt that management
>>>should be based on review of the most current literature. Many of the
>>>recommendations included in this booklet are not necessarily
>>>substantiated by our body of literature, but rather based on legal case
>>>history. As such, we are being coerced into practicing medicine based
>>>on law rather than medicine. I was further personally offended by the
>>>fact that a booklet like this is issued without the inclusion of
>>>references or bibliography - probably because most of it would be
>>>referenced in West Law. It is time that the fricking attorneys stayed up
>>watching a tracing at 2:00 am like I did last night.
>>>Lynn
>>
>>--
>>" 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
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
