ReThinking Patient Safety

"Never Again," Extreme Examples , & the torture of disabled children. Here. In America.

Video showing the electroshock torture of

children with disabilities in America. 

http://www.youtube.com/watch?v=aAj9W0ntUMI

___

link here  http://bit.ly/IQdzq6

 

Electroshock. Nazis electroshocked Jews.   http://bit.ly/J2s7WY,    http://bit.ly/KKWwag, and   http://bit.ly/KKWOxS   Electroshock was a part of the Nazi rule of Germany, commonly viewed as the most evil episode in history. The historic details have been studied, and recommendations made. If mankind has learned any lesson, hopefully it would be that those horrors should never happen again. When events veer in that direction, they must be stopped. Immediately. Sadly, we have not learned that lesson. 

 

Welcome to the Rotenberg Educational Center in Chatham, Massachusetts. In 2007, five years ago, Mother Jones ran an expose . http://www.motherjones.com/politics/2007/08/school-shock  In 2010, 2 years ago, a U.N representative asked the U.S. government to act. http://abcnews.go.com/Nightline/shock-therapy-massachussetts-school/story?id=11047334  A former employee authored a disturbing description of the facility. http://canton.patch.com/articles/letter-to-the-editor-a-former-judge-rotenberg-center-worker-speaks-out A horrifying videotape has emerged.http://www.youtube.com/watch?v=aAj9W0ntUMI   Yet, it continues. How is this even possible? 

 

Extreme Examples

Extreme examples are instructive because they clarify conceptual boundares. Much can be learned by studying this one. If we cannot stop this obviously outrageous and evil behavior, then we should not be surprised that progress in other areas is  so difficult. 

 

Seventy years after it happened at the hands of the Nazis, it is happening again. I am asking for your help researching and thinking about this problem. We have  failed these children. We have failed ourselves. What can we learn about patient safety, and the inertia of medical institutions and the government agencies that regulate them, from this example? More important, what can we learn about our human species and our resistance to learning from mistakes? 

Never Again?

 

Electroshocks intentionally administered to children. 

Electroshocks intentionally administered to children with disabilities. 

Electroshocks intentionally administered to children with disabilities in America.

Electroshocks intentionally administered to children with disabilities in America  at an "educational / medical" institution. 

Electroshocks intentionally administered to children with disabilities in America at an "educational / medical" institution that kill. 

Licensed institutions and licensed professionals intentionally administering electroshocks   to children with disabilities in America at an "educational / medical" institution after a child dies.

A United Nations representative criticizes this practice. Still it does not stop. It continues. For years. 

Can our species learn anything?

This cannot be dismissed as the acts of a few misguided souls in Massachusetts. Had we learned the lessons of Hitler and the Nazis, the problem would have been solved within a week after it first became public. Some authorities somewhere would have found a way to have stopped this practice. 

Here we are, several years and hundreds of news articles later. Local news, national news, international news. It gets worse. Nearly two years ago, the UN spoke up. 

To be frank, I was shocked when I was reading the report," said Manfred Nowak, the UN's Special Rapporteur on Torture. "What I did, on the 11th of May, was to send an urgent appeal to the U.S. government asking them to investigate."

http://abcnews.go.com/Nightline/shock-therapy-massachussetts-school/story?id=11047334#.T6VtnetDwpW

A lawsuit for damages was settled, but it failed to stop the practice .

http://www.science20.com/countering_tackling_woo/judge_rotenberg_trial_ends_settlement_nothing_changes_jrc_though-89394

 

What next for us?

 

Why can't we learn from our worst mistakes?  If we cannot learn from our worst mistakes, it should not surprise us that we cannot learn from lesser ones.  We need to understand this extreme example.  Please help me figure this one out.   Much is at stake. If we can understand the failure to correct this, perhaps we can understand the failure to correct the other mistakes in medicine. 

 

Link to gratify impulse to take some kind of immediate action by adding your name to Change.org petition.   http://chn.ge/StopElectroshockTortureOfDisabledKids Sign it and share. 

Feel free to copy and use  my tweet. 

"  Never again" to electric "therapy" that kills children @ Rotenberg Cntr - Change.org petition http://chn.ge/StopElectroshockTortureOfDisabledKids  "

REQUEST: Please add links and your recommendations for any action below. Help. 

http://www.disabilityrightsintl.org/wordpress/wp-content/uploads/USReportandUrgentAppeal.pdf

Worse than Playing with Matches: Sean Harris' Hate Speech from the Pulpit "Give them a good punch"

<Note: Sean Harris' hate speech and the mistreatment of Lakay Roberts demand comment, even if outside the scope of "patient safety." >                                 

 Hate Speech from the Pulpit 

to Parents of Gay Children

Sean  "Give them a good punch" Harris

"Dads. the second you see your son dropping

 the limp wrist, you walk over there and

crack that wrist.  Man up!  Give  them  a

good punch. OK. You're not going to act like

that. You were made by God to be a male

and you're going to be a male."  

