March 30, 2011
I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will only receive a maximum of $250,000 in a medical malpractice lawsuit. This is definitely a “lose-lose” situation for patients.
Managed care is bad news for pregnant women. Extremely bad news. Every ultrasound, lab test and hospital admission that your physician or midwife orders on your behalf will have to be pre-approved by a gatekeeper who is on a mission to increase the profits of their company by reducing the amount of money that is spent on you. So you must therefore be on a mission to keep both you and your unborn baby out of harm’s way. How do you do that? Here are a few suggestions that are taken from The Smart Mothers Guide to a Better Pregnancy:
- Research your prospective healthcare provider through your State Board of Medicine’s licensing department to make certain they do not have any 7-figure malpractice suits settled or pending
- If you’ve had a previous high-risk pregnancy, request a referral to a Maternal Fetal Medicine high-risk specialist for your prenatal care
- If you delivered a preterm baby in the past, chances are likely you will do it again. Ask to have your cervix measured when you have an ultrasound and if it’s short , request a referral to a high-risk specialist
- If you have vaginal bleeding and are pregnant, do not leave a doctor’s office or an emergency room without someone doing an ultrasound to confirm that (a) the fetus is alive and (b) the pregnancy is not in the fallopian tubes (aka) ectopic pregnancy. An undiagnosed ectopic pregnancy could rupture and cause havoc.
- If you complain of a vaginal discharge, do not leave your healthcare provider until someone gives you a diagnosis and treatment. Untreated vaginal infections can lead to preterm labor. Bacteria is not your friend when you’re pregnant
- Back and lower abdominal pain should not be ignored, especially if you are less than 36 weeks. It could represent signs of premature labor
- Become familiar with fetal tracings. Flat lines and “u-shaped” curves during labor could mean your baby is in trouble and needs to be delivered quickly
- Try to deliver in a hospital that has a level 3 nursery and/or a NICU (neonatal intensive care unit)
- If a hospital mistreats you, contact its administrator. If you’re still not satisfied, file a complaint with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) http://www.jointcommission.org/
- Trust your instincts. I can’t emphasize this enough.
Prevention is the key to reducing medical injury, not taking away someone’s right to sue.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do. Check out the video below for my information and pick up a copy of The Smart Mother’s Guide
March 9, 2011
Did you ever love something or someone so much that you had to walk away because it hurt too much to stay? That’s how I feel about medicine. From the moment I saw my first delivery, I was hooked and there was no turning back. Perhaps I’m highly offended at our present state of affairs because I had to work so hard to gain acceptance into med school. I spent countless nights in the library at Columbia School of Physicians and Surgeons studying for the MCATs. Endured physiology, histology, biochemistry, gross anatomy (included the dreaded head and neck) and microbiology so that I could eventually diagnose clinical problems. I walked through the fire of residency training and came out whole on the other side. Yet, despite all of these humble achievements, I couldn’t see the destruction of healthcare coming. And neither did many of my colleagues. However, instead of banning together to save our profession, some of us allowed ourselves to be fiscally co-opted giving rise to the birth of “volume oriented medicine.”
Healthcare is now a business and quality of patient care has flown out the window. Billable procedures with diagnostic codes are the order of the day. “Productivity” is a buzz word, a euphemism for volume. The insurance companies are paying less, yet the healthcare providers are expected to do more. The number of patients on schedules increases and it has become “normal” for some of my colleagues to see 48 pregnant women in a day. A former medical director decided that he wanted to increase “productivity” even more so he paid physicians on a per-patient-basis and of course, his theory worked. When one of his cronies had 80 pregnant women scheduled in 5 minute intervals for one day, I had seen enough. I wrote a letter of complaint to the Florida Board of Medicine and was informed that there was no law that prohibited the number of patients a healthcare provider could see in a day. I then contacted the American College of Obstetrician-Gynecologists (ACOG) and they too, had no protocol or rule about volume. So, it was the wild, wild, west regarding patient care. No rules. No boundaries. And certainly no patient protection. Regime changes occurred, but the “numbers” game continued. I had had enough. So after 15 years of attempting to administer quality care in the midst of chaos and strife, I have tendered my resignation. There is nothing more that I can do except put it in the hands of God.
