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Abstract
While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable.
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Affiliation(s)
- Hari Eswaran
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine
- Institute of Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Everett F Magann
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine
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Affiliation(s)
- Corrette Ploem
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam
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Terp S, Wang B, Burner E, Arora S, Menchine M. Penalties for Emergency Medical Treatment and Labor Act Violations Involving Obstetrical Emergencies. West J Emerg Med 2020; 21:235-243. [PMID: 32191181 PMCID: PMC7081879 DOI: 10.5811/westjem.2019.10.40892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/12/2019] [Accepted: 10/16/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition - labor - specifically included in the title of the law. In light of rising maternal mortality rates in the United States, further exploration into the state of emergency obstetrical (OB) care is warranted. Understanding civil monetary penalty settlements levied by the Office of the Inspector General (OIG) related to EMTALA violations involving labor and other OB emergencies will help to inform the current state of access to and quality of OB emergency care. METHODS We reviewed descriptions of all EMTALA-related OIG civil monetary penalty settlements from 2002-2018. OB-related cases were identified using keywords in settlement descriptions. We described characteristics of settlements including the nature of the allegation and compared them with non-OB settlements. RESULTS Of 232 EMTALA-related OIG settlements during the study period, 39 (17%) involved active labor and other OB emergencies. Between 2002 and 2018 the proportion of settlements involving OB emergencies increased from 17% to 40%. Seven (18%) of these settlements involved a pregnant minor. Most OB cases involved failure to provide screening exam (82%) and/or stabilizing treatment (51%). Failure to arrange appropriate transfer was more common for OB (36%) compared with non-OB settlements (21%) (p = 0.041). Fifteen (38%) involved a provider specifically directing a pregnant woman to proceed to another hospital, typically by private vehicle. CONCLUSION Despite inclusion of the term "labor" in the law's title, one in six settlements related to EMTALA violations involved OB emergencies. One in five settlements involved a pregnant minor, indicating that providers may benefit from education regarding obligations to evaluate and stabilize minors absent parental consent. Failure to arrange appropriate transfer was more common among OB settlements. Findings suggesting need for providers to understand EMTALA-specific requirements for appropriate transfer and for EDs at hospitals without dedicated OB services to implement policies for evaluation of active labor and protocols for transfer when indicated.
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Affiliation(s)
- Sophie Terp
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brandon Wang
- New York University School of Medicine, New York, New York
| | - Elizabeth Burner
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sanjay Arora
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael Menchine
- Keck School of Medicine, University of Southern California, Los Angeles, California
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Affiliation(s)
- Natalie Harrison
- Department of Social Policy, London School of Economics and Political Science, London, UK; The Lancet, London, UK
| | - Hilary Hewitt
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - Pranav Pandya
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dan Reisel
- Centre for Ethics in Women's Health, Institute for Women's Health, University College London, London WC1E 6AU, UK.
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Borges MTR. A Violent Birth: Reframing Coerced Procedures During Childbirth as Obstetric Violence. Duke Law J 2018; 67:827-862. [PMID: 29469554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the United States, women are routinely forced to undergo cesarean sections, episiotomies, and the use of forceps, despite their desire to attempt natural vaginal delivery. Yet, the current American legal system does little to provide redress for women coerced to undergo certain medical procedures during childbirth. Courts and physicians alike are prepared to override a woman's choice of childbirth procedure if they believe this choice poses risks to the fetus, and both give little value to the woman's right to bodily autonomy. This Note proposes a solution for addressing the problem of coerced medical procedures during childbirth by importing a framework created in Venezuela and Argentina that characterizes this issue as "obstetric violence." First, this Note contains an overview of the shortcomings of the existing American legal framework to address the problem. Second, it explains the advantages of the obstetric violence framework and argues that its adoption in the United States would address many of the failures of the existing system. And third, this Note introduces a few legislative and litigation strategies that can be used to implement this framework in the United States and briefly addresses some of the challenges these strategies may pose.
