Thursday, March 8, 2007
Why Are C-Section Rates Still Going Up?
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As an anesthesiologist I provide anesthesia for cesarean sections quite often. In fact, when I'm on overnight call it's what I spend most of my time doing. Usually, anesthesia for c-section consists of a spinal anesthetic, or using a pre-existing epidural catheter, or (more rarely and usually only in emergencies) a general anesthetic. I am therefore quite interested in the subject of cesarean section rates and what effects how often they are done. I learned some things from this article [free full text]:
Cesarean Delivery and The Risk-Benefit Calculus
1. Parturients are different--they are heavier and older.
2. The number of premature and low birth-weight babies has grown.
3. Vaginal breech deliveries are no longer recommended.
4. Operative deliveries (forceps or vacuum) are less common due to better data describing their risks.
5. More labors are induced (20% in 2003 vs 9.5% in 1990) and induced labors are more likely to result in C-section.
6. Changes in provider behavior
"At least one study found that physicians' malpractice premiums, the number of claims against physicians and hospitals, and the physician's preception of the risk fo being sued were all positively correlated with the likelihood of cesarean delivery. Many in the field defend the rising cesarean rates by citing concern about legal jeopardy, and indeed lawsuits often allege a failure to perform a timely cesarean delivery."
Look at John Edwards' list of law cases (thank you, Google). Notice the medical malpractice cases:
MEDICAL MALPRACTICE CASES
Another specialty Edwards developed was in medical malpractice cases involving problems during births of babies. According to the New York Times, after Edwards won a $6.5M verdict for a baby born with cerbral-palsy, he filed at least 20 similar lawsuits against doctors and hospitals in deliveries gone wrong, winning verdicts and settlements of more than $60M.
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| Case |
Summary of Facts |
Case Type |
Result |
Griffin v. Teague, et al.
(Mecklenburg Co. Superior Ct., NC, 1997) |
Application of abdominal pressure and delay in performing c-section caused brain damage to infant and resulted in child having cerebral palsy and spastic quadriplegia. Verdict set record for malpractice award. |
Medical Malpractice |
$23.25M
verdict |
Campbell v. Pitt County Memorial Hosp.
(Pitt County, NC, 1985)
|
Infant born with cerebral palsy after breech birth via vaginal delivery, rather than cesarean. Established North Carolina precedent of physician and hospital liability for failing to determine if patient understood risks of particular procedure. |
Medical
Malpractice |
$5.75M
settlement |
| Wiggs v. Glover, et al. |
Plaintiff alleged infant's severe cerebral palsy was caused by negligent administration of pitocin, failure to use fetal monitor, or timely intervening in baby's fetal distress. |
Medical
Malpractice |
2.5M
settlement |
| Cooper v. Craven Regional Med. Ctr., et al. |
Infant suffered severe brain damage after obstetrician failed to moderate use of Picotin after baby displayed clear fetal distress. |
Medical
Malpractice |
$2.5M
settlement |
Dixon v. Pitt County Memorial Hospital
(Pitt County, NC) |
Birth-related injuries including cerebral palsy and mental retardation allegedly caused by obstetrician's failure to diagnose fetal distress, including umbilical cord wrapped around baby's neck prior to delivery. |
Medical
Malpractice |
2.4M
settlement
|
Despite the increase in c-section rates nationwide, we have seen no reduction in the cerebral palsy rate...
Monday, February 26, 2007
Lieberman on Iraq
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OpinionJournal - Featured Article
"We are at a critical moment in Iraq--at the beginning of a key battle, in the midst of a war that is irretrievably bound up in an even bigger, global struggle against the totalitarian ideology of radical Islamism. However tired, however frustrated, however angry we may feel, we must remember that our forces in Iraq carry America's cause--the cause of freedom--which we abandon at our peril."
