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Re: EFMFrom: ainsron (ainsron@sbcglobal.net)Wed Jul 11 17:41:08 2007
Agree! Agree! Agree! Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of William D. McIntosh, M.D Sent: Wednesday, July 11, 2007 6:32 AM To: Multiple recipients of list OB-GYN-L Subject: Re: EFM If the current Dept Chief wants to take over the management of one of my patients without my permission, he had better bring a sack lunch and a lot of help, because it is going to be a long, hard day. He has no legal or professional standing to overrule my management as long as I am physically and mentally competent. He might not like my plan, and my privileges might be challenged later, but the relationship between my patient and me is not open to review by my hospital. SHE can fire me, or SHE can sue me, but the poor sod stuck with Dept Chair has no jurisdiction over that relationship. Management might be open to debate, but in the end, I would be the only doctor in the room with a doctor-patient relationship (in both the legal and professional senses), and that relationship can only be altered by the direct participants. For that matter, if he were to touch the patient without her permission, would that not constitute assault? William D. McIntosh, MD, FACOG Clarksville, TN -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Robert J. Carpenter, Jr. MD, JD Sent: Tuesday, July 10, 2007 7:50 PM To: Multiple recipients of list OB-GYN-L Subject: Re: EFM Given facts of the case, your responsibility as service chief is evaluation of the nurse's concern as chain of command decision-maker. If you agreed with the nurse, then discussion with the attending MD about your agreement is mandated. If he did not agree to C/S, then you could/should take over management after discussion with the patient concerning the events, findings, and the differences in opinion. If you do not agree with the nurse then you have fulfilled your duties and continued management of the labor would be appropriate. If following the delivery, the nurse's opinion is validated and continued vaginal delivery was allowed, then you may have to explain why you made the decision you did and failed to intervene. On the otherhand, if the baby is severely impaired, you may have to prove that the interval from your consultation to the penultimate delivery, did not change the outcome of the patient. It is not an enviable situation to be in but been there, done that, and I have both intervened and continued current management. As Mr. Truman said: "The buck stops here." True for all of us in chain of command status. Look fwd to the outcome Robert J. Carpenter, Jr. MD, JD 6624 Fannin, #2720 Houston, TX 77030 (O) 713-795-4600 (F) 713-795-4422 "Life is difficult" The Road Less Travelled by Scott Peck Premier Medical Group's HIPAA Compliance Policy states that unencrypted Protected Health Information (PHI) will not be sent to external email recipients. If this email contains PHI, please inform both the original sender and Premier Medical Group's Security Officer (securityofficer@premiermed.com or 931-245-7044) of this policy violation. Thank you for assisting us in our commitment to safeguard our patients' personal information.
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