Re: [ozmidwifery] admission ctg and the furphy of litigation(LONG) (even longer reply)
Dear Monica You have not told us much of your story and I do not doubt you. However having worked in both systems I can not but feel that fragmentation of care is part of the cuase and the solution! I do not suggest either is Perfect but presently we not only have a system of chineses whispers but one where many voices are impacting on both the woman and her care givers with out any chance for things to be resolved or clarified between each woman and the multitude of people who give her care.. I give you 2 quotes from Implementing NMAP in WA State wide caseload midwifery options would address objectives of the DoH WA Office of Safety and Quality in Health (OSQH) such as 'to promote consumer focused, safe, quality health care across the WA health system'. The Clinical Governance Unit of this DoH division acknowledges that as more individuals from more groups look after a patient within a tighter time frame, maintaining a consistently high standard of care - even across a single health care episode becomes more challenging. The potential for error increases particularly whenever responsibility is handed from one agency to the next. This document refers to the Douglas Inquiry's findings of poor policies and practices and inadequate systems that resulted in poor outcomes for patients and their families. as emblematic of system wide concerns . The OSQH unit's review of legal precedents and system responses supports the British concept of Clinical Governance, which has resulted in resource savings, including reductions in clinical negligence premiums in the UK. As above, continuity of midwifery care for women can address concerns in WA about litigation risks and the price of PI insurance premiums. Both are cited as a factors contributing to Australia-wide reported withdrawal from practice of GP obstetricians and specialist obstetricians. Caseload options offer midwives development opportunities for all competencies and clinical applications as per the NHMRC, Australian Maternity Action Plan (AMAP) and WA Enhanced Role of the Midwife Project, as well as more efficient utilisation of midwifery workforces by employers or contractors of midwives. For example a South Australian audit showed that in the current fragmented system each midwife working shifts provides care for the equivalent of 25 women, with each woman seeing between 15 - 25 midwives depending on risk factors in the pregnancy, type of labour and length of post-natal stay. However each full-time caseload midwife working in a sub-group of 3 (Adelaide's Midwifery Group Practice) will provide care for 40 women per year throughout each pregnancy episode. The CMP is a proven example of a community based solution which supports individuals and families taking personal responsibility for health and effective parenting, as outlined in NMAP. Politicians, media and many other authoritative figures are currently offering these concepts as a means of addressing many social problems. Continuity of care by a known midwife supports and strengthens each women's networks and development of problem solving skills and resources. Denise Hynd Never believe that a few caring people can't change the world. For, indeed, they are the only ones who ever have. Margaret Mead - Original Message - From: mh [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Saturday, September 18, 2004 9:30 PM Subject: Re: [ozmidwifery] admission ctg and the furphy of litigation(LONG) (even longer reply) Justine, For the past two and a half years I have been pursued by a woman who sincerely believes she has grounds for complaint. I can't go into the details of the case because of patient confidentiality (not that it has stopped this woman slandering me in national papers, on network radio, etc) but it has been investigated four times now, three times coming to the conclusion that there is no case to answer and the last (HCCC) not yet completed. It has been dismissed as vexatious by the coroner. This case has caused me the most profound distress. It has destroyed my peace of mind, damaged my relationship with my partner and children because I can't think of anything else and is losing me my career because I cannot continue to put myself in the path of this kind of event in the future. There is virtually no protection for health professionals against allegations from unhappy consumers. I am sorry if that sounds harsh but it is true. In any other court, one is considered innocent until proven guilty; in these cases, an unhappy health consumer can make any kind of allegation, it need not be backed up by any kind of evidence, and the health professional has to prove that it did not happen. It makes no difference if one has followed hospital procedure or protocol. It makes no difference that (in my case) the woman was fully advised and consulted at the time and agreed with the course of action taken- she now says she was not consulted and it comes to my word against hers. It makes
Re: [ozmidwifery] admission ctg and the furphy of litigation(LONG) (even longer reply)
