List Archives

Wed Jul 25 03:07:46 BST 2007

I don't quite see the difficulty?

All countries (I hope) have some version of a "good Samaritan"
principle, where provided what you do in an emergency is in good faith,
and in the patient's best interests, then there is no problem. 

In my own state (NSW, Australia) there is a Public Guardian whose job
is to make decisions for those who cannot consent for themselves and
have no appropriate surrogate. If I phoned the on call Public Guardian
about this case the response would be "go and fix the pain, do whatever
you need to do, then come and and we will talk about the ongoing
Guardianship issues for this patient".

Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Director of Clinical Research, Sydney West AHS
Clinical Lecturer, University of Sydney

>>> KMATTOX at aol.com 20/07/2007 1:06pm >>>

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

************************************** Get a sneak peek of the all-new
AOL at 
http://discover.aol.com/memed/aolcom30tour 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

######################################################################
Attention: 
This message is intended for the addresses named and may contain 
confidential information. If you are not the intended recipient, please
delete it and notify the sender. Views expressed in this message are 
those of the individual sender, and are not necessarily the views of 
Sydney West Area Health Service.

This e-mail has been scanned for viruses
######################################################################

List Archives

For your convenience, find the Trauma List Archive Below

Table Top Test - CALL to you "an on call medical supervisor"