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Dutta SS. Doctors at India's top hospital call for new inquiry into woman's death after resident is sacked. BMJ 2017; 356:j1502. [PMID: 28336514 DOI: 10.1136/bmj.j1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dyer C. Appeal Court overturns first case based on ruling that patients have right to information on treatment options. BMJ 2017; 356:j992. [PMID: 28232395 DOI: 10.1136/bmj.j992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carcopino X, Sabiani L, Bretelle F, Boubli L, d'Ercole C. [What all obstetricians should be told about obstetric expertise in court]. Gynecol Obstet Fertil 2016; 44:257-258. [PMID: 26724210 DOI: 10.1016/j.gyobfe.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Indexed: 06/05/2023]
Affiliation(s)
- X Carcopino
- Service de gynécologie obstétrique, hôpital Nord, Assistance publique des Hôpitaux de Marseille (AP-HM), 13015 Marseille, France; Aix-Marseille université (AMU), 13284 Marseille, France; CNRS, IRD, Avignon université, IMBE UMR 7263, 13397 Marseille, France.
| | - L Sabiani
- Aix-Marseille université (AMU), 13284 Marseille, France; Service de gynécologie obstétrique, hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - F Bretelle
- Service de gynécologie obstétrique, hôpital Nord, Assistance publique des Hôpitaux de Marseille (AP-HM), 13015 Marseille, France; Aix-Marseille université (AMU), 13284 Marseille, France
| | - L Boubli
- Service de gynécologie obstétrique, hôpital Nord, Assistance publique des Hôpitaux de Marseille (AP-HM), 13015 Marseille, France; Aix-Marseille université (AMU), 13284 Marseille, France
| | - C d'Ercole
- Service de gynécologie obstétrique, hôpital Nord, Assistance publique des Hôpitaux de Marseille (AP-HM), 13015 Marseille, France; Aix-Marseille université (AMU), 13284 Marseille, France
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Proust A, Boyer de Latour FX. [Quality is not a problem: It is a solution]. ACTA ACUST UNITED AC 2016; 44:195. [PMID: 27032757 DOI: 10.1016/j.gyobfe.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Indexed: 11/17/2022]
Affiliation(s)
- A Proust
- Département de gynécologie-obstétrique, hôpital privé d'Antony, maternité les Vallées, 1, rue Velpeau, 92160 Antony, France.
| | - F-X Boyer de Latour
- Clinique Saint-François, 1, boulevard du Dr-Schweitzer, 02109 Saint-Quentin, France
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Edney DP. I'll Be Glad When They Go Back Home. J Miss State Med Assoc 2016; 57:123-124. [PMID: 27328476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Starr L. Weeding out fake and rogue practitioners--a duty owed to consumers. Aust Nurs Midwifery J 2015; 23:27. [PMID: 26665641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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John A. Towards midwifery education and regulation in Nepal. Pract Midwife 2015; 18:24-26. [PMID: 26547996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is a short reflection of four wonderful weeks spent in Nepal supporting, advocating and strengthening the existing work of the Midwifery Society of Nepal and the Global midwifery twinning project (GMTP) with the Royal College of Midwives. Although Nepal is on target to achieve reduction in its maternal mortality rate for millennium goal 5 there is still no registered protected title of 'midwife' In order to establish a strong midwifery workforce in Nepal, the three pillars that need to be highlighted are: midwifery education, midwifery regulation and professional midwifery association. The four-week programme led by GMTP volunteers helped towards building capacity in leadership, advocacy and campaigning skills in Nepal.
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Pektorová M, Ventruba P. [Surrogacy, yes or no? Case report]. Ceska Gynekol 2015; 80:299-301. [PMID: 26265418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Case study of surrogacy which did not come up to client-couple´s expectation. DESIGN Case report. SETTING Department of Gynaecology and Obstetrics, Uherske Hradiste Hospital a. s., Uherske Hradiste. METHODOLOGY Description of the case, case study. CONCLUSION In the Czech Republic, missing legislation when subject matter is surrogacy does not allow to make a complex legal contract. This fact causes legal uncertainty to all participants. Irresponsible approach of doctors, surrogate mother, client-couple, and in the upshot care of disabled child at government expense can be results.