Wednesday, February 21, 2007
CRNA Independent Practice: Deciding Which Question to Answer
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In doing some more reading on the CRNA independent practice issue, I found what I thought was a curious quote in a Centers for Medicare and Medicaid Services press release from January 17, 2001. The press release is an announcement that Medicare will leave decisions on whether physician supervision of CRNA's is necessary to the States. Here's the quote from the second to the last paragraph:
"There is no evidence that CRNA independent practice would cause adverse outcomes."
I think asserting that there is no evidence that CRNA independent practice would cause adverse outcome is the wrong question to address. I think the question should be, 'is there evidence that CRNA independent practice would be as safe for patients as the present system?' (we're a six sigma specialty, remember).
The Safe Seniors Assurance Study Act of 1999 was to address the issue but it never made it out of committee:
"(1) The Secretary of Health and Human Services shall conduct a study of mortality and adverse outcome rates of medicare patients by providers of anesthesia services. In conducting the study, the Secretary shall analyze the impact of physician supervision of providers of anesthesia services, or lack thereof, on such mortality and adverse outcome rates.
(2) In conducting the study, the Secretary shall consult with appropriate national professional organizations with respect to the methodology of the study, and shall use medicare operating room anesthesia data, adjusted for patient acuity and other relevant scientific variables."
Sounds like a good starting point for this discussion, however...
Monday, February 19, 2007
Is CRNA Independent Practice Coming to Pennsylvania?
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Governor Rendell's 2007 budget document includes a section titled Prescription for Pennsylvania on page A3.32. The first paragraph of that section states:
"Ensuring that all licensed health care providers – including nurses, advanced nurse practitioners, midwives, physician assistants, pharmacists and dental hygienists – can practice to the fullest extent of their training. Pennsylvania consistently lags behind other states in fully utilizing health care providers who are not physicians. Prescription for Pennsylvania will seek to eliminate the barriers in existing laws, regulations and insurance reimbursement policies that limit the ability of health care providers to practice to the fullest extent allowed by their training and education."
Sounds like independent practice to me. Rather than write a knee-jerk reaction right now, I'd like to take some time to educate myself and consider the ramifications...
Wednesday, February 2, 2005
FactCheck: MoveOn.org Social Security Ad
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FactCheck.org got its start during the presidential election cycle and aims to "reduce the level of deception and confusion in U.S. politics." A project of the Annenberg Public Policy Center of the University of Pennsylvania, it periodically published 'fact checks' when it feels facts need to be checked (obviously). Their latest analysis is titled 'MoveOn.org Social Security Ad: Liberal group's ad falsely claims Bush plan would cut benefits 46 percent'.
" Summary
MoveOn.org launched a false TV ad in the districts of several House members, claiming through images and words that President Bush plans to cut Social Security benefits nearly in half. Showing white-haired workers lifting boxes, mopping floors, shoveling and laundering, the ad says "it won't be long before America introduces the working retirement."
Actually, Bush has said repeatedly he won't propose any cuts for those already retired, or near retirement. What MoveOn.org calls "Bush's planned Social Security benefit cuts" is actually a plan that would hold starting Social Security benefits steady in purchasing power, rather than allowing them to nearly double over the next 75 years as they are projected to do under the current benefit formula. The White House has discussed such a proposal, and may or may not adopt it when the President puts forth a detailed plan expected in late February. "
As physicians I think we need to be familiar with the facts about such major policy changes and FactCheck helps. If you like, you may sign up to receive future reports automatically.
Sunday, January 30, 2005
A Momentous Day
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The Fox News headline sums it up rather well: "A New Dawn of Democracy".
Iraq, our thoughts and prayers are with you--especially today. Let Freedom Ring!
Sunday, November 21, 2004
Should Anyone Be Giving Light Water Fuel to Iran?