Justine, For the past two and a half years I have been pursued by a woman who sincerely believes she has grounds for complaint. I can't go into the details of the case because of patient confidentiality (not that it has stopped this woman slandering me in national papers, on network radio, etc) but it has been investigated four times now, three times coming to the conclusion that there is no case to answer and the last (HCCC) not yet completed. It has been dismissed as vexatious by the coroner. This case has caused me the most profound distress. It has destroyed my peace of mind, damaged my relationship with my partner and children because I can't think of anything else and is losing me my career because I cannot continue to put myself in the path of this kind of event in the future. There is virtually no protection for health professionals against allegations from unhappy consumers. I am sorry if that sounds harsh but it is true. In any other court, one is considered innocent until proven guilty; in these cases, an unhappy health consumer can make any kind of allegation, it need not be backed up by any kind of evidence, and the health professional has to prove that it did not happen. It makes no difference if one has followed hospital procedure or protocol. It makes no difference that (in my case) the woman was fully advised and consulted at the time and agreed with the course of action taken- she now says she was not consulted and it comes to my word against hers. It makes no difference to have the most complete documentation (I was lucky, I had only the one lady to look after and wrote contemporaneous notes every ten minutes). Basically, as the Investigator from the HCCC told me engagingly, as long as this woman wants to bring complaints and allegations against me, the HCCC can pursue me 'to the grave.' This may seem off topic but it may give some insight into why some midwives and Obstetricians act in other than evidence based ways. I cannot describe what this case has done to me. I've been a midwife for 22 years and confidently expected to remain one until I retire. Not now. And though I can't leave the profession I love until this case is at least through the present investigation, I make sure that I practice defensively and will continue to do so. This means not always doing what 'best practice' suggests, rather it is doing what is not going to have me on the receiving end of another complaint. Unfortunately, as soon as this case is resolved, I am leaving midwifery. I believe I am a good midwife. I have the unfailing support of my peers at work, of my manager, the OBs, the Stream director and the director of clinical management; everyone who could give me support, has done so. It isn't enough to keep me here because they have all admitted that anyone can bring a case for any reason, justified or not. It isn't being in the wrong that is so devastating in these events. You might not realise the time and effort that goes into answering these complaints. I am fortunate in that I am covered by the hospital's guidelines, policies and protocols and my own comprehensive notes but even so, I am a mess after spending three weeks solid answering the most detailed and in some cases, insulting questions. (eg, Ms X stated you told her to sit and watch her baby die. Please respond.) This is because of beaurocracy gone mad, political correctness and the rights of the consumer completely over-riding the rights of the care provider, even when no one has done anything wrong or other than best Practice according to Australian and international standards. So pity help anyone who practices according to evidence if it is not supported by the lawyers who proscecute these cases, and you won't find many people being sued or complained against for recording a CTG whereas there are all too many precedents for being sued for failing to record one. Monica (who is in a fragile state and apologises if this post was incoherent.) - Original Message - From: Justine Caines [EMAIL PROTECTED] To: OzMid List [EMAIL PROTECTED] Sent: Saturday, September 18, 2004 10:40 PM Subject: Re: [ozmidwifery] admission ctg and the furphy of litigation(LONG) Hi All Is there something I am missing re admission CTG's and CTG's in general? I see the whole issue of their use in reducing litigation as spurious. Is it true that only around 10% of hypoxic events can be attributed to labour and that the vast majority of damage cannot be linked to a certain time (ie the event could of taken place at 31 wks while Mum was washing up at home) Although my hat goes off to each and every one of you that work in these sick systems with a profession (Obstetrics) that epitomises misogyny midwives still have a responsibility to try and claw back normal birth and I would think challenging these ridiculous protocols as an important part. I agree working with women is very important
Re: [ozmidwifery] admission ctg
The National Institute of Clinical Excellence (NICE) in the UK, and which is the statutory body the provides recommendations to the National Health Service. Clinicians are supposed to follow these guidelines. It has issued guidelines on fetal monitoring. It recommends intermittent auscultation for women who are 'healthy and have a trouble-free pregnancy', and says that the evidence does not support the use of EFM (i.e. a ctg) on admission. There are full guidelines, and summaries available - see http://www.nice.org.uk/page.aspx?o=20051 Debbie Slater Perth -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] admission ctg and the furphy of litigation (LONG)
Justine, As the President of Maternity Coalition, I KNOW that you are taking these facts to the pollies assisting us MC members to do the same. You do a wonderful job I'm so thankful to have you on our side. Jen Find local movie times and trailers on Yahoo! Movies. http://au.movies.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] admission ctg