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Silva F, Rodrigues E Rodrigues M, Bernardes J. [Disciplinary Actions in Gynecology and Obstetrics in the North of Portugal from Year 2008 to 2012]. ACTA MEDICA PORT 2015; 28:194-203. [PMID: 26061510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 02/04/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Disciplinary actions may have a significant impact in medical doctors' and patients' lives. The objective of this study was the assessment of the disciplinary actions in Obstetrics and Gynecology that occurred in the north of Portugal in years 2008 to 2012. MATERIAL AND METHODS Retrospective descriptive study based on the anonymized data contained in the annual activity reports of Conselho Disciplinar da Seção Regional Norte da Ordem dos Médicos from 2008 to 2012. We calculated the proportion of disciplinary actions in Obstetrics and Gynaecology over the total number of registered specialists in that speciality. We also analysed the type of complainers, accused, institutions, complaints and decisions. For statistical inference proportions with 95% confidence intervals were estimated. RESULTS From years 2008 to 2012, we registered 1040 complaints in all medical specialities in the north of Portugal. Obstetrics and Gynecology was the forth most affected specialty, with a total of 54 complaints. Forty-three complaints were related with medical malpractice and if we only consider this type of complaint Obstetrics and Gynecology was the most affected specialty. The most frequent complainers and accused were, respectively, patients themselves and female physicians, with 41 to 60 years of age. Fifty-two complaints were archived without punishment while two still await conclusion. DISCUSSION The overall results of this study are in agreement with those reported by other authors. CONCLUSIONS Obstetrics and Gynecology was the forth speciality with highest risk for any disciplinary action in the north of Portugal in years 2008 to 2012 and the first one in relation with alleged negligence. All presented and already concluded complaints were archived without penalty, except two that are still under evaluation.
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Affiliation(s)
- Francisco Silva
- Mestrado Integrado em Medicina. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | | | - João Bernardes
- Conselho Disciplinar. Seção Regional Norte. Ordem dos Médicos. Porto. Portugal
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Food and Drug Administration, HHS. Medical devices; obstetrical and gynecological devices; classification of the assisted reproduction embryo image assessment system. Final order. Fed Regist 2015; 80:10330-3. [PMID: 25898424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Food and Drug Administration (FDA) is classifying the Assisted Reproduction Embryo Image Assessment System into class II (special controls). The special controls that will apply to the device are identified in this order, and will be part of the codified language for the Assisted Reproduction Embryo Image Assessment System classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.
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Figo Committee For The Ethical Aspects Of Human Reproduction And Women's Health; International Federation of Gynecology and Obstetrics. Ethical guidance on healthcare professionals' responses to violence against women. Int J Gynaecol Obstet 2015; 128:87-8. [PMID: 25458409 DOI: 10.1016/j.ijgo.2014.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kovalev AV, Pletianova IV, Fetisov VA. [The scope of expert competence for the evaluation of non-compliance with the requirements of the departmental normative legal acts in the course of forensic medical panel examinations concerning "medical practice" in the criminal legal procedures]. Sud Med Ekspert 2014; 57:21-24. [PMID: 25764878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article is devoted to the analysis of the problem of expert competence for the evaluation of non-compliance with the requirements of the departmental normative legal acts in the course of forensic medical panel examinations concerning "medical practice" in the criminal legal procedures. The approaches to the solution of his problem are exemplified by forensic medical expertise of selected cases from obstetric and gynecological practice. It is demonstrated that investigations into non-compliance events arising in the work of medical facilities must include the analysis of the departmental normative legal acts that govern the organizational and diagnostic processes. These documents should be regarded as pertaining to an additional direct object and considered to be one of the constituent elements of.the offence to be identified during forensic medical expertise. Such documents are very specific in terms of their content and can not be properly interpreted by independent specialists possessing juristic knowledge alone. Therefore, the expert judgments concerning these issues must include well-reasoned arguments and solidly established evidence of normative legal character.