February 10, 2011
The story of Mareena Silva, a 19 year old pregnant woman who was mistakenly given a medication that could have caused a miscarriage is a precautionary tale of why it’s so important to be vigilant during pregnancy.
Silva was prescribed an antibiotic at six weeks gestation. Although the name of the antibiotic was not given, she ultimately received Methotextrate, an anticancer drug that is sometimes used to treat ectopic or tubal pregnancies and could have caused a spontaneous abortion. Silva unknowingly took one pill before realizing that the pharmacy had made an error. Of course, she is now concerned that her unborn child might be adversely affected as a result of the error. However there’s a deeper story regarding Silva. Her physician prescribed an antibiotic at a critical time of the first trimester called organogenesis which occurs between 6 to 10 weeks gestation. During organogenesis the brain and central nervous system of the baby develop. This is an extremely important time of fetal development and most physicians use a hands off approach regarding prescribing medicine unless the patient is critically ill and compromised. As a patient safety measure, here are some suggestions to avoid incurring a similar or repeat episode of Silva’s near-fiasco:
- If you are given a medication during the first trimester, ask your healthcare provider if you can wait until after your 10th week to take it.
- When receiving a prescription, look up the generic name of the medication as well as the trade name so that you will familiar with both names in order to detect potential errors.
- Make certain that everyone knows you’re pregnant. If you’ve missed your period but haven’t had an official pregnancy test, please request it.
- When picking up medicines from the pharmacy, confirm the name of the medication, including the correct spelling, the strength, the dose of the medicine and number of times it should be taken in a day.
- Ask your healthcare provider about the category of the medicine and potential side effects. A category “A” and “B” are safe during pregnancy but again, it should be deferred if possible until the second trimester.
Never take medication during pregnancy without knowing the risks as well as the benefits. If the risk outweighs the benefit, buyers beware.
Linda Burke-Galloway, MD, MS, FACOG, is the author of The Smart Mother’s Guide to a Better Pregnancy (Red Flags Publishing). Her book is available on Amazon.com and other bookstores. For author requests, please contact Ms. Zanade, L. Mann of Online and Off Marketing and PR Agency, 347-968-8067. All Rights Reserved
February 7, 2011
In less than six months after writing Seven Reasons Why Pregnancy Becomes a Deadly Affair , the public outrage is faint and inaudible regarding domestic violence committed against pregnant women. The subject therefore has to be revisited again.
On a college campus, less than 90 minutes away from my home, a 17 year old woman was kicked and punched in her abdomen for no apparent reason other than she carried life within her womb. The alleged father of her baby, Devin Nickels, a college student at Florida State University was apparently not happy about his new prospective role. He purportedly contacted a high school buddy, Andres Luis Marrero, who now attended the University of Tampa and asked him to beat his girlfriend until she had a miscarriage for $200.00. Marrero, instead, offered to assault the girl for free.
According to the University of Tampa’s newspaper, The Minaret, Nickels drove his girlfriend to a secluded wooded area near an apartment complex and Marrero allegedly assaulted her despite her pleas that she was pregnant. The woman was treated at a local hospital and her pregnancy was still viable. Hours later, Marrero allegedly wrote about the attack on his Facebook® wall describing it as “fun”. He was subsequently arrested for armed kidnapping and aggravated assault on a pregnant woman. His father made a statement that his son was an “outstanding kid all his life” and he had no idea “where this was coming from.”Nickels was also arrested on the FSU campus.
Unfortunately these travesties continued. A Comcast.com online newsletter reported the story of a 17- year- old Ypsilanti high school that allegedly stabbed a classmate 12 times in the back of the head, with whom he had sex because she told him she “might be pregnant.” She ultimately had surgery that resulted in an intensive care unit admission. The classmate lived because she “played dead.”
