Wednesday, August 24, 2005
The death of VBAC
"For some women, birth has become the latest battleground for reproductive rights.
At a growing number of hospitals, women are being forced to schedule a repeat cesarean section just because they already had one. Doctors and hospitals say they fear lawsuits if they allow a patient to attempt a vaginal birth after a C-section - called a VBAC - and something goes awry.
'We think the risk is more of a legal risk than a medical risk,' acknowledges Bob Wentz, CEO of California's Oroville Hospital, which banned VBACs two years ago.
As the overall C-section rate in the USA continues to climb, so will the proportion of pregnant women who have already had one. C-sections hit an all-time high of 27.6% in 2003, the most recent year for which information is available." (via Overlawyered)
"For some women, birth has become the latest battleground for reproductive rights.
At a growing number of hospitals, women are being forced to schedule a repeat cesarean section just because they already had one. Doctors and hospitals say they fear lawsuits if they allow a patient to attempt a vaginal birth after a C-section - called a VBAC - and something goes awry.
'We think the risk is more of a legal risk than a medical risk,' acknowledges Bob Wentz, CEO of California's Oroville Hospital, which banned VBACs two years ago.
As the overall C-section rate in the USA continues to climb, so will the proportion of pregnant women who have already had one. C-sections hit an all-time high of 27.6% in 2003, the most recent year for which information is available." (via Overlawyered)
Posted by Kevin |
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Comments:
I'm a mother of 8 in The Netherlands.
I didn't have easy births as some people think, but I had the opinion that what nature gets in, nature will let out.
I never accepted painkilling because I wanted my baby to be as unharmed as possible.
You are right in considering a repeat C-section taking care of the legal risks.
It's time people get aware that nature is a force on itself and non can guarantuee a good outcome. Never. Not with hurricanes and not with childbirth.
I also think that women in my country are more aware of the fact that a C-section is a mayor operation, with the risks that go with a mayor operation.
I think every c-section should be conducted after carefull and realistic consideration of the medical profits and costs for both mother and child.
I pay my doc not for skipping medical risks, but for providing me the best of care.
I didn't have easy births as some people think, but I had the opinion that what nature gets in, nature will let out.
I never accepted painkilling because I wanted my baby to be as unharmed as possible.
You are right in considering a repeat C-section taking care of the legal risks.
It's time people get aware that nature is a force on itself and non can guarantuee a good outcome. Never. Not with hurricanes and not with childbirth.
I also think that women in my country are more aware of the fact that a C-section is a mayor operation, with the risks that go with a mayor operation.
I think every c-section should be conducted after carefull and realistic consideration of the medical profits and costs for both mother and child.
I pay my doc not for skipping medical risks, but for providing me the best of care.
"I pay my doc not for skipping medical risks, but for providing me the best of care."
Actually, you're paying your docs office costs, costs of tests he needs to do (ultrasounds, anesthesia consult, neonatology on call) that are simply not necessary but are defensive. You are also paying your OB for every pregnancy that has resulted in a bad outcome in this country, that has led to his $150,000 a year malpractice insurance coverage. If this is the "best of care" so be it. Just realize if you are a woman who's uterus is being sliced open to deliver a baby, you have the John Edwards of the world to thank for your surgical incision.
Actually, you're paying your docs office costs, costs of tests he needs to do (ultrasounds, anesthesia consult, neonatology on call) that are simply not necessary but are defensive. You are also paying your OB for every pregnancy that has resulted in a bad outcome in this country, that has led to his $150,000 a year malpractice insurance coverage. If this is the "best of care" so be it. Just realize if you are a woman who's uterus is being sliced open to deliver a baby, you have the John Edwards of the world to thank for your surgical incision.
# posted by 
: 9:41 AM
: 9:41 AM
This is more of a question than a comment. Many patients, I believe would prefer if my doctor's decisions are based on medical necessity than a legal risk. Yet I understand the fear of beeing sued as well. So why isn't it possible to a) tell a patient honestly about the risks associated with either choice b) even while making a recommendation that is based on a fear, make it clear that this recommended choice is not necessarily based on science c) if the patient's choice has higher risk of future litigation, ask the patient to sign a release form that absolves the doctor of liability
Would having such a signed form protect doctors from future litigation?
Would having such a signed form protect doctors from future litigation?