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Fejgin MD, Shvit TY, Gershtansky Y, Biron-Shental T. Retained placental tissue as an emerging cause for malpractice claims. Isr Med Assoc J 2014; 16:502-505. [PMID: 25269342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Removal of retained placental tissue postpartum and retained products of conception (RPOC) abortion is done by uterine curettage or hysteroscopy. Trauma to the endometrium from surgical procedures, primarily curettage, can cause intrauterine adhesions (Asherman's syndrome) and subsequent infertility. The incidence of malpractice claims relating to intrauterine adhesions is rising, justifying reevaluation of the optimal way of handling these complications. OBJECTIVES To review malpractice claims regarding intrauterine adhesions, and to explore the clinical approach that might reduce those claims or improve their medical and legal outcomes. METHODS We examined 42 Asherman's syndrome claims handled by MCI, the largest professional liability insurer in Israel. The clinical chart of each case was reviewed and analyzed by the event preceding the adhesion formations, timing and mode of diagnosis, and outcome. We also assessed whether the adverse outcome was caused by substandard care and it it could have been avoided by different clinical practice. The legal outcome was also evaluated. RESULTS Forty-seven percent of the cases occurred following vaginal delivery, 19% followed cesarean section, 28% were RPOC following a first-trimester pregnancy termination, and 2% followed a second-trimester pregnancy termination. CONCLUSIONS It is apparent that due to the lack of an accepted management protocol for cases of RPOC, it is difficult to legally defend those cases when the complication of Asherman syndrome develops.
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Domingues AP, Moura P, Vieira DN. Lessons from a decade of technical-scientific opinions in obstetrical litigation. J Forensic Leg Med 2014; 25:91-4. [PMID: 24931871 DOI: 10.1016/j.jflm.2014.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 02/18/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022]
Abstract
The authors aimed to assess the Portuguese circumstances concerning situations of medico-legal dispute in Obstetrics, evaluate the conclusions of technical-scientific opinions and analyze their consequences. The analysis of all cases of Obstetrics medical responsibility examined in Medico-legal Council since the creation of the National Institute of Legal Medicine was performed. Technical-scientific opinions of those files were examined according to the existence of a causal link and of infringement of the 'leges artis'. The most common reasons for dispute in Obstetrics were perinatal asphyxia (50%), traumatic injuries of the newborn (24%), maternal sequelae (19%) and issues related to prenatal diagnosis and/or obstetric ultrasound (5.4%). In the technical-scientific opinions of files examined, the existence of a causal link was established in 17.4%, and the infringement of the 'leges artis' was suggested in 15.5% of cases, numbers which have grown significantly over the years and which are particularly relevant in the proceedings of perinatal asphyxia and traumatic lesions of the newborn. In 11% of cases the opinion was inconclusive due to the poor quality of the clinical process sent for analysis. These results highlight the impact that litigation can have on the professional activity and personal lives of obstetricians. It should alert them for the need to better fulfill medical clinical files in order to reduce or avoid medico-legal conflicts, as well as to the fact of the increasing practice of defensive medicine and its consequences in daily clinical routine for doctors and patients.
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Affiliation(s)
- Ana Patrícia Domingues
- Obstetrics Department, Maternidade Dr Daniel de Matos, Coimbra University Hospitals, Portugal.
| | - Paulo Moura
- Obstetrics Department, Maternidade Dr Daniel de Matos, Coimbra University Hospitals, Portugal; Obstetrical Clinic of Coimbra Faculty of Medicine, Coimbra University, Portugal
| | - Duarte Nuno Vieira
- Coimbra Faculty of Medicine, Coimbra University, Portugal; National Institute of Legal Medicine, Portugal
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Dyer C. Doctor who carried out three abortions as favour to colleague is allowed to resume unrestricted practice. BMJ 2014; 348:g2314. [PMID: 24662149 DOI: 10.1136/bmj.g2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Uphoff R. [Medical malpractice decisions and guidelines for monitoring responsibility in the neonatal period]. Kinderkrankenschwester 2014; 33:58-59. [PMID: 24649581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Secourgeon JF. [How much longer?]. J Gynecol Obstet Hum Reprod 2013; 42:607-608. [PMID: 23566752 DOI: 10.1016/j.jgyn.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/23/2013] [Indexed: 06/02/2023]
Affiliation(s)
- J-F Secourgeon
- Service d'obstétrique, pôle Femme-Mère-Enfant, centre hospitalier de la Côte-Basque, 13, avenue de l'Interne-Jacques-Loëb, 64000 Bayonne, France.
