Comments on: http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54788 Anonymous Fri, 26 Aug 2005 13:40:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54788 "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." <br/><br/><br/><br/>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. “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.

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54784 Anonymous Fri, 26 Aug 2005 10:58:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54784 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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54781 Anonymous Fri, 26 Aug 2005 04:54:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54781 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". 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”.

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54778 Anonymous Fri, 26 Aug 2005 02:26:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54778 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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54769 Anonymous Thu, 25 Aug 2005 18:55:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54769 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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54768 Anonymous Thu, 25 Aug 2005 18:51:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54768 "I don't think you're having a heart attack, but because of liability purposes, I recommend going to the ER".<br/><br/>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. “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.

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54761 Anonymous Thu, 25 Aug 2005 15:55:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54761 <i>Would having such a signed form protect doctors from future litigation?</i><br/><br/>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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54758 Anonymous Thu, 25 Aug 2005 15:07:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54758 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". <br/><br/>Or "I don't think you're having a heart attack, but because of liability purposes, I recommend going to the ER".<br/><br/>Patients understand. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54756 Anonymous Thu, 25 Aug 2005 14:46:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54756 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<br/>Would having such a signed form protect doctors from future litigation? 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?

]]> By: Anonymous http://www.kevinmd.com/blog/2005/08/death-of-vbac-for-some-women-birth-has.html/comment-page-1#comment-54755 Anonymous Thu, 25 Aug 2005 14:41:00 +0000 http://clients.emmense.com/kevinmd/2005/08/18797.html#comment-54755 "I pay my doc not for skipping medical risks, but for providing me the best of care." <br/>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. “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.

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