Re: Malpractice questionairre
From: R. Daniel Braun (rd.braun@gmail.com)
Wed Jun 27 13:47:30 2007
I would suggest that you state what you really do. If you are ever going to
get them, I would do it if the 5 minute apgar is 6 or less. This is exactly
what I did, when I was still delivering. I would collect a cord segment on
all deliveries and set it on the table. When I heard the 5 minute apgar, if
it was 6 or less, I would send them down to the lab for gasses.\
However in my opinion, that is also worthless as is any Apgar score done
these days. I have not seen a correctly done Apgar score for over 20 years.
An Apgar score is a procedure that is DONE at 1 and 5 minutes. It includes
putting a catheter in the babies nostril to elicit a reflex response e.g.
cough/sneeze=2, grimace =1, no response=0.When you ask the peds at 8 minutes
what were the Agar scores and the response is "I don't know, I will have to
think about it when I get around to it and let you know" then you know that
they didn't do it.
They usually tell you, we were too busy to do it at the appropriate times.
OK, then report Apgar NOT DONE. Don't make up some false value 30 minutes
later that will become a significant issue in a court of law 4-10 years down
the line.
Dan
On 6/27/07, Elrod, Darryl G Maj 48 MDOS/SGOBO <
Darryl.elrod@lakenheath.af.mil> wrote:
>
> So Garry and Dan,
>
> What would you tell the malpractice carrier? I do exactly the same as
> Garry. Floppy baby, bad strip, etc I will collect the cord for possible
> sample. If baby has looked great and comes out screaming, I don't.
>
> Like Dan said, this could come back to haunt me later, I suppose.
>
> Glen
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
> E. Siegel, M.D.
> Sent: Tuesday, June 26, 2007 6:17 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Malpractice questionairre
>
> Dan:
>
> Don't hold your thoughts back. . .
>
> Garry
>
> FWIW, if the apgars are good, I don't do them. If the apgars aren't, or
> the tracing was funny/meconium or maybe things don't seem right, then I
> do them--not very often, though.
>
> Garry
>
> At Tue, 26 Jun 2007, R. Daniel Braun wrote:
> >
> >All cord gases do is cover the insurance comany's ass at the expense pf
> the
> >patient. They are of no value to the mother or the newborn and are a
> waste
> >of money.
> >I can say that since I am now retired and don't have to purchase
> Malpractice
> >insurance any longer.
> >
> >Dan
> >
> >On 6/26/07, Elrod, Darryl G Maj 48 MDOS/SGOBO <
> >Darryl.elrod@lakenheath.af.mil> wrote:
> >>
> >> Joe,
> >>
> >> Yeah! I know. There are a bunch of questions all like that.
> >> Thankfully, most I 'do' the right thing and don't have to explain
> >> myself. It just got me questioning if on this one I SHOULD be
> >> collecting a sample of cord for gases on each and every delivery.
> Did I
> >> miss some new policy statement that makes it standard of care? Of
> >> course the malpractice carrier will be the first ones to pick up on
> this
> >> for sure.
> >>
> >> Glen
> >>
> >> -----Original Message-----
> >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joe
> >> Sent: Tuesday, June 26, 2007 1:34 AM
> >> To: Multiple recipients of list OB-GYN-L
> >> Subject: Re: Malpractice questionairre
> >>
> >> Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
> >> > I am filling out my first malpractice questionnaire. It read
> through
> >> a
> >> > list of questions and if you pick the 'wrong' answer (ie Do you
> apply
> >> > fundal pressure for relief of shoulder dystocia? If YES, then
> >> explain)
> >> > they make you explain the answers.
> >> >
> >> > One of the questions is 'Do you routinely collect cord blood at ALL
> >> > deliveries' If NO, then explain.
> >> >
> >> > Somehow, because I was trained that way, just doesn't seem salient.
> >> > What do you all do with regard to cord blood collection at delivery
> >> and why?
> >> >
> >> > Thanks,
> >> >
> >> > Glen
> >> >
> >> Is this for your own insurance carrier? From legal point of view
> >> whatever you put in print may come back to haunt you. Joe C
> >>
> >--
> >R. Daniel Braun, MD FACOG(L) CMT
> >Professor Emeritus
> >Dept. of Obstetrics and Gynecology
> >Indiana U. School of Medicine
> >
> >R. Daniel Braun
> >
> > "Science without Religion is LAME; Religion without Science is
> BLIND"
> > Einstein 1941
> >
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
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