Money Matters
hoffse
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Switching doctors?
OK this is out of character for me, but...
A jury verdict just came down against the hospital where my OBGYN practices. In a nutshell, a woman was trying to have a natural birth in a particular position. The doctor hadn't arrived yet when the baby was coming, so the nurses flipped her over, restrained her, and then pushed the baby back inside until a doctor arrived.
Baby was fine, but mom suffered permanent nerve damage, because they held the baby in the birth canal for several minutes after he was ready to come out. $16M jury award.
I get that stuff like that is rare, but... there are two other hospitals in the area that have a good reputation for women's health that are in network for my insurance. I like my doctor just fine, but I only see her once a year. Given that H and I still plan to TTC at the end of the year, would you switch doctors/hospitals based on a story like that?
A jury verdict just came down against the hospital where my OBGYN practices. In a nutshell, a woman was trying to have a natural birth in a particular position. The doctor hadn't arrived yet when the baby was coming, so the nurses flipped her over, restrained her, and then pushed the baby back inside until a doctor arrived.
Baby was fine, but mom suffered permanent nerve damage, because they held the baby in the birth canal for several minutes after he was ready to come out. $16M jury award.
I get that stuff like that is rare, but... there are two other hospitals in the area that have a good reputation for women's health that are in network for my insurance. I like my doctor just fine, but I only see her once a year. Given that H and I still plan to TTC at the end of the year, would you switch doctors/hospitals based on a story like that?
Re: Switching doctors?
I would probably change doctors - there is likely a culture in that hospital that made that nurse think that what she did was acceptable. That said - I'm a litigation paralegal and I used to do med mal. I run a full litigation and background search on every doctor I or my family sees.
If this had happened at our hospital prior to me giving birth there, I would have switched.
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Oooohhh. That's a tough one. I don't know that I would definitely switch, but I would really scrutinize both reviews and hospital stats for maternity, especially for C-sections.
Certainly C-sections are sometimes necessary, but I've come across the statistic in a few articles (about healthcare, in general) that women are substantially more likely in Southern states to be told they need a C-section (once they are in labor) than anywhere else in the country. With the implication that hospitals with higher than average c-section rates are putting the hospitals' lawsuit fears above the health of their patients. The gist I got was natural births, whenever possible, are generally healthier for baby and mom. But unusual things can happen in a natural birth, which leads to more lawsuits, than as compared to a C-section.
I think my biggest concern from that story is I'd be worried that the staff would not be sensitive to (and listen!) to what my needs would be for a birth. I don't know what ever came of it, but I read about a lawsuit where a woman claimed to have PTSD from her OB/GYN badgering her incessantly, while she was in labor, to agree to a C-section. She claimed the doctor was belittling and patronizing to her and essentially forced her to agree to the C-section, even though there wasn't a medical need for it.
I like her, and she's one of the few female GYN's in town (which I prefer), but I would be open to switching. She is rather young - she's been practicing medicine about as long as I've been practicing law - and that kind of flips me out too. And while this is minor, some of the stuff she has said to me (with great confidence) regarding billing and insurance has just been flat wrong.
I have no idea what happened to the nurses involved. I think it was actually 5 of them!
OK I'm glad I'm not the only one who thought that sounded bad enough to look elsewhere if the time ever comes. This same hospital also just went through a huge merger where they were the acquired hospital, and that gives me pause too. They are likely to be dealing with a huge amount of data integration, and I'm not sure I want to be a patient there while that transition is taking place.
By chance, were they acquired by HCA?
I have to admit, I definitely pick doctor's based on how long/short they have been out of medical school. 10-25 years out is my preference.
Shorter than that, and I feel they may not have the wealth of experience. I once had an atrocious doctor who had only been out of his residency for 1 year. Arrogant and patronizing. "Misdiagnosed" me, because apparently the other 3 endocrinologists I'd seen over the last 10 years were wrong? Yeah, okay. Refused to fill a prescription I'd been taking for years, even though his own test results showed my thyroid was extremely low. And accidentally called my birth control prescription in as pills that were actually for menopause. Then never called in to fix it when I alerted him to the mistake. Fortunately, my pharmacist questioned me about it before filling it because she could see I was only 31 (at the time).
Longer than 25 years, and I feel like I don't relate/communicate with them as well. I'm also concerned they aren't up on the latest and greatest for my condition.
What happened to this poor mom and baby is awful. I think what concerns me about the hospital is that apparently no other OBGYN was available in an emergency??? If this mother-to-be had another type of emergency, what would they have done?
I know a lady that recently gave birth. Everything was fine and then she suddenly didn't feel well. They had only a very small amount of time to save her and the baby - amniotic fluid embolism. Very rare but it happened to them. Literally the hospital called it a miracle.
We recently had to change my wife's birth control. The first one they prescribed had a $20 copay. Huh? I thought they were supposed to be covered due to the ACA now? So we called the doctor's office and they said they have no way of knowing what's covered and what's not. So we ended up calling our insurance who pointed us to a PDF online which we ended up reading over the phone to one of the nurses after sending several emails (patient portal) where the responding nurse obviously didn't read the entire email. I swear, we love the doctor herself, but the support staff are somewhat useless sometimes.
Making no excuse for what happened, but it reminds me of a conversation I had with the nurse when our son was being born. The nurse pretty much did everything and the doctor (not our normal doctor) showed up literally right at the end to catch the baby essentially. I had asked the nurse before hand what happens if she ended up delivering the baby as our son was apparently in quite a hurry. She said she was qualified to do it, but there was a ton of paperwork she'd have to fill out to explain why she delivered the baby and not the doctor. Wonder if someone was trying to avoid the paperwork?
