Drug abuse is here is a horrible problem, not only with meth, but also oral
analgesics. The state has laws that forbid prescribing methadone for longer
than 72 hours. Because of this, I have been stuck three times after being
called by the detention center telling me that they have a pregnant heroin
addict who they arrested, withdrawing. So, screening is a nice idea, but
you have to have provisions for the screening and what to do with the
positive results once obtained. When the state ranks 48th in economics,
there ain't no money for programs.
--
Lynn D. Montgomery, M.D.
Obstetrics & Gynecology, Maternal-Fetal Medicine
The Birth Center/Rocky Mountain Women's Health
1211 S. Reserve St.
Missoula, Montana, 59801
406-549-0978
fax 406-549-0987
e-mail: apgar10@qwest.net
_____
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
Theresa333@aol.com
Sent: Monday, September 04, 2006 8:22 PM
To: Multiple recipients of list OB-GYN-L
Subject: Urine Drug Testing
Drug use is everywhere. It is a very real risk that our OB patients have
and we, as clinicians, can't always "pick up" on who is actually using
during pregnancy. Implementing a policy that could direct the women
actively using toward help, protecting us from even more malpractice risks,
and being fair to all patients is tricky.
In an Illinois hospital I trained in perinatology they had switched to a
protocol whereby mothers with unexplained bleeding, fetal or maternal
cardiac arrhythmia, or any transfer to NICU was screened. They increased
their "pick up" by 20%; they were surprised to find some of the positives
were well-to-do Caucasian women not considered high--risk. These women had
resources to access help and did.
Rural and urban populations have many unidentified drug users. We should
try to identify them, just like we try to identify gestational diabetes,
syphilis, and other problems in pregnancy. It is part of being a thorough
clinician and doing a good job.
Theresa Bartos Holladay, DO
Lakeside Women's Health Center
Ludington, MI
http://www.DoctorHolladay.com
In a message dated 9/4/2006 6:28:29 P.M. Eastern Standard Time,
ob-gyn-l@obgyn.net writes:
I have a quick question and what I think may be a big problem.
Is anyone else doing urine drug screens as a routine part of prenatal care?
It seems that the other providers in my rural area are doing a urine screen
during pregnancy. So now we are getting all the patients that are abusing or
train wrecks waiting to happen.
Our administration talked to the lawyers and they said as long as we test
everyone, then we can do RDS screens on all OBs at least once. If they are
posi
tive, we then refer them to the treatment centers in the area and our DHHR
Right From The Start Program. Positive test patients are then referred for
a
social service consult at delivery and the peds test the baby.
Someone around here said the ACOG standards changed to approve of RDS, but
I
can't find any references.
I have some moral and ethical heartburn with this situation, but I am not
quite sure what I need to do. We have to report the drug use if the baby is
positive at birth, but in WV there is not a mandatory reporting law for
pregnancy. The treatment options are scarce. If they are medicaid, then
there is an
outpatient treatment center with once a week meetings. If they are private,
most insurances will not pay for therapy.
According to administration, as long as I give the referral information to
the pt (phone numbers, contacts), then we are covered legally.
An example that has us sick with worry:
35 yo G6 P3 TAB X 2 who does not have custody of her children because of
drug abuse. She was still abusing (but didn't admit to anything but THC),
alcoholic (she had CUT DOWN to one case of beer per day). I did the initial
OB
intake and physical. When she came back a week later for US with our OB, she
had
a fetal demise. The OB did a D&C, but she continued to bleed and bleed. The
only IV line they could get was a leg vein. She had a lateral tear on the
cervix that he thought was the cause, but it didn't stop after repair.
During the
course of the train wreck the general surgeon came in and put in a central
line. By the time he opened her belly,she had 3000 cc blood in the belly.
DIC
and it is a long mountain road downhill. After God knows how many units of
PRBCs and everything else he could think of- he did an emergency hyst. She
still bled and he packed her belly and flew her off to our referral center.
They
removed packing, opened and repacked, removed the packing and the opened
her
again and found a ruptured spleen. Then they did an uterine artery embolism
and she finally quit bleeding. But she is still in hepatic and renal
failure.
I forgot to mention that she was Hep C positive with no treatment. They
said
the only way to save her is a liver transplant and she is not a candidate.
I have done 3 new OBs in the last week that are almost as bad. That is why
the administration wants to do the RDS on the first visit or for the already
established patients, once at their next visit. I think it is knee jerk
cover
our butts reaction, but I don't blame them. WV is one of the highest
litigation states and it is next to impossible to get malpractice already.
Suggestions?
If ACOG standards have changed, can someone give me the reference please.
Thank you,
Vicki
Vicki Smith, CNM, MSN
West Virginia
Midwives- changing the world one baby at a time.
Love,
Theresa Ed AshleyBen and John Holladay
