Re: vbac on demand
From: Efrain Ramirez (eramirezt@coqui.net)
Thu May 15 05:47:50 2008
El-- she is not refusing treatment - she is not consenting to one of the
treatment options .. jeopardizing her unborn child but for her,
apparently, is of no concern. -- BTW - how did the whole drama turn
out?
Ef
At Wed, 14 May 2008, Dr Eberhard W Lisse wrote:
>
>Lynn,
>
>the statute reads to me, that if a patient refuses treatment she is not
>covered by EMTALA any more.
>
>I am not saying or have ever said that that one should even
>contemplate forcing surgery. I am also not saying that an "own"
>doctor should abandon her.
>
>The way I read EMTALA is that someone who does *not* have an
>"own" physician can not be dumped, unless, and that I still
>maintain, unless she refuses treatment, which is reasonable
>as in this case, an ACOG recommendation.
>
>The statute says hospital, not physician, and I am not sure, emergency
>treatment under the statute without payment establishes a doctor-patient
>relationship.
>
>But, the idea can not be to use this statute to force an obstetrician
>to perform a VABC against his wishes on a patient he's never
>seen before.
>
>el
>
>On May 14, 2008, at 17:12, Lynn Montgomery wrote:
>
>> 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.
--
"I can accept failure, but I can't accept not trying." - Michael Jordan
