What Will Prenatal Care Look Like in the Future?

In today’s tough U.S. economy, healthcare is in the forefront because of the three trillion dollars spent each year. Patients are not seeing their money’s worth and neither is the U.S. government who writes the check for a large percentage of it. The cost of women having babies too early or prematurely costs our society $26 billion dollars each year. Something has to give.

Women’s health is the topic of great political debate as you may well be aware if you listen to the news or watched both political parties’ national conventions during the past two weeks. Do women control their destinies? Do we and will we continue to have control over our bodies? These are the questions at hand. While there’s great chatter about this topic as the U.S. election nears, there’s also a quiet revolution occurring in our healthcare system that will directly affect pregnant women.

Prenatal care as we know it will begin to change, especially if you receive Medicaid or government sponsored insurance. The current trend is to visit your healthcare provider’s office individually and wait to be seen. In the future, you will be seen by your healthcare provider as a member of a group, not as an individual. This is called enhanced prenatal care with group appointments and will be the wave of the future.

Groups of 10 pregnant women will be seen at the same time for approximately 10 prenatal visits that will last approximately 90 minutes. It is anticipated that 2 healthcare providers will not only take your vital signs, listen to your baby’s heartbeat, but will also allow you to interact with the other patients in this group setting to discuss prenatal issues, receive health education information and any concerns that you may have. Believe it or not, this model of care is not new.  The concept was called Centering Pregnancy and was developed by nurse midwife Sharon Shindler-Rising in 1989.

In the future, doulas and social workers along with midwives will become more prominent in terms of prenatal care as things continue to evolve. Are you ready for group prenatal visits?

Is Nurse “Burn-Out” Hazardous to Your Health?

ImageJoNel Allecia’s NBC News article, Burned Out Nurses Linked to More Infections , addresses an important issue that is often overlooked and ignored. Let’s be brutally honest, without an appropriate nursing workforce, our entire healthcare system would collapse.  As our healthcare system continues to shift to a business and profit model, both nurse and physician burnout will only increase.

Decisions to “cut corners” by not providing adequate nursing staff are made on a daily basis to our detriment. There was a time when additional nurses would be brought in based on the patient census for the day or evening shift but those days are gone forever.

According to a recent medical study, for every extra patient added to a nurse’s workload, there is one hospital acquired infection for every 1,000 patients. While this may not sound significant to the uninitiated, a hospital acquired infection can wreck havoc because it is usually caused by antibiotic-resistant bacteria that are difficult to treat and Methicillin-Resistant Staph Aureus (aka flesh-eating bacteria) or MRSA is a perfect example.

The study goes on to report that when an additional patient is added to 5.7 patients per nurse, 1,351 additional hospital infections occur that are preventable. The statistics are alarming.

A few months ago I reviewed a medical ob-gyn case where the labor room nurses were short-staffed and the patient unfortunately died of complications. The physician had patients in labor but chose to finish his office hours rather than attend to a sick patient so the short-staffed labor room nurses were essentially managing his high-risk patients.

What can a patient do? Plenty.

  1. Ask what the patient to nurse ratio on the day of your hospital admission and if the nursing staff pattern is inappropriate, ask your insurance company if you are eligible for a private duty nurse based on the increased hazards associated with inadequate nursing staffs.
  2. Ask your physician to come to the hospital to closely oversee your care or make sure there’s a hospitalist on duty
  3. File a formal complaint with the hospital administrators, State Board of Nursing and the Joint Hospital Commission for jeopardizing your patient safety based on inadequate staffing patterns

When nurses are overloaded with work, an entire community suffers.

Patient’s Miscarriage Gets Hospital in Trouble

It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession.  Loni Hildebrandt was a 29 year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and her boyfriend saved their money and obtained fertility treatments. Her mother, Jo Novtny, a nurse of 30 years was ecstatic when she saw the ultrasound of her two grandbabies but her happiness was short-lived. One day after the procedure, Hildebrandt began to bleed so they went to Sarasota Memorial Hospital in Florida.

Sarasota Memorial Hospital has an excellent maternal fetal medicine (aka high-risk obstetrics) department but Hildebrandt never made it there. She got as far as the hospital’s emergency room where she was attended to by one of its physicians. Despite repeated requests to have her blood sugar checked, Hidebrandt had to wait six hours before it was done. An ultrasound at the hospital revealed a blood clot that was causing the contractions and the ER doctor told her that he could probably save one by “suctioning the clot so the labor would stop.”  According to The Herald Tribune, the physician suctioned the clot and one of the twins as well. Hildebrandt allegedly began bleeding more, passing bright red blood clots. They called for help but no one came. According to the newspaper report, a nurse put the afterbirth in a bedpan and left it near Hildebrandt’s head where she was lying. Her mother moved it and placed it under her daughter’s bed. Novtny ultimately delivered the second twin because no one else was around.  The ER doctor returned to the room saw the fetus in Novotny’s hand took it from her and put it in a bucket.

Novtny states her daughter did not receive proper treatment until her personal physician arrived and remained in a pool of blood for over 10 hours. Hildebrandt’s iron count was dangerously low because of the bleeding. Her mother’s request to speak with the hospital administrator was met with no response so she wrote a letter to the governor instead.  An investigation was done, gross negligence was found, the ER doctor resigned and Hildenbrandt’s nurse was cited for “lack of critical thinking skills.” The hospital will now have unannounced federal inspections in order to keep their Medicare payments. The hospital administrator issued a public apology.

