Re: Insurance "recommendations" for practice
From: Charlie Chambers (ricechaz@earthlink.net)
Mon Jul 24 13:59:02 2006
Somehow I'm not surprised by their lack of response.
On Jul 24, 2006, at 9:52 AM, Lynn Montgomery, MD wrote:
> Interesting, my knee jerk reaction, as well as most on the list,
> was to contact ACOG. I inquired to the specific ACOG liability
> source and got NO response what-so-ever. Really beginning to make
> me wonder why I pay that $800 per year...
> Lynn
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> ainsron
> Sent: Monday, July 24, 2006 10:34 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Insurance "recommendations" for practice
>
> I agree with you, I would be pissed too. Are other carriers an
> option? Can your ACOG district offer any assistance on reviewing
> this piece of trash?
>
> Ronald E. Ainsworth, MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Lynn Montgomery, MD
> Sent: Wednesday, July 19, 2006 6:46 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Insurance "recommendations" for practice
>
> 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
>
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