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1.
Clin Obstet Gynecol ; 64(2): 392-397, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33904844

RESUMO

While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable.


Assuntos
Barreiras de Comunicação , Acesso aos Serviços de Saúde , Obstetrícia , Privacidade , Telemedicina , Feminino , Health Insurance Portability and Accountability Act , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/organização & administração , Humanos , Internet , Licenciamento , Obstetrícia/ética , Obstetrícia/legislação & jurisprudência , Obstetrícia/métodos , Obstetrícia/organização & administração , Gravidez , Privacidade/legislação & jurisprudência , Tecnologia , Telemedicina/ética , Telemedicina/legislação & jurisprudência , Telemedicina/métodos , Telemedicina/organização & administração , Estados Unidos
4.
West J Emerg Med ; 21(2): 235-243, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32191181

RESUMO

INTRODUCTION: The Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition - labor - specifically included in the title of the law. In light of rising maternal mortality rates in the United States, further exploration into the state of emergency obstetrical (OB) care is warranted. Understanding civil monetary penalty settlements levied by the Office of the Inspector General (OIG) related to EMTALA violations involving labor and other OB emergencies will help to inform the current state of access to and quality of OB emergency care. METHODS: We reviewed descriptions of all EMTALA-related OIG civil monetary penalty settlements from 2002-2018. OB-related cases were identified using keywords in settlement descriptions. We described characteristics of settlements including the nature of the allegation and compared them with non-OB settlements. RESULTS: Of 232 EMTALA-related OIG settlements during the study period, 39 (17%) involved active labor and other OB emergencies. Between 2002 and 2018 the proportion of settlements involving OB emergencies increased from 17% to 40%. Seven (18%) of these settlements involved a pregnant minor. Most OB cases involved failure to provide screening exam (82%) and/or stabilizing treatment (51%). Failure to arrange appropriate transfer was more common for OB (36%) compared with non-OB settlements (21%) (p = 0.041). Fifteen (38%) involved a provider specifically directing a pregnant woman to proceed to another hospital, typically by private vehicle. CONCLUSION: Despite inclusion of the term "labor" in the law's title, one in six settlements related to EMTALA violations involved OB emergencies. One in five settlements involved a pregnant minor, indicating that providers may benefit from education regarding obligations to evaluate and stabilize minors absent parental consent. Failure to arrange appropriate transfer was more common among OB settlements. Findings suggesting need for providers to understand EMTALA-specific requirements for appropriate transfer and for EDs at hospitals without dedicated OB services to implement policies for evaluation of active labor and protocols for transfer when indicated.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/legislação & jurisprudência , Obstetrícia , Transferência de Pacientes , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Obstetrícia/legislação & jurisprudência , Obstetrícia/métodos , Transferência de Pacientes/legislação & jurisprudência , Transferência de Pacientes/métodos , Gravidez , Estados Unidos
6.
Anaesthesia ; 75(4): 541-548, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31721144

RESUMO

Medicolegal claims for neurological injury following the use of central neuraxial blockade in childbirth represent the second most common claim against obstetric anaesthetists. We present an analysis of 55 cases from a database of 368 obstetric anaesthetic claims. Common themes that emerge from the analysis include: consent; nature of nerve injury (non-anaesthetic; direct; chemical; compressive); recognition; and management. Specific advice arising from these cases includes: the importance of informing patients of the risks of nerve damage; keeping below the conus of the cord for intrathecal procedures; responding appropriately if a patient complains of paraesthesia; and having a high index of suspicion if recovery of normal neurological function is delayed. As ever, principles of good practice, including respect for patient autonomy, early provision of information, good communication and a high standard of record-keeping, will minimise the frustration of patients that can then lead them to seek a legal route to redress if they suffer an injury following central neuraxial blockade.


Assuntos
Anestesia Obstétrica/efeitos adversos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Bloqueio Nervoso/efeitos adversos , Obstetrícia/legislação & jurisprudência , Traumatismos dos Nervos Periféricos/etiologia , Feminino , Humanos , Gravidez
8.
Obstet Gynecol Clin North Am ; 46(4): 853-862, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677758

RESUMO

This article addresses coding and liability related to obstetric and gynecologic ultrasound examinations. The coding section includes an overview of general concepts, highlighting the differences between coding in hospital-owned facilities and provider-owned clinics. It also addresses the importance of correct International Classification of Diseases, 10th edition, coding, emphasizing the use of the most specific applicable codes. This section discusses proper coding and applicable parameters for early pregnancy and gynecologic ultrasound examination. The liability section addresses common errors leading to litigation in obstetric and gynecologic ultrasound practice. Examples are given demonstrating how such errors lead to liability actions.