 

Sean Harris'  "Give them a good punch" Pulpit

You shouldn't urge people to beat up others just because they are different.

You shouldn't urge people to beat up others just because they are different

1. in a church,

2. from the pulpit as the leader of the church,

3. as a part of the weekly church service,

4. during the sermon,

5. using the platform of a loving God and claiming the authority of a holy book,

6. to be recorded and placed on the internet to be broadcast to millions,

7. so that it might persuade hundreds of unstable listeners to act, and

8. put untold numbers of others deemed different at risk of being harmed or killed.

 

Sean Harris: "Dads ...  Give them a good punch"

Worse than playing with matches

 

When kids play with matches around flammable materials, you take the matches away. You don't care what the intent is. The danger of injury or death is too great. Just take the matches away.

 

Sean Harris' hateful words were more powerful than matches. Sean Harris consciously and intentionally provoked violence. He knew the power of those words. He chose to say them anyway.

The Decision Sean Harris Made 

 "Give them a good punch"

Sean Harris knew his hate speech urging violence would be broadcast to millions online. He knew that his words from the pulpit have an impact. He knew that some unstable listeners might act on them. He knew that some against whom he urged violence might be hurt or killed. He knew all this. He decided to shout his hateful words anyway. Whatever his real agenda, he decided it was more important than anything else, including  the legal right of millions of citizens to be left alone. His real agenda was more important than the safety of the targets of his verbal hatred. His real agenda was more important than acting responsibly.  His real agenda was more important than the loving God he claims to worship, the Ten Commandments, the teachings of Jesus, the Bible, his responsibility to his parishoners.

 

Sean Harris decided on that Sunday morning that his real agenda was more important than every principle he claims to stand for.  Knowing that, he chose to shout his hate speech urging violence anyway. He chose some short term agenda over long term values. 

The Decision Berean Baptist Church Must Make

Will church elders embrace the message:  "Give them a good punch"

 

Sean Harris' church, the Berean Baptist Church, witnessed all this. They heard. They knew the risks then and they know them now.

 

They know that Sean Harris behaves from the pulpit like a child with a matchbox. They know it is only matter of time before he exercises such bad judgment again.

 

If the Berean Baptist Church wants to behave like a group of responsible adults, then it needs to take away Sean Harris opportunity to provoke violence from the pulpit they provide him.

The  "Give them a good punch"  Pulpit?

Everyone would expect, indeed insist, that a parent to take the matches away from a child. The Berean Baptist Church's pulpit is now Sean Harris' matchbox for provoking violence. Let's tell the church to behave like responsible adults and take away the pulpit he uses as a matchbox. Tell the church what you think.

 

I plan to add to this page links to sites with information for expressing your views to the church.  Let's tell the church they must act responsibly. They must take away the pulpit from which Sean Harris shouts his hate speech urging listeners to violence. 

 ______________________________________________________________

ACTION ? 

 

What do you think will convince this church to do the right thing?  

Look at the church's web pages.

See how other groups are addressing this misconduct.

Write a letter to the editor of a paper.

Share your ideas here. 

 According to its web page,the church's number is  910 868 5156 /868.2511 after hours

Mailing address:

Berean Baptist Church
517 Glensford Drive
Fayetteville, NC 28314

Fax Number: (910) 868-9609   If  the  fax  number is still  hooked up, you can send a free one page  as easily as sending an e mail at  http://faxzero.com

More links for telling the church what you think.

http://www.bbcfnc.org/     http://www.bereanbaptistchurch.org/

Contacts   http://bit.ly/KwWeTt   *****   e mail addresses for 28  people affiliated with church.

Ministry Leaders    http://bit.ly/J7tPHo  Call them at the church, or by getting contact information from one of the internet search engines for finding people. 

                     Zabasearch.com, Pipl.com  Spokeo.com

Outreach officer Bill Sturm  http://bit.ly/KwWrGr

Maybe others whose names grace the church's web pages should speak up against this hate speech.  http://www.bbcfnc.org/greattheologybooks.php

Its Global Partners   http://www.bbcfnc.org/globalpartners.php 

Interesting  -  Volunteers are expected to model responsible behavior http://bit.ly/KwWKkk

 

Please share your ideas and links. Together, we can have a bigger impact. 