Marilyn- Unfortunately, being enlightened in one area of practice doesn't guarantee enlightenment in others. This was his (very commendable) idiosyncracy; in other ways he was dismissive of others' points of view, paternalistic, inclined to do the opposite of whatever was suggested... it was a happy day for us to see a change of directors. I guess no one is all bad... or all good. We thought no one could be worse, to work with, I mean, but his successor, while easier to get along with, doesn't seem to have the same fire for reducing intervention. Oh well. The grass is always greener- Monica - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Saturday, September 18, 2004 11:23 PM Subject: Re: [ozmidwifery] admission ctg Monica: I think your Director needs to do a nationwide lecture tour on both admission ctg's and vbac. marilyn - Original Message - From: mh [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, September 17, 2004 4:22 AM Subject: [ozmidwifery] admission ctg I work in a high risk 'Delivery Suite' in a tertiary hospital where we have frequent antenatal transfers for reasons of our own level 3 nursery. Also, because of our proximity to the state's primary Children's hospital we have antenatal transfers of care so women whose babies have particularly bad abnormalities which can be treated surgically can have their babies as close to this facility as possible. So our clientele is heavily skewed towards high risk pregnancies and extremely anxious mothers and partners. The decision was made, however, many years ago, to forgo routine admission traces in the Delivery Suite. There has to be a particular reason for doing a ctg trace on admission and they are audited frequently. I hold no brief for our long time director of Delivery Suite (now replaced) but one thing he consistently did was to try to limit the use of *routine* ctgs and also to push (very aggressively) VBAC in our hospital, so that we have a 70% success rate. It was sold to the other OG's that admission traces, per se, increased the likelihood of a C/S by I forget the rate, ?40%. We are so conservative in other areas of practice I had thought this must be the norm everywhere- is it not? How many places do routine admission traces? I would be very interested to see a cross section Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] admission ctg
Our director has made his decision on a risk assessment model of care. Litigation being the prime reason. Hence nothing to do with evidence based practice or clinical need. G... Don't you hate because if you go against the establishment policy/protocol and something happened you wont be supported by the hospital lawyers. Let there be a national insurance scheme like NZ ACC. Then we can all practise evidenced based care. Cheers Barb -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of mh Sent: Saturday, 18 September 2004 5:18 PM To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] admission ctg Marilyn- Unfortunately, being enlightened in one area of practice doesn't guarantee enlightenment in others. This was his (very commendable) idiosyncracy; in other ways he was dismissive of others' points of view, paternalistic, inclined to do the opposite of whatever was suggested... it was a happy day for us to see a change of directors. I guess no one is all bad... or all good. We thought no one could be worse, to work with, I mean, but his successor, while easier to get along with, doesn't seem to have the same fire for reducing intervention. Oh well. The grass is always greener- Monica - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Saturday, September 18, 2004 11:23 PM Subject: Re: [ozmidwifery] admission ctg Monica: I think your Director needs to do a nationwide lecture tour on both admission ctg's and vbac. marilyn - Original Message - From: mh [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, September 17, 2004 4:22 AM Subject: [ozmidwifery] admission ctg I work in a high risk 'Delivery Suite' in a tertiary hospital where we have frequent antenatal transfers for reasons of our own level 3 nursery. Also, because of our proximity to the state's primary Children's hospital we have antenatal transfers of care so women whose babies have particularly bad abnormalities which can be treated surgically can have their babies as close to this facility as possible. So our clientele is heavily skewed towards high risk pregnancies and extremely anxious mothers and partners. The decision was made, however, many years ago, to forgo routine admission traces in the Delivery Suite. There has to be a particular reason for doing a ctg trace on admission and they are audited frequently. I hold no brief for our long time director of Delivery Suite (now replaced) but one thing he consistently did was to try to limit the use of *routine* ctgs and also to push (very aggressively) VBAC in our hospital, so that we have a 70% success rate. It was sold to the other OG's that admission traces, per se, increased the likelihood of a C/S by I forget the rate, ?40%. We are so conservative in other areas of practice I had thought this must be the norm everywhere- is it not? How many places do routine admission traces? I would be very interested to see a cross section Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] admission ctg and the furphy of litigation (LONG)