Assuntos
Codificação Clínica/legislação & jurisprudência , Feto/diagnóstico por imagem , Genitália Feminina/diagnóstico por imagem , Ginecologia/legislação & jurisprudência , Obstetrícia/legislação & jurisprudência , Ultrassonografia/normas , Codificação Clínica/métodos , Codificação Clínica/normas , Diagnóstico por Imagem , Feminino , Ginecologia/economia , Ginecologia/normas , Humanos , Responsabilidade Legal , Obstetrícia/economia , Obstetrícia/normas , Gravidez , Radiologia/economia , Radiologia/legislação & jurisprudência , Radiologia/normas , Ultrassonografia/economia , Ultrassonografia/métodos
11.
BJOG ; 126(12): 1437-1444, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31131503

RESUMO

OBJECTIVE: To validate the NHSLA maternity claims taxonomy at the level of a single maternity service and assess its ability to direct quality improvement. DESIGN: Qualitative descriptive study. SETTING: Medico-legal claims between 1 January 2000 and 31 December 2016 from a maternity service in metropolitan Melbourne, Australia. POPULATION: All obstetric claims and incident notifications occurring within the date range were included for analysis. METHODS: De-identified claims and notifications data were derived from the files of the insurer of Victorian public health services. Data included claim date, incident date and summary, and claim cost. All reported issues were coded using the NHSLA taxonomy and the lead issue identified. MAIN OUTCOME MEASURES: Rate of claims and notifications, relative frequency of issues, a revised taxonomy. RESULTS: A combined total of 265 claims and incidents were reported during the 6 years. Of these 59 were excluded, leaving 198 medico-legal events for analysis (1.66 events/1000 births). The costs for all claims was $46.7 million. The most common claim issues were related to management of labour (n = 63, $17.7 million), cardiotocographic interpretation (n = 43, $24.4 million), and stillbirth (n = 35, $656,750). The original NHSLA classification was not sufficiently detailed to inform care improvement programmes. A revised taxonomy and coding flowchart is presented. CONCLUSIONS: Systematic analysis of obstetric medico-legal claims data can potentially be used to inform quality and safety improvement. TWEETABLE ABSTRACT: New taxonomy to target health improvement from maternity claims based on NHSLA Ten Years of Maternity Claims.


Assuntos
Benchmarking , Imperícia/legislação & jurisprudência , Obstetrícia/normas , Feminino , Humanos , Revisão da Utilização de Seguros , Serviços de Saúde Materna/legislação & jurisprudência , Serviços de Saúde Materna/normas , Obstetrícia/legislação & jurisprudência , Gravidez , Melhoria de Qualidade , Medicina Estatal , Reino Unido
13.
Obstet Gynecol ; 132(1): 9-17, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29889758

RESUMO

OBJECTIVE: To evaluate financial relationships between obstetrician-gynecologists (ob-gyns) and industry, including the prevalence, magnitude, and the nature of payments. METHODS: We conducted a cross-sectional study in which we obtained a list of industry contributions to U.S. obstetricians and gynecologists through the Centers for Medicare and Medicaid Services Open Payments Database from August 1, 2013, to December 31, 2015. These data were cross-referenced with the entire cohort of practicing obstetricians and gynecologists, who were identified using the National Provider Identification database, because not all practicing ob-gyns received payments. These payments were analyzed with respect to 1) types of payments, 2) demographic attributes of health care providers receiving payments, and 3) comparisons between obstetrician and gynecologist subspecialties. Continuous data were compared using the Mann-Whitney test for variables that were not normally distributed and with the t test for variables that are normally distributed. RESULTS: A total of 517,077 nonresearch payments, totaling $79,965,244, were made to 23,292 ob-gyns. Physicians receiving payments were predominantly female, younger than 65 years old, allopathic physicians who graduated from U.S. medical schools in the late 1990s, and were board-certified subspecialists (P<.001 for all). Half of all ob-gyns received payments of varying amounts from drug manufacturers, device manufacturers, or both, with most of the payments for honoraria, faculty compensation, or consulting. Female pelvic medicine and reconstructive surgery physicians received the largest median dollar amount; maternal-fetal medicine physicians received the smallest. CONCLUSION: Obstetricians and gynecologists receive a substantial amount of payments from industry. Most of these payments were for honoraria, faculty compensation, or consulting and totaled less than $400 per health care provider. Although this total amount is less than typically received by surgical providers, including orthopedic surgeons who account for the highest compensated group in total and mean industry payments, the median payment value for obstetrics and gynecology subspecialists surpasses the median payment to orthopedic surgeons. These financial relationships warrant further exploration with future research.