Perhaps one day hospitals will do the right thing, even when no one is watching.  Hopefully, Hildebrandt will become pregnant again and have a better outcome.

Fighting an Uphill Battle on Behalf of Pregnant Women

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?

A Nurse’s Courage

In celebration of Nurse’s Week, I’d like to share an inspiring story about a nurse with whom I work with, Beth Ann Hedrick, RN, BSN.

To look at Beth today, you would never know that she is a breast cancer survivor who had a battle with death and won.

My first encounter with Beth was via the telephone approximately 14 years ago, when I called the labor and delivery suite of our local hospital. In 2006, I was surprised to learn that Beth joined our health department as a supervisory nurse. After 18 years of working in the hospital, she had a calling to provide public service. However shortly after Beth started her new position, she was diagnosed with stage 2 breast cancer.  One of her most difficult challenges was breaking the news to her three children and husband, who had been recuperating from recent back surgery.

Two days after Christmas in 2006, Beth underwent a double mastectomy with breast reconstruction. What was supposed to be a four-hour procedure took 12 hours instead. Beth awoke in the ICU on a ventilator and remained in the hospital for the next two weeks. Thirteen days after her procedure she encountered severe low back pain inhibiting her ability to walk. Three physicians diagnosed her with back strain as the result of her breast reconstruction. However, the pain persisted and she insisted on seeing her primary physician. During the car ride to his office, she screamed and writhed in pain. Upon her arrival, her primary care physician immediately called 911 and she was admitted to the hospital. A diagnostic MRI revealed possible metastasis to the bone and she was taken to the OR.

The neurosurgeon found a pocket of pus as he had prepared to operate on her spine. The “bone metastasis” was actually a MRSA (Methicillin Resistant Staph Aureus) infection that would have killed her, had it ruptured. Beth spent the next 12 weeks in and out of the hospital and self-administered IV antibiotics twice a day during that time period. Her breast implants were removed and her chemo therapy was postponed for six months.

Beth had economic setbacks as well. She lost her home and depleted her 401K retirement savings. However, despite insurmountable obstacles, her three children excelled in school and her husband remained by her side.

Fast-forward to the present: Beth’s daughter, Megan, is graduating from Oprah Winfrey’s alma mater, Tennessee State University at the age of 20 on an athletic full-scholarship and there has been a documentary highlighting her accomplishments (http://www.youtube.com/watch?v=UV8thlMSzW0). Her son, Matthew has also received a full-athletic scholarship to play football at West Virginia State and her youngest son is doing well in elementary school. Beth is cancer-free and is enrolled in a graduate program to become an advanced nurse practitioner.

Happy Nurse’s Day, Beth. You’re an inspiration to us all, and may your light continue to shine.

Physicians Will Quit? Why Now?

The Basil and Spice article, Doctors Will Quit Under New Healthcare Proposals really touched a raw nerve. The author, Dr. Jeffrey English, an Atlanta neurologist proposed that physicians will “quit” because of government healthcare involvement. Dr. English, with all due respect, please speak for yourself.

The time for physicians to “quit” was when the insurance industry took over our profession. They introduced managed care, bribed our colleagues with “capitation” income and then entered the back door of our profession and like a thief in the night, took over. We, as physicians are to blame for this unholy mess. We never stood up to the insurers for fear of being “disenrolled” from their lousy plans. We never protested for fear of being deemed as “antitrust.” We never complained when they redefined us as “providers.” And sadly, many of us never fought for our patients’ rights or dignity for fear of making waves.

The nonsense of “government” takeover is a joke! The “government” wouldn’t have to intervene if we had stood our ground, but we didn’t. We now have to depend on the government to make the insurance companies pry their greedy hands off our profession and patients. I’m an Ivy League grad (Columbia U.) and a board certified ob-gyn physician. I’ve devoted my life to serving vulnerable, public health patients, the kind none of my colleagues want to manage. I live next door to a teacher, a bank manager and live within my means. My kids attend public school. I’ve been taking care of Medicaid patients all my life and I’m not starving, still breathing and living in a country that allows me to be free. Doctors will quit? Really? I think it’s much too late for that now. We, as physicians need to put our egos in our pockets, roll up our sleeves and find some solutions instead of whining like babies.

A Love Letter to My Congresswoman Suzanne Kosmas

The Russians have a saying: “One who sits between two chairs may easily fall down.” Representative Kosmas, as a constituent in your 24th Congressional District and as a public health physician, thank you for having the courage to vote for healthcare reform. I know this was a difficult journey and that your professional career is on the line. However by voting for healthcare reform, you will be remembered in history as a pioneer who gave the American people a beacon of light and returned the “care” back in healthcare.

The healthcare bill is not perfect, I actually cried when I first read it. As a physician, I have witnessed the devastation that insurance dynasties have created by placing profit before people and billing codes before treatment. They thought they could marginalize physicians and nurses by referring to us as “providers.” They ignored our years of expertise and training. They annihilated the profession of medicine.

I know that the pharmaceutical and insurance lobbyists were bombarding you with temptation that would have been easy to deposit into the bank of future favors. However as a very wise man once said “What good does it profit a person to gain the whole world but forfeit his soul?”

Tomorrow, you will cast your vote and change the course of history. You have pushed through your fears and stepped into greatness. As your constituent, please rest assured that I will have your back.  You have earned both my trust and my vote in the next election. I will knock on doors for you. I will volunteer for you. I will be there for you in your time of celebration but also in your time of need. You are now the crown jewel of my congressional district. May God continue to bless you.