Hi All Is there something I am missing re admission CTG's and CTG's in general? I see the whole issue of their use in reducing litigation as spurious. Is it true that only around 10% of hypoxic events can be attributed to labour and that the vast majority of damage cannot be linked to a certain time (ie the event could of taken place at 31 wks while Mum was washing up at home) Although my hat goes off to each and every one of you that work in these sick systems with a profession (Obstetrics) that epitomises misogyny midwives still have a responsibility to try and claw back normal birth and I would think challenging these ridiculous protocols as an important part. I agree working with women is very important and there is an element of letting women refuse etc, but as we all know many women place trust in health professionals (and are so fearful and have little relationship with carers in a highly fragmented system), so in the end will pretty much go with whatever! So many insidious practices can hide behind the shield of 'defensive medicine' and 'fear of litigation'. We need to help empower women and what we know about litigation is whenever a doctor is successfully sued, individual doctors, the AMA, and indemnity organisations start trotting out the old story of the medical negligence crisis¹ and its link to rising insurance premiums¹ (Banham Dasey, 2003). However, contrary to popular opinion, the evidence does not support claims of a medical negligence crisis. The Health Care Complaints Commission (HCCC), set up to provide an accessible process for complaints about all facets of health care (not just medical practitioners), received a total of 2673 complaints for the year 2001-2002, 215 fewer than the year before. Of these complaints, 212 were assessed as suitable for investigation by the commission (Annual Report 2001-2002). While there is no central database containing information on the number of common law negligence cases, it can be extrapolated from the HCCC¹s annual reports that the amount of cases that eventually come before a court would be low indeed (Review of Professional Indemnity Arrangements for Health Care Professionals, 1995). It can be assumed that a potential litigant would at first establish their case with the HCCC, and consequently these complaints are likely to be included in the HCCC¹s statistics. In the Commonwealth Government¹s Review of Professional Indemnity Arrangements for Health Care Professionals (1995) the issues of professional indemnity, negligence actions and adverse outcomes were described as surrounded by myths and assertions supported by little hard data. Much of the information relating to the litigation crisis¹ was anecdotal: ³evidence for a so-called claims crisis is scant², said the Report, concluding that a crisis mentality has been fostered by some medical defence organisations to deflect attention from their own ³irresponsible financial management². Although an increase in the rate of incident reporting was noted, the Final Report held that this did not appear to be reflected in an increase in claims filed in courts. Hirsch (2003) also explains that the rise in medical insurance has more to do with the chronic mismanagement of the medical indemnity industry, and the global decline in investment markets, than to the handful of people who sue doctors and the even smaller proportion of those who do so successfully. The current climate of litigation¹ and the link between this and rising insurance premiums is yet to be borne out by evidence. However, despite the evidence, when a medical negligence case is successful judgements are met with hysteria, scare mongering, and threats. In relation to the Melchoir judgment, the Queensland Court of Appeal agreed, as did the Supreme Court, and finally the High Court, that the doctor was negligent and yet doctors were still ³stunned² by the decision (Graycar, 2003). One doctor wrote a letter stating, ³The constant threat of litigation makes the provision of medicine a living hell² and questioned, ³what sort society rewards such behaviour [of the person suing] while punishing those who devote their lives to helping the sick?²(Owen, 2003). Another doctor wrote in and stated, ³as of today, I shall not perform tubal ligation (sterilisation)² (Symington, 2003). The AMA and indemnity insurance organisations also threatened that this case will further increase insurance premiums and cause doctor shortages (Banham Dasey, 2003). How? I can¹t help but wonder isn¹t this the purpose of medical indemnity - to pay for medical negligence claims? It is hard to believe that the extremely small amount of successful plaintiffs that are compensated can cause the collapse of an entire industry. If this is the case, then it is obvious that the industry is not managed correctly, as the collapse of United Medical Protection organisation so painfully revealed. It is misleading to blame the rise in indemnity premiums, and
Re: [ozmidwifery] admission ctg and the furphy of litigation (LONG)
Justine I found your email very informative and learnt much about the smoke screen that is the medical indemnity/litigation crisis currently being touted. You really have done your homework and I hope you are taking these facts to the pollies and that they are listening! It is really hard to argue with the doctors when they sprout off about doing Caesarians/inducing labour because of litigation risks (They also like to say because the woman asks for it) Your email spells out that this is a convenient but not substantiated claim. I would however, like to acknowledge that it is difficult to argue with a doctor in a hospital situation whether they are wanting to do a routine CTG / a caesarian/ an induction for whatever reason they think it is necessary. In the hospital system, the buck stops with them whether we like it or not and management usually side with the doctors as they are considered a more precious commodity than midwives (rightly or wrongly so). It doesn't mean that midwives shouldn't present doctors with