Assuntos
Apoio Financeiro , Ginecologia/economia , Setor de Assistência à Saúde/economia , Relações Interprofissionais , Obstetrícia/economia , Adulto , Centers for Medicare and Medicaid Services, U.S. , Conflito de Interesses , Estudos Transversais , Bases de Dados Factuais , Feminino , Ginecologia/legislação & jurisprudência , Setor de Assistência à Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Obstetrícia/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Estados Unidos
14.
Duke Law J ; 67(4): 827-62, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29469554

RESUMO

In the United States, women are routinely forced to undergo cesarean sections, episiotomies, and the use of forceps, despite their desire to attempt natural vaginal delivery. Yet, the current American legal system does little to provide redress for women coerced to undergo certain medical procedures during childbirth. Courts and physicians alike are prepared to override a woman's choice of childbirth procedure if they believe this choice poses risks to the fetus, and both give little value to the woman's right to bodily autonomy. This Note proposes a solution for addressing the problem of coerced medical procedures during childbirth by importing a framework created in Venezuela and Argentina that characterizes this issue as "obstetric violence." First, this Note contains an overview of the shortcomings of the existing American legal framework to address the problem. Second, it explains the advantages of the obstetric violence framework and argues that its adoption in the United States would address many of the failures of the existing system. And third, this Note introduces a few legislative and litigation strategies that can be used to implement this framework in the United States and briefly addresses some of the challenges these strategies may pose.


Assuntos
Direitos Civis/legislação & jurisprudência , Coerção , Parto Obstétrico/legislação & jurisprudência , Episiotomia/legislação & jurisprudência , Violência de Gênero/legislação & jurisprudência , Violações dos Direitos Humanos/legislação & jurisprudência , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Obstetrícia/legislação & jurisprudência , Parto , Autonomia Pessoal , Cuidado Pré-Natal/legislação & jurisprudência , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Violência/legislação & jurisprudência , Saúde da Mulher/legislação & jurisprudência , Direitos da Mulher/legislação & jurisprudência , Aborto Legal , Argentina , Feminino , Feto , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Parto Normal/legislação & jurisprudência , Obstetrícia/métodos , Parto/psicologia , Gravidez , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Trauma Psicológico , Estados Unidos , Venezuela
15.
J Matern Fetal Neonatal Med ; 31(8): 1108-1109, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28367648

RESUMO

The authors emphasize the importance of performing an intrapartum ultrasonography in order to prevent maternal and neonatal complications but also physician legal liability. The main advantages of using this technique are: improvement of fetal head's malposition diagnosis; prevention of maternal and fetal complications of childbirth due to the use of forceps or vacuum extractor (VE); a more accurate planning of cesarean section; a proof of professional correctness.


Assuntos
Distocia/diagnóstico por imagem , Obstetrícia/legislação & jurisprudência , Feminino , Humanos , Responsabilidade Legal , Gravidez , Ultrassonografia
16.
J Obstet Gynaecol ; 38(2): 200-205, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28891358