_________________________________________________

 

Thankfully, most of the rest of the world disagrees with Sean Harris. Here is a great piece of performance art made today in Michigan by some of my friends. 

 

 

Let Lakay Walk

 

Let Lakay Walk 

Support our brave role model of determination

 

by Lee Tilson

The purpose of this page is to serve as an information hub of links  and information about 5 year old Lakay Roberts in her attempts to use her walker while attending school in the New Caney school district in Texas.  I am supporting her family's efforts to get permission for her to use the walker at school. According to news reports, that permission was recently revoked because Lakay fell once after the person preparing  her walker for her failed to "snap" the walker into place. It collapsed. I have studied as many news articles as I can find and researched the medical literature. I strongly believe we need to support this child and this family.

Below are many information links. I established a Facebook group https://www.facebook.com/groups/letlakaywalk/.  Here are two links to video clips of news reports: 

MSNBC News video and article 

http://moms.today.msnbc.msn.com/_news/2012/03/29/10910817-school-bans-girl-with-cerebral-palsy-from-using-walker

 

Fox News Video: 

http://www.myfoxhouston.com/dpp/news/local/120322-mom-says-district-mistreating-disabled-daughter

 

If someone wants to convince me that I am wrong, feel free to try.  Share our arguments. I am willing to hear reasonable arguments. What I am not willing to do is sit on the sidelines and remain silent while  watching the schools that should be removing obstacles in her path make unwise choices that create problems for Lakay and her family. I cannot remain silent.

I am also concerned that the overwhelming public support for Lakay and her family has not been able to resolve the issue for her. It appears that this segment of our community needs more support. 

I hope that those of us who work on this issue can develop a network that can ensure that other brave children who struggle daily with disabilities do not find unnecessary obstacles in their path. Let's work together to remove them. Let's do more to support our community. Please share your ideas with me at   peoplematter@gmx.com  or   letlakaywalk@gmx.com.  How can we better support our children?

I have been representing children with cerebral palsy and other disabilities in medical malpractice litigation. This community understands what it means for us to be human and have limitations. It understands that we are all flawed and need each other. This community understands humanity far better than any other with which I am familiar. 

Many look at Lakay and see motor skills she may lack in comparison to themselves. 

I look at Lakay and see more heart, determination, perseverance, joy, and love than we can find elsewhere. She is our teacher. She is our role model. She is our hero. 

Let's not let her down. 

Maybe Lakay needs to learn a few things about walking and balance from us. We need to start learning from her. One thing we know, Lakay has shown more "grace under pressure," President Kennedy's definition of courage, than the rest of us combined. She has already demonstrated more resilience than anyone able to read this page. Look at her profound handicap and her relentless struggle. We have so much we can learn from her. Is it her mother's love that enables it? How can anyone look at her with her walker and not be inspired? 

Question for us: 

Do we have the heart, determination, the desire to help Lakay get permission to use the walker? 

Do we? What will we do?   

I hope we prove that as human beings, we deserve to belong to the same species she does. 

 

Below are some information links. Please forgive my disorganization here. I do not want to spend time perfecting the organization at the expense of Lakay being deprived of her walker one more day than is necessary. 

Thanks

 Sections below: 

      Overview:

     Purpose of this effort:

     Short term goals: 

     Long term goals: 

     Facebook Groups:

     How you can help:

     What we anticipate / hope to happen in the future:

     Background:

     Videos:

     News articles:

     Decisionmakers in the New Caney School District. 

     What we are doing:

     Please do:

     Sample letters:

     A Few of the Letters sent:

 

Overview:

I am supporting a 5 year old with cerebral palsy who is determined to walk: The school district of New Caney, Texas, should support 5 year old Lakay Roberts' efforts to walk.  

Purpose of this effort:

This effort is being organized to support 5 year old Lakay Roberts and her mother Kristi Roberts. They seek to change a decision by the New Caney Schools that took away Lakay's use of a walker at school. Lakay has put up a valiant struggle to overcome her disabilities. The schools should not become an obstacle that keeps her from walking.  Common sense and basic human decency require that her ability to use the walker at school be restored.

Short term goals: 

To persuade the schools to let Lakay use the walker at school

To make sure that the schools know that the public strongly support this girl and her mother.

Long term goals: 

To connect with others who care about this issue generally. 

To make it easier for children and families like Lakay and Kristi Roberts get the support they need from us. 

Facebook Groups:

https://www.facebook.com/groups/letlakaywalk/  Let Lakay Walk Facebook group

https://www.facebook.com/groups/people.do.matter/  People Matter Facebook group

How you can help:

For the goal of persuading the New Caney, Texas, school system to let Lakay use her walker. 