research based evidence on the latest clinical issues, in an effort to change their practices, but it is a long slow process and I think the easiest way to go about it is to just keep them out of the picture i.e. as in the midwifery led care. I felt that it was a bit cruel/patronizing for you to generalize all hospital based maternity care by labelling them as sick and empitomizing misogny without acknowledging the efforts of the many midwives who bust a gut to try and improve the system on a daily basis. Everyone wants to be proud of their workplace/profession and these midwives have a lot to be proud of too. Anyway, on a lighter note, thanks again for the time and effort you have obviously spent in enlightening us to the other side of the medical indemnity crisis and for being so passionate in working towards improving maternity services for all Australian women. Cheers Helen Cahill - Original Message - From: Justine Caines [EMAIL PROTECTED] To: OzMid List [EMAIL PROTECTED] Sent: Saturday, September 18, 2004 10:40 PM Subject: Re: [ozmidwifery] admission ctg and the furphy of litigation (LONG) Hi All Is there something I am missing re admission CTG's and CTG's in general? I see the whole issue of their use in reducing litigation as spurious. Is it true that only around 10% of hypoxic events can be attributed to labour and that the vast majority of damage cannot be linked to a certain time (ie the event could of taken place at 31 wks while Mum was washing up at home) Although my hat goes off to each and every one of you that work in these sick systems with a profession (Obstetrics) that epitomises misogyny midwives still have a responsibility to try and claw back normal birth and I would think challenging these ridiculous protocols as an important part. I agree working with women is very important and there is an element of letting women refuse etc, but as we all know many women place trust in health professionals (and are so fearful and have little relationship with carers in a highly fragmented system), so in the end will pretty much go with whatever! So many insidious practices can hide behind the shield of 'defensive medicine' and 'fear of litigation'. We need to help empower women and what we know about litigation is whenever a doctor is successfully sued, individual doctors, the AMA, and indemnity organisations start trotting out the old story of the Omedical negligence crisis¹ and its link to Orising insurance premiums¹ (Banham Dasey, 2003). However, contrary to popular opinion, the evidence does not support claims of a medical negligence crisis. The Health Care Complaints Commission (HCCC), set up to provide an accessible process for complaints about all facets of health care (not just medical practitioners), received a total of 2673 complaints for the year 2001-2002, 215 fewer than the year before. Of these complaints, 212 were assessed as suitable for investigation by the commission (Annual Report 2001-2002). While there is no central database containing information on the number of common law negligence cases, it can be extrapolated from the HCCC¹s annual reports that the amount of cases that eventually come before a court would be low indeed (Review of Professional Indemnity Arrangements for Health Care Professionals, 1995). It can be assumed that a potential litigant would at first establish their case with the HCCC, and consequently these complaints are likely to be included in the HCCC¹s statistics. In the Commonwealth Government¹s Review of Professional Indemnity Arrangements for Health Care Professionals (1995) the issues of professional indemnity, negligence actions and adverse outcomes were described as surrounded by myths and assertions supported by little hard data. Much of the information relating to the Olitigation crisis¹ was anecdotal: ³evidence for a so-called claims crisis is scant², said the Report, concluding
Re: [ozmidwifery] admission ctg and the furphy of litigation (LONG)
Hi, I can only hope that every midwife and consumer on this list gives copies of your fantastically clear and well referenced article on the myths of litigation to every birthing family they come across and also learn the jargon to defend women against the obvious misled and unsupported claims around litigation in the birthing world. Well done Justine, I'm voting for you in these coming elections!! Sue Cookson Hi All Is there something I am missing re admission CTG's and CTG's in general? I see the whole issue of their use in reducing litigation as spurious. Is it true that only around 10% of hypoxic events can be attributed to labour and that the vast majority of damage cannot be linked to a certain time (ie the event could of taken place at 31 wks while Mum was washing up at home) Although my hat goes off to each and every one of you that work in these sick systems with a profession (Obstetrics) that epitomises misogyny midwives still have a responsibility to try and claw back normal birth and I would think challenging these ridiculous protocols as an important part. I agree working with women is very important and there is an element of letting women refuse etc, but as we all know many women place trust in health professionals (and are so fearful and have little relationship with carers in a highly fragmented system), so in the end will pretty much go with whatever! So many insidious practices can hide behind the shield of 'defensive medicine' and 'fear of litigation'. We need to help empower women and what we know about litigation is whenever a doctor is successfully sued, individual doctors, the AMA, and indemnity organisations