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Walton K. Tort reform task force flips focus for forward momentum. Iowa Med 2013; 103:8. [PMID: 25208445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Guilbaud L. [Professional liability insurance of the resident in gynecology-obstetric: is it still possible to have safety private practice in France?]. Gynecol Obstet Fertil 2013; 41:341-342. [PMID: 23647818 DOI: 10.1016/j.gyobfe.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- L Guilbaud
- AGOF, 9 rue de la Goulée, 95510 Villiers-en-Arthies, France.
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Nizard J, Horovitz J. [Summary of EBCOG council minutes, Brussels, November 2012]. J Gynecol Obstet Hum Reprod 2013; 42:297-299. [PMID: 23478042 DOI: 10.1016/j.jgyn.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 01/30/2013] [Indexed: 06/01/2023]
Affiliation(s)
- J Nizard
- Service de gynécologie-obstétrique, groupe hospitalier Pitié-Salpêtrière, 83, boulevard de l'hôpital, 75013 Paris, France.
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Asher E, Dvir S, Seidman DS, Greenberg-Dotan S, Kedem A, Sheizaf B, Reuveni H. Defensive medicine among obstetricians and gynecologists in tertiary hospitals. PLoS One 2013; 8:e57108. [PMID: 23483896 PMCID: PMC3590209 DOI: 10.1371/journal.pone.0057108] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 01/22/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the daily work practice under the threat of defensive medicine among obstetricians and gynecologists. STUDY DESIGN A prospective cross-sectional survey of obstetricians and gynecologists working at tertiary medical centers in Israel. RESULTS Among the 117 obstetricians and gynecologists who participated in the survey, representing 10% of the obstetricians and gynecologists registered by the Israel Medical Association, 113 (97%) felt that their daily work practice is influenced by concern about being sued for medical negligence and not only by genuine medical considerations. As a result, 102 (87%) physicians are more likely to offer the cesarean section option, even in the absence of a clear medical indication, 70 (60%) follow court rulings concerning medical practices, and 85 (73%) physicians mentioned that discussions about medical negligence court rulings are included in their departments' meetings. CONCLUSIONS Defensive medicine is a well-embedded phenomenon affecting the medical decision process of obstetricians and gynecologists.
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Affiliation(s)
- Elad Asher
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
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Shurtz I. The impact of medical errors on physician behavior: evidence from malpractice litigation. J Health Econ 2013; 32:331-340. [PMID: 23328349 DOI: 10.1016/j.jhealeco.2012.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/27/2012] [Accepted: 11/29/2012] [Indexed: 06/01/2023]
Abstract
How do medical errors affect physician behavior? Despite the importance of this question empirical evidence about it remains limited. This paper studies the impact of obstetricians' medical errors that resulted in malpractice litigation on their subsequent choice of whether to perform a C-section, a common procedure that is thought to be sensitive to physician incentives. The main result is that C-section rates jumped discontinuously by 4% after a medical error, establishing an association between medical errors and treatment patterns. C-section rates continued to increase afterwards, bringing the cumulative increase 2.5 years after a medical error to 8%.
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Affiliation(s)
- Ity Shurtz
- Department of Economics, The Hebrew University, Jerusalem 91905, Israel.
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Tingle J. An analysis of NHS Litigation Authority maternity claims. Br J Nurs 2013; 22:110-111. [PMID: 23587895 DOI: 10.12968/bjon.2013.22.2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- John Tingle
- Nottingham Law School, Nottingham Trent University, UK
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Affiliation(s)
- Sara Rosenbaum
- Health Law and Policy, Department of Health Policy, The George Washington University School of Public Health and Health Services, Washington, DC 20006, USA.
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Abstract
Malpractice fears are believed to influence various aspects of obstetrical practice. They seem to have contributed in small part to the rising primary caesarean section rate, but have also played a considerable role in the downtrend in vaginal birth after caesarean statistics. The rising vaginal birth after caesarean section rate between 1981 and 1995 was interrupted by a spate of lawsuits associated with broadened indications for vaginal birth after caesarean section in conjunction with requirements for immediate clinician availability. These factors dramatically reduced the availability of hospitals and clinicians willing to offer vaginal birth after caesarean section. This reversal, however, has not diminished the demand for vaginal birth after caesarean section from various stakeholders in the name of patient autonomy, clinician beneficence and optimal care. Nevertheless, as long as stringent requirements remain for clinician attendance during vaginal birth after caesarean section, and as long as the spectre of preventable error and the lingering dread of lawsuits retain their hold on obstetrical practice, caesarean section trends are unlikely to change.