Express your support of Lakay Roberts and her mom Kristi Roberts to the decisionmakers at the schools. Information about fax numbers, e mail addresses, and phone numbers are listed.

Short one or two sentence letters are fine. Likely, we will have to send several.

For the goal of making these efforts easier in the future. 

Help us "grow" this effort by asking one person a day to join.

Do not do anything with which you are uncomfortable.

Feel free to ask questions and make suggestions.

Tell us how we can make this effort good for you or others. 

What we anticipate / hope to happen in the future:

Given the failure of the schools to respond to significant publicity and criticism, we anticipate that this may take some time. It would be much better to send five or ten faxes consisting of one short paragraph than one long perfect letter.

We want to post many of your letters and e mails on line so the world can see them.

 

Background:

Despite medical predictions at birth that she would not walk or talk, Lakay Roberts does both. She needs the walker to walk. 

Videos:

MSNBC News video and article 

http://moms.today.msnbc.msn.com/_news/2012/03/29/10910817-school-bans-girl-with-cerebral-palsy-from-using-walker

Fox News Video: 

http://www.myfoxhouston.com/dpp/news/local/120322-mom-says-district-mistreating-disabled-daughter

Kristi Roberts   http://www.youtube.com/watch?v=3BTVNQRkKfY  ****  

Kristi Roberts   http://www.youtube.com/watch?v=YYLtIJtycm8 

News articles:

https://www.facebook.com/groups/letlakaywalk/doc/125206670946713/  page with news links. 

http://moms.today.msnbc.msn.com/_news/2012/03/29/10910817-school-bans-girl-with-cerebral-palsy-from-using-walker 

http://www.huffingtonpost.com/2012/03/26/lakay-roberts-texas-5-yea_n_1380691.html

 

http://www.myfoxhouston.com/dpp/news/local/120322-mom-says-district-mistreating-disabled-daughter

 

http://www.myfoxhouston.com/dpp/news/local/120323-mom-plans-to-sue-school-district

 

http://www.ksee24.com/news/local/School-Bans-Girls-With-Cerebral-Palsy-From-Using-Her-Walker-144445905.html

 

http://www.dailymail.co.uk/news/article-2120993/School-bans-cerebral-palsy-girl-using-walker--unsafe-children.html

 

http://slumz.boxden.com/f5/apr-6-lakay-roberts-texas-5-year-old-cerebral-palsy-denied-use-unsafe-walker-school-1731323/

Decisionmakers in the New Caney School District. 

School District site.      http://www.newcaneyisd.org/   

Note: there is a navigational menu at the top of the website that I cannot copy here. 

Organizational chart

http://www.newcaneyisd.org/apps/pages/index.jsp?uREC_ID=130527&type=d&pREC_ID=258234 

Director of Special Education: Gary Lemley  

http://www.newcaneyisd.org/apps/pages/index.jsp?uREC_ID=125087&type=d 

NOTE:  Post an e mail to Special Education Director  Lemley here:   http://bit.ly/HSDcvE  

Important Special Education Staff

http://www.newcaneyisd.org/apps/pages/index.jsp?uREC_ID=125087&type=d&pREC_ID=253361 

Other Staff

http://www.newcaneyisd.org/apps/pages/index.jsp?uREC_ID=125087&type=d&pREC_ID=staff 

Special Programs

http://www.newcaneyisd.org/apps/pages/index.jsp?uREC_ID=125086&type=d   

Student Support Program

http://www.newcaneyisd.org/apps/pages/index.jsp?uREC_ID=125087&type=d&pREC_ID=255230   

Superintendent Kenn Franklin

http://www.newcaneyisd.org/apps/pages/index.jsp?uREC_ID=127335&type=d   

School Board 

http://www.newcaneyisd.org/apps/pages/index.jsp?uREC_ID=124887&type=d  

What we are doing:

Sending short, one sentence letters to Gary Lemley supporting Lakay and Kristi

Fax

E Mail

Asking you to send a copy of letter to   letlakaywalk@gmx.com

Asking everyone to find one new member to write letter, contact us, or join Facebook groups:

Follow up with more letters at least twice a week:

Please do:

Send  a copy of your letters to us here:   letlakaywalk@gmx.com

Ask a friend to join.

Remember case is being litigated. 

Share this information with friends in media. 

Share your suggestions.

Ask questions you may have.

Tell me how we can make this effort good for you. 