A few facts are in order for those misguided individuals who look at violence as a means of ending a pregnancy. According to a medical study, violence does not influence pregnancy loss. A 45 year old pregnant woman has an 80% chance of having a miscarriage. A 17 year old girl, despite being kicked in the stomach does not. One of the consequences of having sex is procreation. According to CDC, 49 % of all pregnancies in this country are unplanned. Teens need to be aware of the awkward fact that if they have sex, there is a near 50% chance that they will become pregnant and if their partner is not happy, they are at a greater risk of experiencing domestic violence even to the point of death.
Violence against pregnant women is becoming unparalleled in its viciousness. How many dead bodies will it take before we start doing something about it?
February 2, 2011
When our country starts closing obstetrical units in hospitals because they “cost too much” money to operate, pregnant women need to start running for cover and their babies are in serious trouble. Such was the case of the most recent casualty, South Seminole Hospital, a 200-bed hospital, that’s located within 30 minutes of my neighborhood.
More than 20,000 babies were born in South Seminole Hospital during the past 18 years and many of the babies were delivered by a local obstetrician who died approximately three years ago. I recall sitting in the emergency room of the hospital with a fractured ankle and listening to a chime that used to ring every time a baby was born. It was a soothing and humbling sound knowing that a new life was making its grand entrance each time that chime rang. Now, it will be replaced with silence.
Unfortunately, this phenomenon is not unique to Florida. In 1997 the closing of a North Philadelphia hospital (Northeastern) affected six additional hospitals in the community and their 23,570 annual births. In my hometown of Brooklyn, New York, Long Island Hospital had an annual delivery rate of 2,800 babies but still closed its doors to the community and sold the hospital as prime real estate to the highest bidder citing low reimbursement rates and high premiums for malpractice insurance as the culprit behind the decision. The Bedford Stuyvesant community of Brooklyn, New York lost St. Mary’s Hospital, a delivery center of thousands of babies in 2005.
Not only are hospital maternity units affected by money but by politics as well. How many times have I witnessed the closure of a hospital maternity unit because a “premier” ob-gyn group acted like spoiled brats when they didn’t get their proverbial way and took their patients en masse to a competitor hospital? A hospital might have hired a hospitalist group to deliver uninsured patients and the local ob-gyn physicians were annoyed because they weren’t “included in the decision-making process?” Or a popular ob-gyn physician is chastised by a head nurse for missing a delivery or having a preventable error and vows never to return to the hospital.
As pregnancy continues to be deemed a pre-existing condition with low reimbursement rates and high malpractice premiums, the disappearance of maternity wards will continue. If you live in a community where this phenomenon has occurred, I strongly encourage you to seek prenatal care at a teaching hospital where there are attending and resident physicians trained to manage low-risk and high-risk prenatal problems.
Remember a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
January 19, 2011
Although the journey to a healthy pregnancy and delivery begins with the selection of a healthcare provider; the challenge is to find the right one. This is the person who will be in charge of your pregnancy up until the time of the delivery, so it certainly is not a casual date. For the next 280 days, your life and the life of your unborn child will be in this person’s hands. A background check is therefore in order.
One of the best ways to find the right provider is by word-of-mouth referral from neighbors, friends or family members however please don’t stop there. Labor and delivery nurses are also a great source of referral because they have seen physicians and midwives under their most vulnerable and challenging moments. Once you have a name, you need to check the provider’s credentials. You can obtain this information from your local medical society or state medical board, and in many instances it can be verified online. In the appendix of The Smart Mother’s Guide, you will find the addresses, phone numbers and websites of the state medical boards in all fifty states, as well as Puerto Rico and the Virgin Islands.
Please do not feel intimidated about checking a provider’s credentials; they are public information. You can find out whether the provider’s medical license is current or expired. You will also be able to obtain information on whether the provider was ever disciplined by the Board for medical malpractice or unprofessional behavior or misconduct. Health care providers are not exempt from problems with alcoholism, drug addiction, professional incompetence, unprofessional or unethical behaviors. Although less than 5 percent of providers have egregious problems, you want to make certain that your provider is not one of them.