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Henary BY, Al-Yahia OA, Al-Gabbany SA, Al-Kharaz SM. Epidemiology of medico-legal litigations and related medical errors in Central and Northern Saudi Arabia. A retrospective prevalence study. Saudi Med J 2012; 33:768-775. [PMID: 22821312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE To study medico-legal litigations and related medical errors in Central (Al-Qassim), and Northern (Hael) districts in the Kingdom of Saudi Arabia (KSA), and to identify types and causes of errors to reduce medical errors and patient harm. METHODS This retrospective prevalence study was carried out between May 2010 and December 2011 to analyze medico-legal litigations in Al-Qassim and Hael districts that were investigated by the Al-Qassim Medico-Legal Committee, Al-Qassim, KSA. Final verdicts issued between 1992 and 2009 included 293 cases. RESULTS The patient`s mean age was 29.5 years. Fifty-seven percent of the patients were females, and 92% were Saudis. The Obstetric and Gynecology department was involved in 29.7% of litigations followed by General Surgery, and Pediatrics (11.3% each). Of the 635 defendants, 90% were physicians, and 7.6% were nurses. Investigations showed no error in 47.1% of cases, error but no harm in 11.9%, and error resulted in harm in 39.6%. Errors were negligence (45.8%), wrong diagnosis (14.2%), surgical error (10.3%), and administrative error (5.2%). The average total duration of litigations was 13.9 months. Type of harm was the most significant predictor to determine a guilty decision (p<0.001). CONCLUSION Obstetric practice in Al-Qassim and Hael districts and provider negligence contribute to a large portion of medico-legal litigations, and therefore this has to be further studied to recognize the specific causes and possible interventions. A systematic review of the medico-legal committee is needed to shorten the long duration of litigation.
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Affiliation(s)
- Basem Y Henary
- Medical Education, Training, and Research Administration (MERC), King Fahd Specialist Hospital, Al-Qassim Health Directorate, PO Box 2290, Buraidah, Al-Qassim, Kingdom of Saudi Arabia.
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Wagner P. Reducing liability in obstetric care. Minn Med 2012; 95:55-57. [PMID: 22611823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Shmelev IA, Mysiakov VB. [The ethical and legal aspects of professional activities of obstetrician-gynecologist]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2011:42-43. [PMID: 22611990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article demonstrates that both highly developed bioethical consciousness and legal awareness and high level of bioethical and legal culture among obstetrician-gynecologists are important factors of enhancement of medical care quality. This postulate is discussed on the example of issues related to the induced abortion. The approaches to this issues applied in various countries are considered.
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Jurek T, Swiatek B, Rorat M, Drozd R. [Legal and medico-legal assessment of medical errors in obstetrics]. Arch Med Sadowej Kryminol 2011; 61:343-350. [PMID: 22715678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
The authors review the doctrine of criminal law and the jurisdiction of the Supreme Court in search of a starting point for the legal protection of human life and health. In cases of medical errors in obstetrics concerning a fetus, an act of a perpetrator can be classified as manslaughter or exposure to direct danger of loss of life or great bodily injury depending on whether the fetus is recognized as "a human being". The authors criticize the doctrinal criteria of the beginning of legal protection: spatial, physiological, obstetric, and developmental, pointing to the possibilities of decriminalization of medical errors of omission. A solution to this situation is the presented evolution of the jurisdiction of the Supreme Court. It moves towards establishing the beginning of legal and criminal protection of life and health at the "moment of emergence of objective grounds to necessitate delivery".
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Affiliation(s)
- Tomasz Jurek
- Z Zakładu Prawa Medycznego Katedry Medycyny Sadowej Akademii Medycznej we Wrocławiu.