start trotting out the old story of the medical negligence crisis¹ and its link to rising insurance premiums¹ (Banham Dasey, 2003). However, contrary to popular opinion, the evidence does not support claims of a medical negligence crisis. The Health Care Complaints Commission (HCCC), set up to provide an accessible process for complaints about all facets of health care (not just medical practitioners), received a total of 2673 complaints for the year 2001-2002, 215 fewer than the year before. Of these complaints, 212 were assessed as suitable for investigation by the commission (Annual Report 2001-2002). While there is no central database containing information on the number of common law negligence cases, it can be extrapolated from the HCCC¹s annual reports that the amount of cases that eventually come before a court would be low indeed (Review of Professional Indemnity Arrangements for Health Care Professionals, 1995). It can be assumed that a potential litigant would at first establish their case with the HCCC, and consequently these complaints are likely to be included in the HCCC¹s statistics. In the Commonwealth Government¹s Review of Professional Indemnity Arrangements for Health Care Professionals (1995) the issues of professional indemnity, negligence actions and adverse outcomes were described as surrounded by myths and assertions supported by little hard data. Much of the information relating to the litigation crisis¹ was anecdotal: ³evidence for a so-called claims crisis is scant², said the Report, concluding that a crisis mentality has been fostered by some medical defence organisations to deflect attention from their own ³irresponsible financial management². Although an increase in the rate of incident reporting was noted, the Final Report held that this did not appear to be reflected in an increase in claims filed in courts. Hirsch (2003) also explains that the rise in medical insurance has more to do with the chronic mismanagement of the medical indemnity industry, and the global decline in investment markets, than to the handful of people who sue doctors and the even smaller proportion of those who do so successfully. The current climate of litigation¹ and the link between this and rising insurance premiums is yet to be borne out by evidence. However, despite the evidence, when a medical negligence case is successful judgements are met with hysteria, scare mongering, and threats. In relation to the Melchoir judgment, the Queensland Court of Appeal agreed, as did the Supreme Court, and finally the High Court, that the doctor was negligent and yet doctors were still ³stunned² by the decision (Graycar, 2003). One doctor wrote a letter stating, ³The constant threat of litigation makes the provision of medicine a living hell² and questioned, ³what sort society rewards such behaviour [of the person suing] while punishing those who devote their lives to helping the sick?²(Owen, 2003). Another doctor wrote in and stated, ³as of today, I shall not perform tubal ligation (sterilisation)² (Symington, 2003). The AMA and indemnity insurance organisations also threatened that this case will further increase insurance premiums and cause doctor shortages (Banham
Re: [ozmidwifery] admission ctg and the furphy of litigation(LONG)
Dear Barb Health administrators are scared and they have only a very scant understanding of law. Oh Barb, this is very sad. I understand the law (I read the act) and I am a Mum at home in her PJ's most of the time! NO EXCUSE, if they are making decisions about practice and citing litigation they don't understand as a reason then that is even more dangerous! The fact is outside of catastrophic injury their is little any one can claim any more (In NSW and the ACT especially). To get anything you need to claim at least 10% permanent injury (and that's considerable) How does one respond to that mothers loss? How can one say evidence shows ' to a woman dealing with a loss. Part of the problem is we have a generation of consumers who do not understand adverse outcomes can occur no matter how diligent one is. They look for blame and financial gain. Another we have non-clinicians and I include some consumer groups here, making rules and decisions without understanding how the system works nor how toxic the working environment is for midwives. Naturally it is very difficult, when dealing with such loss to imply well hey it sometimes happen, but again it is the truth. Loss like this will always be devastating but when a woman has a trusting relationship with a midwife she knows then it has to help. As for consumers making rules. Consumers are advocating for choice and from your e-mail it and the many thousands of other anecdotes we hear it is ABSOLUTELY NECESSARY. Barb you are doing your best (like so many more). Please don't fall into the trap of thinking that when we criticise the 'system' we are criticising you as an individual. We will continue to fail if midwives respond 'personally' to our criticisms of the system. Unfortunately 95% of midwifery staff are part-time that come to WORK for 8 hours will not challenge this directive, they are not interested. A general comment and I apologise in advance to those who are not like this they have a good balance in their life/work arrangement. Yet another reason for major change, that acknowledges what midwifery is and enables a scope of midwifery practice. Then you wouldn't have to fight continuously! Also why can't midwives work caseload practice part-time? In a group practice of 3 (with back-up for on-call etc) but with a designated caseload women would have much better care and midwives would work as they were trained through the continuum. With this model it would also be necessary to assert the scope of practice so you would not need to tango with the CTG etc etc. I remember what struck me most about labour for the first time it is from Janet Balaskas. She says birth is like the ocean, if you fight the current (rip) you may be pulled under and drown. If you go with it, you will go further than you have ever before, but later you will be able to swim back to the safety of the shore! Perhaps we all need to apply this to the urgent need for maternity services reform. Change can be scary but when we look at what we have, it can't be much worse! In solidarity JC xx -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] admission ctg and the furphy of litigation (LONG)