Knowing how to check a provider’s credentials becomes especially important if you have relocated to a new community and are not familiar with healthcare providers. It is also helpful if you belong to an HMO (health maintenance organization) that presents you with a limited selection of providers. If you discover that someone on that list has a history of problems, you have leverage in negotiating for a different provider.
Be unapologetically pro-active about checking the backgrounds of prospective healthcare providers. A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
October 18, 2010
This past Sunday morning I awoke on a mission. I loaded my children in the car, went to church and stood in front of the altar asking my pastor and congregation to pray for our country’s healthcare system. Of late, I’ve been disheartened and weary. My mammoth burden needed to be turned over to a Higher Power.
One of the main reasons I wrote The Smart Mother’s Guide was to protect pregnant women from becoming victims of medical malpractice based upon practices of neglect and distraction. In recent years, I have witnessed things that I wished I hadn’t. How does one respond when made aware of an ob-gyn physician who typically schedules 80 patients a day at 5 minute-intervals because he’s being paid on a per-patient-basis? The State Board of Medicine deemed it to be “legal” because a statute or law was not written to address the issue. Welcome to Conveyor-Belt Medicine.
The battle of patient scheduling has become a national problem for conscientious physicians and nurses. Overbooking patients jeopardizes patient safety but complaints fall on deaf ears. Because of decreased revenue paid by insurance companies maintaining a medical practice above water has become a numbers game.
How many patients should a physician or healthcare extender see in one day? It depends on the specialty but anything over 30 is clearly pushing the envelope. In my research regarding the average number of patients seen per day by a physician, I came across a 2008 blog written by KevinMd that is shocking. In the thread, Dr. Anonymous admits to seeing 50 to 100 patients per physician per day because “30 to 35 patients per day would hardly pay the rent.” The conversation goes from bad to worse as Dr. Anonymous attempts to justify his actions.
The notion that patients are now “subscribers” that can be used as leverage to obtain insurance contracts and business deals is sickening. Where is the quality care in this? Where is the healing? Greed and immorality have high jacked our healthcare profession and thus far, there is no super hero has been able to lasso it back. Pregnant moms, be your own advocate and protector. Before selecting a healthcare provider, ask a simple question: how many patients does he or she see in a day? Avoid the conveyor belt at all cost. You and your unborn baby are more than just a number.
Do you know how to anticipate and manage the unexpected events that could occur during your pregnancy? You will if you purchase The Smart Mother’s Guide to a Better Pregnancy available on Amazon.com or wherever books are sold.
October 11, 2010
Is your job hazardous to your pregnancy? It might be if you work as a cashier. One more thing has now been added to a pregnant woman’s list of concerns. Recent articles have reported that pregnant women who work as cashiers have an increased risk of exposure to a hazardous chemical called bisphenol A or BPA.
BPA is a chemical that is found in plastic products including drink containers, plastic utensils, the lining of canned foods and in cash register receipts. It has caused prostate and breast tumors in animals and has been associated with heart disease and diabetes in humans. According to medical reports, more than 90 percent of pregnant women had BPA detected in their urine and 87 percent was found in the urine of their babies at birth. High levels of BPA in pregnancy have been linked to an increased risk of obese children and aggressive behavior in girls. A few years ago, concerned mothers successfully advocated for BPA-free baby bottles out of concern for their babies. However, the exposure that the unborn baby receives during pregnancy appears to pose an even greater threat.
Who is at risk for BPA exposure? Pregnant women who work as cashiers and handle cash register receipts as well as pregnant women who eat canned foods on a daily basis. Pregnant women, who are exposed to cigarette smoke, handle vinyl flooring and plastic containers are also at risk. The Occupational Safety and Health Administration (OSHA) is mandated to protect workers from a hazardous work environment by setting standards that employers must follow. Every employer is required to have a Material Safety Data Sheet (MSDS) that contains important information on the chemical properties and health effects of materials used in the work place. It would not be unreasonable to ask your employer for a copy.