RESUMO

In recent years, there has been a remarkable increase in medical malpractice litigations against OB/GYNs in Turkey and globally. This high litigation atmosphere may have changed attitudes, behaviour and practice of OB/GYNs. In the current study, opinions and attitudes of OB/GYNs regarding defensive medicine and to what extent they practice it were investigated. One hundred and eight OB/GYNs participated in the study. All participants found obstetrics and gynaecology riskier when compared with other medical branches and reported that they were increasingly practising defensive medicine. The majority of the OB/GYNs stated that they abstained from many risky interventions and expressed their belief that the high caesarean section (C-section) rate was associated with medico-legal concerns. The majority of the participants supported enacting of a specific medical malpractice law and supported the establishment of medically specialised courts. These regulations demanded by OB/GYNs should be taken into account by health authorities. Impact statement What is already known on this subject: In recent years, there has been a remarkable increase in medical malpractice litigations against OB/GYNs in Turkey and globally. Turkey has serious problems with the high C-section rate, which has been suggested to be related to medicolegal issues in a previous research. Fifty-one percent of babies, namely most of them, are delivered via C-section. There is no specific medical malpractice law and medically specialised court in Turkey. What the results of this study add: It seems like there is a professional liability crisis among OB/GYNs in Turkey. OB/GYNs reported that they were increasingly practising defensive medicine, and stated that they abstained from many risky interventions. A high C-section rate was found to be related to medicolegal concerns in OB/GYNs' perspective in the current study. OB/GYNs demanded some reasonable regulations. What the implications are of these findings for clinical practice and/or further research: Regulations demanded by OB/GYNs, which were probed in the current study, such as enacting a specific medical malpractice law and establishment of a medically specialised court, should be taken into account by health authorities in Turkey. The findings of the current study is believed to produce important results for the success of Health transformation programme put into practice in Turkey, which was not able to stop increasing C-section rates. Studies evaluating the direct or indirect costs related to defensive medicine practices of OB/GYNs in Turkey should be performed in subsequent research.


Assuntos
Atitude do Pessoal de Saúde , Medicina Defensiva/estatística & dados numéricos , Ginecologia , Responsabilidade Legal , Obstetrícia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Ginecologia/legislação & jurisprudência , Humanos , Masculino , Imperícia/legislação & jurisprudência , Pessoa de Meia-Idade , Obstetrícia/legislação & jurisprudência , Gravidez , Inquéritos e Questionários , Turquia
17.
Rev. direito sanit ; 19(1): 121-143, 2018.
Artigo em Português | LILACS | ID: biblio-915924

RESUMO

Este artigo tem por objetivo identificar, nas decisões do Superior Tribunal de Justiça (STJ), as principais causas dos danos decorrentes da prática médica obstétrica no momento do parto. O estudo analisou 21 decisões julgadas pela corte entre 2004 e 2014 relacionadas a indenizações judiciais na obstetrícia. O critério de seleção dos casos utilizou como método a busca de decisões no site do STJ, cujos descritores foram: "parto", "erro médico"; "médico"; "paciente"; "profissional da saúde"; "dano moral"; "dano material"; "SUS"; "responsabilidade civil" e "indenização por erro médico". O Rio de Janeiro foi o estado com maior número de ações indenizatórias (28,6%) apreciadas pelo STJ, seguido de São Paulo e Minas Gerais, com 14,3% cada um. No tocante aos réus que figuraram no polo passivo das demandas, 38,1% eram médicos e hospitais. Verificou-se que 71% das supostas falhas médicas que originaram as ações ocorreram durante a realização do parto natural, contra 29% dos casos de cesariana. A principal causa dos danos relatados foi a demora na realização do parto, seguida dos traumatismos. Apesar de pesquisas demonstrarem que a cesariana oferece maiores riscos para a parturiente e o feto, os resultados obtidos das decisões judiciais analisadas pelo STJ evidenciaram que os danos que resultaram sequelas irreversíveis no nascituro foram recorrentes nos casos relacionados ao parto natural, sugerindo que atenção especial deve ser dada à formação médica obstétrica, bem como à compreensão dos aspectos socioculturais envolvendo a indicação e a escolha pelo tipo de parto.


This article intends to identify the main reasons of damage caused by obstetric medical practice during childbirth, on the decisions of the Supreme Court of Justice of Brazil. The study analyzed 21 decisions judged between 2004 and 2014 related to legal compensations concerning obstetrics. The criteria for the selection of cases was to search the Supreme Court's website, for decisions containing descriptors such as: "birth", "medical error"; "doctor"; "patient"; "health professional"; "moral damage"; "property damage"; "SUS"; "Liability" and "compensation for medical error". Rio de Janeiro was the state with the largest number of compensation claims (28.6%) appreciated by the court, followed by São Paulo and Minas Gerais with 14.3%. Among the defendants listed on the demands, 38.1% were doctors and hospitals. It was found that 71% of the alleged malpractices that led to these actions occurred during vaginal delivery and 29% of cases correspond to caesarean section. The main cause of damages reported was the delays in performing delivery, followed by trauma. Although research has shown that the cesarean section poses greater risks to the woman and the fetus, the results obtained from the decisions analyzed by the court showed that damages resulting in irreversible sequelae in unborn children were recurrent in natural birth related cases, suggesting that special attention should be given to obstetric medical training as well as to the understanding of the sociocultural aspects that surround medical indication and choice of the type of childbirth method