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Abstract
The profession of medicine has evolved into an extremely specialised occupation. Yet, recent research has neglected the intra-occupational processes influencing medical specialisation. This article aims to correct this oversight. It develops an historical account of intra-occupational factors influencing the decision to establish gynaecologic oncology as American ob/gyn's surgical subspecialty in 1972. Working within the framework initially developed by Everett C. Hughes and his students, the article examines this development as the outcome of a three-party relationship among gynaecologic oncologists, American ob/gyns, and gynaecologic pelvic surgeons. Aggressive movement by the gynaecologic pelvic surgeons challenging the established élite's identity definition for the ob/gyn specialty helped spur official recognition of gynaecologic oncology, a less threatening subspecialty. The article draws theoretical implications from the case regarding the role of a threatening other in influencing the specialisation process.
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Affiliation(s)
- James R Zetka
- Department of Sociology, The University at Albany, State University of New York, NY 1222, USA.
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Dubreuil VL. A true witch hunt. Midwifery Today Int Midwife 2011:50-51. [PMID: 21322893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
The Emergency Medical Treatment and Active Labor Act (EMTALA) affects all clinicians who provide triage care for pregnant women. EMTALA has specific regulations for hospitals relative to women in active labor. Violations can carry stiff penalties. It is critical for clinicians performing obstetric triage to understand the duties and obligations of this law. This article discusses EMTALA and reviews common liability risks in obstetric triage as well as strategies to modify those risks.
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Affiliation(s)
- Diane J Angelini
- Department of Obstetrics-Gynecology, Brown University, Providence, RI 02905, USA.
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Dyer C. GMC imposes conditions on surgeon's registration after two babies die. BMJ 2010; 341:c5663. [PMID: 20940221 DOI: 10.1136/bmj.c5663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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45
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MGMA. Facts, figures, findings. MGMA Connex 2010; 10:8-9. [PMID: 21049808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Affiliation(s)
- Robert L Conason
- Gair, Conason, Steigman, Mackauf, Bloom & Rubinowitz, New York, NY, USA
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Racinet C, Hoffmann P. [Perinatal asphyxia and cerebral palsy: medicolegal implications]. Bull Acad Natl Med 2010; 194:891-901. [PMID: 21513126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Over the last 30 years, improvements in obstetric practice (systematic fetal perpartum monitoring, Caesarean section, etc.) have markedly reduced the incidence of perinatal asphyxia, especially in the perpartum period. Yet the incidence of cerebral palsy has remained stable, at around 2 per 1000 live births, owing to the fact that this disorder is generally due to antenatal factors. Population-based studies have further demonstrated that acute perpartum asphyxia is a rare cause of cerebral palsy. Obstetrics is a discipline particularly subject to insurance claims, often because of late use or non use of Cesarean section. Perinatal judicial expertise is too often based on obsolete notions. Reform is necessary, focusing on upstream structural problems. The American model initiated by neurologists and adopted by many other disciplines should be widely adopted, including by lawyers and magistrates. It involves verifying the ethical character of the expertise challenged by the injured party, and drawing conclusions for professional practice?
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Affiliation(s)
- Claude Racinet
- Handicap de l'Enfant, 23 Boulevard Albert 1er de Belgique, 38000 Grenoble.
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Defendants' judgment reversed: plaintiff's experts to testify. Grantham v. Crawford, COA09-528 NCCA (5/18/2010)-NC. Nurs Law Regan Rep 2010; 50:1. [PMID: 20557018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Pierre F. [Recommendations for medical management of women with preeclampsia]. Ann Fr Anesth Reanim 2010; 29:e161-e169. [PMID: 20488647 DOI: 10.1016/j.annfar.2010.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
When analyzing various recommendations formulated by the colleges of specialty, as well as precedents, the following guidelines can be formulated with respect to communication as part to the management of PE. These guidelines affect the professionals & the pregnant women within a healthcare network. Recommendations destined to the former include: Recommendations destined to the latter include:
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Affiliation(s)
- F Pierre
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU et université de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France.
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50
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Nurses failed to respond to Ob/Gyn patient's pleas for help. Case on point: Nasser v. St. Vincent Hospital Health Svcs., 49A020919-CV-955, (4/14/2010)-IN. Nurs Law Regan Rep 2010; 50:4. [PMID: 20557021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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