Ideally, BPA should be banned from consumer products but until that happens here are some helpful tips for pregnant working moms:
- Ask permission from your supervisor or Human Resource department to wear gloves if you are a cashier, if they give you a difficult time; show them this link and then mention the regulatory agencies such as OSHA and the EPA
- Eliminate or reduce eating canned foods
- Microwave food in glass only
- Lobby your local politicians to have BPA removed from cash register receipts and cans
By being proactive, you are improving your chances of having a healthy baby. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
July 26, 2010
When you’re constantly fighting for people to do the right thing, something is terribly wrong. One of my best friends called the other day in a state of despondency. Her patients needed to have a C. Section and the anesthesiologist was acting like a jerk. The patient had two previous successful VBACs but this time had a placenta previa which meant the placenta was covering the opening to the womb . A vaginal delivery was impossible. The patient was 38 weeks and my friend instinctively felt that she needed to be delivered. Gratefully, she wasn’t bleeding.
The anesthesiologist refused to give the patient an epidural, citing her “high-risk” status and was also rude in the process. He felt the main hospital operating room was a more appropriate arena for the delivery as opposed to the labor and delivery suite. My friend had had problems with this physician before. He would play the “dumping” game using any excuse to postpone performing a case until the next shift took over. My friend was not about to play Russian-Roulette with the patient’s baby and refused to send her home. “What should I do?” she asked in frustration. “I’m trying not to lose my composure and I’m not in the mood to fight.”
My friend needed encouragement. I reminded her that she was a brilliant physician whose calling was to heal women and save babies. I suggested that she get the hospital’s administrator and ob-gyn chairman involved to deal with the anesthesiologist directly and document on the patient’s chart why she was unable to deliver the baby. Above all, she must trust her instincts.
The high-risk specialist agreed with my friend’s assessment and wrote a note on the chart as well. My friend shared her dilemma with the nurse-in-charge who then took control of the situation and forced the hand of the anesthesiologist.
The baby was ultimately delivered and had a low APGAR score at one minute although there was nothing on the fetal tracing to suggest why. Had my friend not intervened, the baby could have possibly died.
My friend scored a moral victory with this delivery. But what will happen the next time?
June 14, 2010
The greatest social changes usually begin at the grassroots and works its way up. Based on growing dissent regarding limited options for VBACS, a panel of the National Institute of Child Health Development (NICHD) met in March of this year to determine why VBACs were declining. Between 2006 and 2008, 20% of obstetricians stopped offering VBAC as an option. In 2006, the numbers were even higher at a rate of 26%. The NICHD panel concluded that a trial of labor is a reasonable option for many women with a prior cesarean delivery (see “Vaginal Birth After Cesarean: New Insights”). So, why all the fuss and resistance? Because there is a small risk of uterine rupture (less than 1%) and most hospitals require a physician to be in the hospital to manage a laboring VBAC patient. Dr. George Macones was interviewed in a recent ob-gyn newspaper and I’d like to share some of his observations and comments. Macones is a maternal fetal medicine specialist and the ob-gyn chair at Washington University in St. Louis.
According to Macones, there are no scientific models that can predict who will succeed and who will fail a trial of labor after cesarean section but he did offer these helpful insights:
- A VBAC candidate who has had a previous vaginal delivery has an 89% success rate for a VBAC and fewer complications as opposed to a woman who has never had a vaginal delivery. It is therefore not appropriate to ask women who’ve had successful vaginal deliveries to have repeat c. sections based on “hospital policy.”
- Women who have spontaneous labors have more successful VBACs than women who are induced in labor.
- Doses of oxytocin or Pitocin greater than 20 mu/min increase the risk of uterine rupture
- Intrauterine pressure catheters do NOT accurately predict uterine rupture and should not be used for that purpose.
- VBAC candidates who need more than one medication to induce labor are at an increased risk of uterine rupture
- If a VBAC candidate has an epidural and still feels significant pain or needs frequent doses of the epidural anesthetic, there is a significant risk that there might be a uterine rupture.
Performing repeat c. sections in women who have had previous vaginal deliveries is morally wrong. Patient safety should always take precedence over physician convenience.