Assuntos
Humanos , Masculino , Feminino , Cesárea , Compensação e Reparação , Conhecimentos, Atitudes e Prática em Saúde , Judicialização da Saúde , Erros Médicos , Parto Normal , Obstetrícia/legislação & jurisprudência
18.
BMC Pregnancy Childbirth ; 17(1): 392, 2017 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-29166880

RESUMO

BACKGROUND: Companionship during labor is known to have both physical and psychosocial benefits to mother and baby. Sri Lanka made a policy decision to allow a labour companion in 2011. However, implementation has been unsatisfactory. Given the leading role Obstetricians play in the implementation of policy, a study was undertaken to assess the knowledge, attitudes and practices among them. METHOD: A descriptive cross sectional study was conducted among consultant obstetricians working in the state hospitals using the platform 'Survey Monkey'. RESULTS: Out of the 140 consultant obstetricians invited, 68(48.5%) participated. Among the study participants, 40 (58.8%) did not allow labour companions in their wards. Lack of space (n = 32; 80%) and the volume of work in the labor wards (n = 22; 55%) were the commonest reasons for not allowing a companion. Only 16.7% (n = 5) of the obstetricians handling more than 300 deliveries per month allowed a companion (p = 0.001). Less than 50% of the obstetricians were aware of the advantages associated with the practice such as shorter labor, lesser analgesic requirement, higher chances of a normal birth, improved neonatal outcome and reduced requirements for labor augmentation for slow progress of labor. Knowledge on advantages on breast feeding and reduced need of instrumental delivery also remained low. CONCLUSION: In an individual unit, the consultant often decides policy. The study points out the need to improve awareness among the practitioners.


Assuntos
Atitude do Pessoal de Saúde , Parto Obstétrico/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Trabalho de Parto/psicologia , Obstetrícia/legislação & jurisprudência , Adulto , Estudos Transversais , Parto Obstétrico/legislação & jurisprudência , Países em Desenvolvimento , Estudos de Viabilidade , Feminino , Política de Saúde , Humanos , Obstetrícia/métodos , Parto/psicologia , Gravidez , Sri Lanka , Inquéritos e Questionários
20.
Syst Rev ; 6(1): 181, 2017 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-28874176

RESUMO

BACKGROUND: The clinical specialty of obstetrics is under particular scrutiny with increasing litigation costs and unnecessary tests and procedures done in attempts to prevent litigation. We aimed to identify reports evaluating or comparing the effectiveness of medical liability reforms and quality improvement strategies in improving litigation-related outcomes in obstetrics. METHODS: We conducted a rapid scoping review with a 6-week timeline. MEDLINE, EMBASE, LexisNexis Academic, the Legal Scholarship Network, Justis, LegalTrac, QuickLaw, and HeinOnline were searched for publications in English from 2004 until June 2015. The selection criteria for screening were established a priori and pilot-tested. We included reports comparing or evaluating the impact of obstetrics-related medical liability reforms and quality improvement strategies on cost containment and litigation settlement across all countries. All levels of screening were done by two reviewers independently, and discrepancies were resolved by a third reviewer. In addition, two reviewers independently extracted relevant data using a pre-tested form, and discrepancies were resolved by a third reviewer. The results were summarized descriptively. RESULTS: The search resulted in 2729 citations, of which 14 reports met our eligibility criteria. Several initiatives for improving the medical malpractice litigation system were found, including no-fault approaches, patient safety policy initiatives, communication and resolution, caps on compensation and attorney fees, alternative payment system and liabilities, and limitations on litigation. CONCLUSIONS: Only a few litigation policies in obstetrics were evaluated or compared. Included documents showed that initiatives to reduce medical malpractice litigation could be associated with a decrease in adverse and malpractice events. However, due to heterogeneous settings (e.g., economic structure, healthcare system) and variation in the outcomes reported, the advantages and disadvantages of initiatives may vary.


Assuntos
Jurisprudência , Imperícia , Obstetrícia , Segurança do Paciente , Políticas , Feminino , Humanos , Imperícia/legislação & jurisprudência , Obstetrícia/legislação & jurisprudência , Gravidez
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