# posted by : 9:46 AM
: 9:46 AM
I do that all the time. I tell my patients: "I don't think you need a CT scan, but I'll recommend it for liability purposes".
Or "I don't think you're having a heart attack, but because of liability purposes, I recommend going to the ER".
Patients understand.
Or "I don't think you're having a heart attack, but because of liability purposes, I recommend going to the ER".
Patients understand.
# posted by : 10:07 AM
: 10:07 AM
Would having such a signed form protect doctors from future litigation?
No. That's the problem. Your doc can still be sued if he deviates from an established standard of care, irregardless of what you sign.
No. That's the problem. Your doc can still be sued if he deviates from an established standard of care, irregardless of what you sign.
# posted by : 10:55 AM
: 10:55 AM
"I don't think you're having a heart attack, but because of liability purposes, I recommend going to the ER".
You've got to be careful how you word "I don't think you're having a heart attack". On our AMA forms, it's very specific: "You are at risk of death" if you don't follow our recommendations. On the inside I know it's alot of crap, that there's nothing wrong with the patient, but I have only a million of coverage to back me up on this, so on the outside, I have to act like it's a life or death situation they are admitted for their bogus chest pain.
You've got to be careful how you word "I don't think you're having a heart attack". On our AMA forms, it's very specific: "You are at risk of death" if you don't follow our recommendations. On the inside I know it's alot of crap, that there's nothing wrong with the patient, but I have only a million of coverage to back me up on this, so on the outside, I have to act like it's a life or death situation they are admitted for their bogus chest pain.
# posted by : 1:51 PM
: 1:51 PM
I've actually had a malpractice lawyer laugh and tell me how easily he can blow through an AMA form in court like it's not even there, so even that doesn't protect us against the sharks.
# posted by : 1:55 PM
: 1:55 PM
First you can be sued even if you follow the standard of care to the letter. YOu may win after a gut wrenching round of depositions, conferences and the humiliation of being insulted in open court at the cost of many thousands of dollars and lost time. you may lose because the patient says that she didnt understand the explanation but didnt ask or just because the jury felt like it. To wit: the guy who gave informed consent for a PSA, patient agreed not to have the test, later got ca of the prostate, sued and won. You always have to second guess every action and how it can be perceived.
# posted by : 9:26 PM
: 9:26 PM
The one thing I do with AMA's: I get a witness to c0-sign. That way if it ever comes up I coerced a plaintiff into signing his AMA I can prove a third party (usually a nurse) explained the AMA to him/her without prejudice. One tactic I like that is done at one ER is they have the desk clerk witness the AMA. She is like a "disinterested third party".
# posted by : 11:54 PM
: 11:54 PM
12:54 AM, I don't litigate med-mal cases, but unless the "desk clerk" is at a hotel where you're making a house-call, I don't think I'd have any trouble suing the employer of the desk clerk as your co-defendant, adding a conspiracy count to get past summary judgment, and then persuading the jury that the form doesn't matter. Is your desk clerk trained to know whether a patient is knowingly signing the form with full understanding? Is your desk clerk willing to testify that he or she felt free to refuse a doctor's order to sign the form as a witness? (And even if he or she is, has there even been an incident where the desk clerk refused to witness?) If not, they're hardly a "disinterested third party," and I'll tell the jury that it's a rubber-stamp, and part of the evidence of the shoddy railroaded health-care my poor client had to go through.
# posted by : 5:58 AM
: 5:58 AM
"I'll tell the jury that it's a rubber-stamp, and part of the evidence of the shoddy railroaded health-care my poor client had to go through."
So "You're client" is not allowed to refuse health care if he is competent? Are we suppose to physically restrain a patient if they want to leave against medical advice? I currently am being sued by the family of a patient who came up to me (after already being admitted, waiting for a bed)and asked me if she could go home. I re-examined her, and let her go. I didn't AMA her. She dropped dead 10 days later. So if I had AMA'd her I'd be "railroading" her? I can't wait to get out of this profession.
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So "You're client" is not allowed to refuse health care if he is competent? Are we suppose to physically restrain a patient if they want to leave against medical advice? I currently am being sued by the family of a patient who came up to me (after already being admitted, waiting for a bed)and asked me if she could go home. I re-examined her, and let her go. I didn't AMA her. She dropped dead 10 days later. So if I had AMA'd her I'd be "railroading" her? I can't wait to get out of this profession.
# posted by : 8:40 AM
: 8:40 AM