Ah Sue Political life and 4 under 5?? Give me a few years!! JC xx -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] admission ctg
I work in a high risk 'Delivery Suite' in a tertiary hospital where we have frequent antenatal transfers for reasons of our own level 3 nursery. Also, because of our proximity to the state's primary Children's hospital we have antenatal transfers of care so women whose babies have particularly bad abnormalities which can be treated surgically can have their babies as close to this facility as possible. So our clientele is heavily skewed towards high risk pregnancies and extremely anxious mothers and partners. The decision was made, however, many years ago, to forgo routine admission traces in the Delivery Suite. There has to be a particular reason for doing a ctg trace on admission and they are audited frequently. I hold no brief for our long time director of Delivery Suite (now replaced) but one thing he consistently did was to try to limit the use of *routine* ctgs and also to push (very aggressively) VBAC in our hospital, so that we have a 70% success rate. It was sold to the other OG's that admission traces, per se, increased the likelihood of a C/S by I forget the rate, ?40%. We are so conservative in other areas of practice I had thought this must be the norm everywhere- is it not? How many places do routine admission traces? I would be very interested to see a cross section Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] admission ctg
Monica: I think your Director needs to do a nationwide lecture tour on both admission ctg's and vbac. marilyn - Original Message - From: mh [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, September 17, 2004 4:22 AM Subject: [ozmidwifery] admission ctg I work in a high risk 'Delivery Suite' in a tertiary hospital where we have frequent antenatal transfers for reasons of our own level 3 nursery. Also, because of our proximity to the state's primary Children's hospital we have antenatal transfers of care so women whose babies have particularly bad abnormalities which can be treated surgically can have their babies as close to this facility as possible. So our clientele is heavily skewed towards high risk pregnancies and extremely anxious mothers and partners. The decision was made, however, many years ago, to forgo routine admission traces in the Delivery Suite. There has to be a particular reason for doing a ctg trace on admission and they are audited frequently. I hold no brief for our long time director of Delivery Suite (now replaced) but one thing he consistently did was to try to limit the use of *routine* ctgs and also to push (very aggressively) VBAC in our hospital, so that we have a 70% success rate. It was sold to the other OG's that admission traces, per se, increased the likelihood of a C/S by I forget the rate, ?40%. We are so conservative in other areas of practice I had thought this must be the norm everywhere- is it not? How many places do routine admission traces? I would be very interested to see a cross section Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] admission ctg
I know of two places that do routine admission CTG's. It's generally accepted as a waste of time, but the MO's demand. Also CTG's for inductions and augmentations. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of mh Sent: Friday, 17 September 2004 9:22 PM To: [EMAIL PROTECTED] Subject: [ozmidwifery] admission ctg I work in a high risk 'Delivery Suite' in a tertiary hospital where we have frequent antenatal transfers for reasons of our own level 3 nursery. Also, because of our proximity to the state's primary Children's hospital we have antenatal transfers of care so women whose babies have particularly bad abnormalities which can be treated surgically can have their babies as close to this facility as possible. So our clientele is heavily skewed towards high risk pregnancies and extremely anxious mothers and partners. The decision was made, however, many years ago, to forgo routine admission traces in the Delivery Suite. There has to be a particular reason for doing a ctg trace on admission and they are audited frequently. I hold no brief for our long time director of Delivery Suite (now replaced) but one thing he consistently did was to try to limit the use of *routine* ctgs and also to push (very aggressively) VBAC in our hospital, so that we have a 70% success rate. It was sold to the other OG's that admission traces, per se, increased the likelihood of a C/S by I forget the rate, ?40%. We are so conservative in other areas of practice I had thought this must be the norm everywhere- is it not? How many places do routine admission traces? I would be very interested to see a cross section Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