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From the Nonproliferation Policy Education Center--A Fresh Examination Of The Proliferation Dangers Of Light Water Reactors (pdf):
""What emerges from this discussion is that Light Water Reactors are not the proliferationresistant technology they have been made out to be. Forgotten from the earlier days of nuclear energy is that LWRs can produce large quantities of near-weapons-grade plutonium, and that a country bent on making bombs would not have much trouble extracting it quickly in a small reprocessing operation, and possibly even keep the operation secret until it had an arsenal. ""
Friday, November 5, 2004
Americans flock to Canada's immigration Web site
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From Reuter's News Agency:
":The number of U.S. citizens visiting Canada's main immigration Web site has shot up six-fold as Americans flirt with the idea of abandoning their homeland after President George W. Bush's election win this week.
"When we looked at the first day after the election, November 3, our Web site hit a new high, almost double the previous record high," immigration ministry spokeswoman Maria Iadinardi said on Friday.
On an average day some 20,000 people in the United States log onto the Web site, www.cic.gc.ca -- a figure which rocketed to 115,016 on Wednesday. The number of U.S. visits settled down to 65,803 on Thursday, still well above the norm.
Bush's victory sparked speculation that disconsolate Democrats and others might decide to start a new life in Canada, a land that tilts more to the left than the United States.""
[Via Drudge]
Fallujah: Why Now?
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Blackhawk pilot 2Slick has a great post on the timing of the Fallujah offensive relative to our elections:
""The ground commander has a large staff of smart people that determine every aspect of the upcoming offensive. He has his intell staffers work specifically on what we call Intelligence Preparation of the Battlefield (IPB). This consists of many things- among them, finding answers to the questions- What is motivating our enemy? What are their objectives?
Our IPB determined (to nobody's surprise and I can tell you this because it's already been reported in the press), among other things, that these insurgents and terrorists were aiming primarily to influence our election and thwart the Iraqi election. It doesn't take a rocket scientist to figure out how they planned on influencing our elections- kill as many Americans as humanly possible.
They did anything and everything to lure us into the fight before Election Day- but we resisted. Because WE were calling the shots, and WE had total control of the situation. Our commanders and staffers up there wisely determined that if we hold off the offensive until after Election Day, it would leave the insurgents with one less thing that drives their will to fight. Almost like a morale issue. Instead of two primary goals, now they only have one- having failed to achieve their first. When you think about it- it's brilliant strategy. We won half the battle by not even fighting!""
Thursday, November 4, 2004
Why Exit Polls Were Wrong--Another Theory
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TCS: Tech Central Station - The Poll Vaulters:
""When a voter is confronted by a pollster in the service of the news media, therefore, what would a rational observer expect an unsatisfied media consumer to do? Would we expect an angry conservative to "spend" the time to help, without compensation, an industry that has by and large ignored that voter's attitudes regarding matters as emotionally charged as the selection of a president?
Clearly, this is an irrational expectation. I personally know numbers of people who have hung up on pollsters and gone out of their way to avoid people carrying clipboards.""
Wednesday, November 3, 2004
Phrases of the Moment
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Michelle Malkin: New, Nauseating Phrases of the Moment:
""
Well, now that the talking heads don't have to say "Too Close To Call" anymore, a new batch of mindlessly repeated phrases are polluting the airwaves
"The Country is Deeply Divided."
"It's Time to Heal."
"We Need to Heal."
"The President Must Reach Out."
Oh, blecch. Yes, civility is all well and good. But it is hard to stomach the sanctimony from liberals who had nothing to say when Teresa Heinz Kerry was insulting the First Lady, when the MSM/ULM was mauling John O'Neill, when Ted Kennedy was smearing the President, when John Ashcroft-haters were celebrating his hospitalization, and when left-wing bigots were mocking Condoleezza Rice and gloating over Ronald Reagan's death.
Yes, the country is divided. Divided between gracious winners and mud-slinging, hypocritical whiners who have nothing else to do now but point to their emotional boo-boos and decry the dirtiness of politics.
""
[Via Michelle Malkin]
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