Thursday, March 30, 2006
Here's a case where OB's were sued for using an FDA category C medication (propranolol) in a pre-natal death. The problem is, many safe medications don't have, and never will have, studies demonstrating pregnancy safety - thus leaving them category C. This lawsuit will further limit the medication choices for pregnant women.
Posted by Kevin |
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Comments:
This is just someone filing suit. Bad outcomes will happen. People will sue. Practicing defensive medicine will not change the above. Preventing people from suing is a cure worse than the disease.
Quite an objective unbiased opinion. Next commentor is Whitney Houston, giving an objective opinion about legalizing Crack Cocaine.
# posted by 
: 2:34 PM
: 2:34 PM
let's stretch it a bit further
"Bad outcomes will happen"->
"People will sue" -> most of the time can't collect as their claim was dubious in the first place -> cause the defendent all types of aches and pains not to mention money -> can't collect the fees -> Defendant sucks it up for greater good to humanity.The system doesn't make them whole.lose-lose situation at best. -> Defensive medicine won't change that -> we know what can change it -> Guess rest of the world practice it ->->-> LOSER PAYS
-> vindicating people by reckless suing is the disease and 'loser pay' is the cure
"Bad outcomes will happen"->
"People will sue" -> most of the time can't collect as their claim was dubious in the first place -> cause the defendent all types of aches and pains not to mention money -> can't collect the fees -> Defendant sucks it up for greater good to humanity.The system doesn't make them whole.lose-lose situation at best. -> Defensive medicine won't change that -> we know what can change it -> Guess rest of the world practice it ->->-> LOSER PAYS
-> vindicating people by reckless suing is the disease and 'loser pay' is the cure
# posted by : 2:49 PM
: 2:49 PM
"The problem is, many safe medications don't have, and never will have, studies demonstrating pregnancy safety"
Actually, there are studies that certain antihypertensive meds such as beta blockers are safer than nonbeta blockers in women with hypertension as the link below shows. It also shows that hypertension in pregnancy is associated with a higher degree of complications.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60658
If I were an OB, I'll just refer these women to OB's who limit their practice to high risk pregnancy only.
-amd
Actually, there are studies that certain antihypertensive meds such as beta blockers are safer than nonbeta blockers in women with hypertension as the link below shows. It also shows that hypertension in pregnancy is associated with a higher degree of complications.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60658
If I were an OB, I'll just refer these women to OB's who limit their practice to high risk pregnancy only.
-amd
# posted by : 3:40 PM
: 3:40 PM
In medical school we all learned that you give hydralazine to treat hypertension in pregnancy or pre-eclampsia...but that is category C as well. I always tell pregnant patients not to take anything and I never prescribe them anything; if they do need a medication I refer them to a consultant (e.g. cardiologist for BP). Defensive medicine would have helped these two docs if they had referred the patient to a cardiologist to cover themselves, then the cardiologist would be on the hook...thanks Kevin for the heads up...you are doing all of us docs a great service by teaching us how to avoid these pitfalls and protect ourselves from these patients.
# posted by : 3:52 PM
: 3:52 PM
Elliot is right. This is a news release, one sided, direct from the lawyers office. Especially in small towns, it creates tremendous pressure on the practitioner to settle. It's a favorite tactic.
A colleague of mine (not the OB) was involved in a bad outcome from a cesarean delivery. He received in the mail 8 X 10 glossy photos of the mom holding the infant in the NICU, with all the iv's and monitor wires prominently shown. The accompanying note from the attorney asked the doc if he thought he could fight this case in court and suggested settlement.
When the baby died a few days later, those same photos appeared on the front page of one of our local papers.
A colleague of mine (not the OB) was involved in a bad outcome from a cesarean delivery. He received in the mail 8 X 10 glossy photos of the mom holding the infant in the NICU, with all the iv's and monitor wires prominently shown. The accompanying note from the attorney asked the doc if he thought he could fight this case in court and suggested settlement.
When the baby died a few days later, those same photos appeared on the front page of one of our local papers.
# posted by : 4:19 PM
: 4:19 PM
I don't think people really understand what the categories say. Here's a version for lay persons.
A: means that drug has been tested in pregnant humans. Get real! For practical purposes, there are no A drugs. No one would test an unknown drug on a pregnant woman.