Another thing to think about is that even if you always see the same OB for your annuals, you're likely to see a rotation of them for your actual pregnancy and be delivered by whoever is actually on call. This makes it important that the whole practice share your philosophy, not just your current doctor.
Every hospital (and hospital system) has its own distinct culture. And, the best way to learn about that culture is to ask the nurses. My mom is a retired RN of 35+ years and she worked in labor/delivery for a bit, but most of her time was in post-partum care of new moms and babies. And, she was in the Cleveland Clinic. She always told me to ask nurses about doctors and about hospitals.
I personally am not sure if I would switch medical practices over this law suit, especially if your practice works out of another facility too. But, to be informed, I think I would need more information and to hear both sides of the story. I personally find it difficult to believe that nurses would restrain a woman giving birth. And, many/most hospitals these days do provide options for natural childbirth...they don't force meds, they offer tubs, they invite women to move around, etc.. I know the money awarded to the woman would dictate that something did occur to her detriment, most likely, but, I would still like to hear both sides of the story.
I must also echo PPs who said that GYN visits and OB visits within a practice of doctors are different. They often ask/encourage OB patients to visit with all the doctors during the course of the pregnancy...you never know when you will go into labor and therefore, any doctor may be on-call at that time. It is helpful to you and to them to "know" one another. I too prefer certain doctors over others (pretty normal) and I also prefer female doctors, but my practice has two males, so yes, I did/do visit them. Quite honestly, when you're in labor...gender of the doctor is the last thing you're thinking of...
All of my friends who insisted on being with one and only one OB for their first pregnancies, (were all in practices with multiple doctors) and refused to see other doctors, ended up scheduling elective inductions just so they could have their doctor of choice. All of them ended up having C-sections. All of them. Studies show that inducing labor (when not medically necessary to protect the safety of mother and/or child), has a higher rate of C-sections result. It's far better to let nature take its course, especially with a first pregnancy, then to manipulate it for scheduling, elective, and personal doctor preference reasons.
Another thing you can do is think about and then write up a birth plan. This is your desires, on paper, for the doctors and nurses about how you want to do labor and delivery.
The one balance with it, though, is that they are the trained professionals who know more than we do. I've heard stories of patients with birth plans, holding to them so rigidly, even when medical staff encouraged other means of intervention, that they refused and problems ensued.
We have decided that I will not use that hospital, though I may not switch actual doctors. I still need to find out if she has privileges elsewhere.
I dug a little deeper and this hospital's C-section rate is 10% higher than the other hospital near our house. It has one of the highest C-section rates in the state, and it's significantly higher than either the national or state average. I got this info from the state.
I've also talked to some litigators I know, and H has done the same thing. They all suggested we look elsewhere, because this hospital consistently gets sued far more often than the other hospital we are considering. Believe me, I fully understand that many lawsuits are frivolous, but the people we were talking to are defense attorneys and are naturally skeptical of medical malpractice suits. They said to avoid it, and I trust their judgment.
Finally, two of my uncles are OBGYN's. My dad sent that info to them. They said that speaking as professionals, there is a very good chance that issue has been addressed and will not be an issue in the future. However, speaking as my uncles, they would prefer I look elsewhere, because what happened to that woman is clearly not up to the normal standard of care.
I do believe the story. The patient is actually the daughter of a prominent physician in town, so I don't think she would have gone into a medical malpractice suit lightly. Besides, the entire thing was laid out in her chart. It noted her agitation and the fact that the baby was held until a doctor could arrive to complete delivery. The chart even noted how long the baby was held back. It was pretty much a slam dunk case.
I'm a lot more concerned about the culture of the hospital and the medical staff, since they do 95% of the work.
I just want to say not all inductions are bad and it doesn't necessarily mean you will end up with a c/section. I was induced at 41 weeks and honestly I wouldn't want to go further than 41 weeks again - it's pretty exhausting. The reason I ended up in a section is because DD was sunny side up and I just couldn't get her out even after pushing for over 3 hours. Otherwise everything in my induction went as it should have. I'm just so much more informed now and a different person than I was back then. I think c/sections get a bad rap when in fact the mother or babies health would be in question without one. Now scheduling a c/section for a first baby is a totally different story. I think some first time moms think c/sections are such a piece of cake but in fact its a major surgery where they cut thru your abdominal wall.
There is one hospital system up here that gets significantly more lawsuits than any other even with all of our protections for doctors - I told DH that even if I'm bleeding and unconscious drive the extra 2 minutes to the better hospital.
http://www.cosmopolitan.com/lifestyle/news/a62592/caroline-malatesta-brookwood-childbirth-lawsuit/
Its so important to interview the OB you want to go with and tour the hospital and talk to hospital staff. Delivering your baby is a very important part of your families life. Sad thing is that this girl did interview the OB but looks like she didn't look into the hospital - like I said the hospital staff and nurses is who you interact the most with during your birth. I do know the OB I have picked out will actually be in there the entire time you push even if its for 3 hours. Lots of referrals from many local ladies in my area have confirmed she is the best at what she does.
Still, though - definitely not going there.
What's crazy is this is the hospital located in the affluent part of town. The two hospitals located in the downtown area (and that see more urban medical issues) are the ones that have a better reputation for maternity care.