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Re: vbac on demand From: Lynn Montgomery (apgar10@thebirthcentermt.com) Wed May 14 11:10:25 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Charles Bloom: "Re: vbac on demand" Previous message: Dr Eberhard Lisse: "Re: vbac on demand" In reply to: Dr Eberhard Lisse: "Re: vbac on demand" Next in thread: Dr Eberhard W Lisse: "Re: vbac on demand" Reply: Dr Eberhard W Lisse: "Re: vbac on demand" EL, Unfortunately, in the US, most hospitals have call schedules that all obstetricians with privileges are required to participate in call "town call" or "no-doc call", etc. When you are on that call, you are required to care for any patients who happen to drop into the hospital and don't have a physician with privileges at that hospital. If that patient is in "labor", EMTALA strictly prohibits transport of a "laboring patient". Here in Missoula, we only have one hospital that provides obstetrics and I get saddled with this type of patient all the time. If a patient with a previous cesarean section presented in this circumstance and refused repeat cesarean, other than providing informed consent, I would be stuck to abide by her wishes, unless of course I could get another physician to take care of her, which would not happen. If I assert surgery without her consent, it is felony assault, not to mention the civil liability. In addition, I must mention that I don't get paid for the vast majority of this care provided, I am liable if the patient decides to sue and I must provide care emergency care (so if she is not really in labor and is discharged, but shows up 2 weeks later in labor, she is mine) for 30 days even if I fire her from my care. Lynn -- 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@thebirthcentermt.com -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr Eberhard Lisse Sent: Wednesday, May 14, 2008 9:24 AM To: Multiple recipients of list OB-GYN-L Subject: Re: vbac on demand She's not his patient in the first place, because we are discussing EMTALA which deals with patients who don't have doctors (or insurance). And the statute clearly says, if she doesn't want the recommended treatment she's history. In this particular case there are ACOG recommendations which say Vaginal Bypass. If you get a Justice of the Piece (and the Politburo) to come witness the failure of getting the signature for informed consent, which implies witnessing the informed consent, you can leave the building. Might even happen that the insurance will come up and say, you recommended the right one, she refused you did the wrong thing, which you were not forced to do under EMTALA, so we are not covering you. During a lull in the war, ask you insurance what they say. greetings, el on 5/14/08 12:36 PM Charles Bloom said the following: > The statute reads: > > ...The hospital shall take all reasonable steps to secure the > individual's (or person's) written informed consent to refuse such > examination and treatment. > > That dosen't mean she is not still your patient. > > Check out: http://icanofportland.org/VBACBan.aspx > http://www.ican-online.org/vbac/enforcing-and-promoting-rights-women-see king > -vaginal-birth-after-cesarean-vbac-primer > > We are all in a quagmire my friends. There are many no-win situations in > obstetrics. > > Charles > > -----Original Message----- > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr > Eberhard W Lisse > Sent: Wednesday, May 14, 2008 1:24 AM > To: Multiple recipients of list OB-GYN-L > Subject: Re: vbac on demand > > Read the statute :-)-O > > el > > On May 14, 2008, at 02:48, Efrain Ramirez wrote: > >> el - I don't think you can do that in this case...EMTALA has been >> triggered IMHO.. >> >> Ef >> >>> At Tue, 13 May 2008, Dr Eberhard Lisse wrote: >>> >>> Nope, >>> >>> you document, document and *DUMP* her for disqualifying herself from >>> EMTALA as she is not your patient. >>> >>> el >>> >> -- >> "I can accept failure, but I can't accept not trying." - Michael >> Jordan >> > -- Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar) el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell) PO Box 8421 \ / Please do NOT email to this address Bachbrecht, Namibia ;____/ if it is DNS related in ANY way Next message: Charles Bloom: "Re: vbac on demand" Previous message: Dr Eberhard Lisse: "Re: vbac on demand" In reply to: Dr Eberhard Lisse: "Re: vbac on demand" Next in thread: Dr Eberhard W Lisse: "Re: vbac on demand" Reply: Dr Eberhard W Lisse: "Re: vbac on demand"

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