B: means tested on pregnant mammals and studied, not tested, in pregnant women. No increased risks noted.
C: means neither tested on pregnant mammals nor formally studied in pregnant humans. So judgment is called for.
D: means it has been studied and there are known risks in pregnant women; in selected cases, benefits may outweigh the risks, but use very cautiously. The classics are anti-seizure meds.
X - banned.
A: means that drug has been tested in pregnant humans. Get real! For practical purposes, there are no A drugs. No one would test an unknown drug on a pregnant woman.
B: means tested on pregnant mammals and studied, not tested, in pregnant women. No increased risks noted.
C: means neither tested on pregnant mammals nor formally studied in pregnant humans. So judgment is called for.
D: means it has been studied and there are known risks in pregnant women; in selected cases, benefits may outweigh the risks, but use very cautiously. The classics are anti-seizure meds.
X - banned.
# posted by : 5:03 PM
: 5:03 PM
"-> Guess rest of the world practice it ->->-> LOSER PAYS"
We already have that.
But hey, while we're getting what the rest of the world has, can we get some universal health care?
We already have that.
But hey, while we're getting what the rest of the world has, can we get some universal health care?
# posted by : 5:05 PM
: 5:05 PM
" most of the time can't collect as their claim was dubious in the first place "
What percent of all claims are "dubious"?
What percent of all claims are "dubious"?
# posted by : 5:14 PM
: 5:14 PM
I'm an OB. With HTN and pregnancy the preferred drug is aldomet. For beta blockers the preferred drug is labetalol, which although class c, seems to have fever problems than propranolol or atenolol.
This pregnancy, from the article seemed to be high risk, with bleeding and HTN. Htn patients are at risk for unexplained stillbirth, even with close supervision such as twice weekly NST's or weekly BPP's. This surveillence will reduce the risk from the chronic effects of HTN. But nothing can predict abruption which can occur at any time with HTN. If the fetal death was from abruption, this is an unpredictable event that can't be screened for....But since I don't know the case I can only speculate....
This pregnancy, from the article seemed to be high risk, with bleeding and HTN. Htn patients are at risk for unexplained stillbirth, even with close supervision such as twice weekly NST's or weekly BPP's. This surveillence will reduce the risk from the chronic effects of HTN. But nothing can predict abruption which can occur at any time with HTN. If the fetal death was from abruption, this is an unpredictable event that can't be screened for....But since I don't know the case I can only speculate....
# posted by : 5:38 PM
: 5:38 PM
It seems like the woman was taking the propranolol before the pregnancy...so the docs did not make a point of telling her to stop taking it. I'm pretty sure most docs would be hesitant to prescribe anything new to a pregnant woman because of the litigious society we are in...but I think it's an easier blunder to make to overlook telling someone to stop something they have been taking already for a while...I wonder if this was the case.
# posted by : 7:27 PM
: 7:27 PM
They were probably bust and overlooked her medication list....I once had a woman come in complaining of vag itch, I gave her flagyl for bacterial vaginosis (class C). She told me she had no medical problems and Only that night when I was writing my charts did I realize the nurse had documented she was on "prenatal vitamins". Hard to know everything when I see 4-5 patients an hour. I should have just let her itch.
# posted by : 7:59 PM
: 7:59 PM
"I should have just let her itch."
What a prince you are. So, what would your net income before taxes be if you saw, say, 3 patients an hour?
What a prince you are. So, what would your net income before taxes be if you saw, say, 3 patients an hour?
# posted by : 12:07 AM
: 12:07 AM
Seeing three patients per hour might cover his overhead. Maybe. And then the other 1-2 ladies would have to go on itching.
# posted by : 12:14 AM
: 12:14 AM
"What a prince you are. So, what would your net income before taxes be if you saw, say, 3 patients an hour?"
I'm An ER Doc. I get paid the same whether I see 1 patient or 50. The way things have been going I'll be all that's left in a few years. I agree, that's scary.
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I'm An ER Doc. I get paid the same whether I see 1 patient or 50. The way things have been going I'll be all that's left in a few years. I agree, that's scary.
# posted by : 1:14 AM
: 1:14 AM
