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Sat Jul 21 07:40:50 BST 2007

This story demonstrates a classic error that ED doctors are prone to making.
Trying to solve other people's problems. Leaving aside the pottiness of the
US payment and legal systems (here in the UK we have two laws that would
allow treatment of this person in an emergency and of course for free) an ED
doctor should not be trying to gain consent for either the anaesthetic nor
the delivery. He isn't going to do either procedure and is unlikely to be
able to gain valid consent from anyone! Let the OB answer his own questions,
get off his backside and deal with his patient. Ditto the anaesthetist
(anaesthesiologist). 

BFM

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: 20 July 2007 04:07
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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Table Top Test - CALL to you "an on call medical supervisor"