Table Top Test - CALL to you "an on call medical supervisor"

[Paul Bailey]

I don't work in America (similar to what Pret said about Texas - I'm sure
America is thankful for this and to be honest so am I) but I am a doctor and
do take physician "call".

I'm amazed that this is even a conversation point.

A friend of mine once said (and I firmly believe) that the best "defence" in
these situations is to *practice good medicine*.  In this case, that means
providing *prompt* analgesia via a spinal / epidural rather than spending
hours on the phone to various estranged relatives and next door neighbor out
of session judges.

If you are having trouble deciding what good medicine is, enlist the help of
the most experienced colleage you can find.

Paul Bailey
Western Australia


On 7/20/07, Bjorn, Pret <pbjorn at emh.org> wrote:
>
> I'm willing to take either physician or administrative call, given that
> this is the Trauma-List.  On "the internets," nobody knows you're a dog.
>
> 1.  The patient is NOT underage (19) given any statute with which I'm
> familiar.  But then, I'm not familiar with Texas (for which I and
> certainly Texas are grateful).  In Maine, if she's pregnant and living
> independently, she's emancipated -- even if she's twelve.  She has made
> the requisite decisions to survive in the world and become pregnant,
> after all.
>
> 2.  The first and overwhelming rule for EMTALA, albeit unwritten, but
> ESPECIALLY in the setting of active labor, is "Do the right freaking
> thing and let the lawyers clean up the details."
>
> 3.  Even IF a psychiatrist's note recommends otherwise, competency is a
> LEGAL issue, not a clinical one.  If a judge has not declared her
> incompetent, then see #2.  Else, you and the psychiatrist (or the
> anesthesiologist or the OB/Gyn or the EM clinician or a passing podiatry
> fellow) can declare appropriate analgesia as being in the best interests
> of your supposedly incompetent patient and her pending progeny.
>
> 4.  This girl is in active labor and in extreme pain.  You're mucking
> around with administrative approval for long-distance charges to
> estranged grandparents while delaying her care and permitting her
> suffering.  Moreover, the intended content of your communication with
> Granny would inevitably include details of the patient's protected
> health information (including, conspicuously, her mental illness and her
> pregnancy).  This is not only an absolute HIPAA (one p, two a's)
> violation, it's a patently stupid approach.  CNN's gonna love this
> story, and your hospital will suffer for the inevitable attention.
>
> Treat the patient.  Do the right frigging thing.  Inform your lawyers
> and your admins, but NEVER ask their permission for practicing
> appropriate and utterly defensible clinical medicine.
>
> Pret Bjorn, RN, MD*, MHA*
> Bangor, ME USA
>
> *as far as you know
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
> Sent: Thursday, July 19, 2007 11:07 PM
> To: trauma-list at trauma.org
> Subject: Table Top Test - CALL to you "an on call medical supervisor"
>
>
> This is a real time Table Top TEST for ALL persons willing to take
> physician
> or administrative Call.   We live with this  DAILY.     I have had at
> least 6
> frustrating policy, system,  ethical, moral, and ethical issues just
> this
> afternoon.    Not  any were patient safety issues (YET), but were close
> to system
> issues which  cause frustrations.    This is real time, and NOT any
> HIPPA
> violations.   Take this table top and keep your own  score.     I will
> leave a
> space between decisions.
>
> You get from a senior faculty to assist with a problem, relating to
> legal
> and ethical policies as well as a rapidly unfolding clinical  need.
>
> A 19 year old woman is in full labor, with her first pregancy.  It is  a
>
> tough progress and she is in a great deal of pain.   She has reached  a
> stage
> where most women are clinically ready for a spinal block to aid in the
> progress
> of the delivery.    She is underage and  unmarried.   She has not
> revealed the
> name of the baby's  father.   No parents are present.     Can she give
> PERMISSION for the spinal anesthesia?
>
>
>
> Good try, but we have a problem.     She is severely  hampered by a
> mental
> health problem and the psychiatriast has written note in  the chart that
> the
> patient cannot give permission for herself.     The chief of obstetrics
> strongly
> desires that a spinal anesthesia be  administered.    NO PERMISSION
> available
> from the  patient.    No parents, available.   No father  available.
> Anesthesia service states that they cannot give spinal  anesthesia
> without permission
> either from a fully aware patient, a surrogate  permission giver, or an
> ad
> lidum.
> What to do?
>
>
>
> While calling for help, it is discovered that there is a phone number in
> the
> purse of the patient of a grandmother in a distant city.   Can  this
> grandmother give permission?
>
>
>
>
>
> GOOD ANSWER and you had a good thought there.   Permission is  granted
> from
> administration to use HCHD funds to call this very long distanced
> telephone
> number and the grandmother answers the phone.      GREAT STROKE OF LUCK.
>
>
>
> Problem.   This grandmother has already disowned her own children  and
> only
> vaguely knows of even the existence of this now your  patient.     She
> states
> that she cannot and will not give  permission and states some words I
> cannot
> print here.      She hangs UP.     What to do?
>
>
>
>
>
> One of the faculty has a good friend that is a family court judge
> (actually
> a neighbor).     She calls that judge for  "advice"    It is 5:20 PM and
> the
> judge and court are CLOSED for  the week end.   "Call back Monday"
> message is
> heard.      What to do?
>
>
> You guessed it.   The chief of OB calls YOU and asks for the  options?
>
> I now ask you to answer this  inquiry?    If you wait long enough to
> find a
> court person, the  baby will be delivered with great pain and suffering
> and a
> huge amount of  horrible screams heard two floors down .     The nurses
> are
> crying that something be done.   The patient is getting more and more
> mentally
> disturbed.   The medicines to be used to sedate her or to  treat her
> psychiatric diagnosis can harm her  baby.         HELP
>
>
>
>
> Woops.    It is late.   I will have to give you  the next installment
> tomorrow.
>
> K Mattox
>
>
>
>
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