Sample letters courtesy Dr. Susan Masten:

Letter 1:

Mr. Lemley,

I am writing to you because  to ask you to please reconsider and allow Lakey to use the walker that  she has so successfully used before.  Yes, she fell once, but hen a  physically able child falls during recess, do you prevent that child  from walking or running again in recess?  When a child with  exercise-induced asthma has an asthma attack, do you prevent that child  from ever exercising again?  If a child chokes during lunch, do you  prevent that child from ever eating lunch again?  If not, then why do  you prevent Lakey from using her walker?

 

Physical mobility is  extremely important to both physical and emotional growth.  I'm not  sure if you ever were in a position where you were confined to a wheel  chair, but if you were, you would understand the challenges that result.   Again, I ask you to reconsider your decision and allow Lakey to leave  as close to a normal life as she is able and which the walker allows.

Letter 2:

Mr. Lemley,

I was  appalled to hear the story of Lakay Roberts and your denial of her use  of a walker in your school.  I was further disgusted when I learned that  you are the Director of Special Education.

Having watched  the You Tube video that documents your comments on Lakay’s use of her  walker I wondered how you came to a place in your life that you would  decide to pursue a career in education, let alone special education.  If  this is merely about the care required to accommodate a deserving young  child in obtaining an education you might consider approaching your  legislators with your concerns about funding.

In reality, Mr.  Lemley, every child needs the opportunity to push themselves both  physically and mentally.  You are cheating Lakay out of the opportunity  to succeed.  Whether general education or special education,  experiencing success is empowering.  More empowering still is the  knowledge that the adults in your life (i.e. parents, teachers, mentors)  genuinely cared about helping you succeed.

I will be contributing to the fund to help with Lakay’s defense.

 

Please consider another career.

 

Sincerely,

Letter 3

 

TO GARY LEMLEY

NEW CANEY SCHOOL DISTRICT

 

Dear Mr. Lemley

 

I write to express my support of Kristi and Lakay Roberts. Please let Lakay use her walker.

You can contact me via fax at  .....  

My e mail address is   ...

 

I look forward to hearing from you.

Letter 4

 

Dear Gary,

 

I wanted to express my support for LaKay Roberts and the utilization of her walker at school.  As an educational expert, It would be my assumption that you would  agree all children have equal rights at school.  Would you disallow a  child from swinging on the Monkey Bars for fear of them falling and  hurting themselves?  Would you not allow a child to ride a bike to  school for fear they would fall down and scrap a knee?  My question to you is this, then why would you not allow LaKay to  utilize her walker when there is no greater risk of injury than the  examples I have given above?  Please reconsider your decision to limit  this child's freedom and ability to walk.  

Respectfully,

A Few of the Letters sent:

From Lee Tilson on April 19
 
TO GARY LEMLEY
NEW CANEY SCHOOL DISTRICT
 
Dear Mr. Lemley
 
I write to express my support of Kristi and Lakay Roberts. Please let Lakay use her walker.
 
You can contact me via fax at 877 793 2177.
 
My e mail address is letlakaywalk@gmx.com
 
I look forward to hearing from you.
 
Lee Tilson
Detroit, MI 48208

From Lee Tilson on April 20

 

 

TO: GARY LEMLEY, SPECIAL EDUCATION DIRECTOR, NEW CANEY SCHOOL DISTRICT

 FROM:  LEE TILSON

DATE: APRIL 20, 2012

RE: LAKAY AND KRISTI ROBERTS. 

 

Dear Mr. Lemley

This will confirm that the attached fax was delivered to you yesterday, April 19, 2012, at 1:47 PM  EST = 12:47 CST. 

 

I found this YouTube video that was published a month ago: 

 

            New Caney ISD takes away walker from student

            http://www.youtube.com/watch?v=3BTVNQRkKfY  

The video raises some troubling questions. I am very interested in the reasons the school has for taking her walker. Could you kindly inform me of the following: 

 

     a. the name of and contact information for the individual(s) who made the decision to prevent  Lakay from using her walker

 

     b. the information considered when making that decision 

 

     c. the notice that Kristi Roberts was given that such a decision was being considered

 

     d. what was done to ensure that Kristi and Lakay Roberts had an opportunity to be heard when that decision was being made

 

     e. whether the school has a process for appealing that decision in the school system

     f. the factors considered in addition to the fact that Lakay apparently fell 

 

     g. what was done to determine why Lakay fell

 

     h. what medical information and experts were consulted before making this decision 

 

     i. whether the school even considered the adverse impact this decision would have on Lakay

 

     j. specifically why you believe the adverse impact of this decision is justified. 

 

I am concerned that Lakay's best interests are not being served.  I am disappointed. 

 

I believe your decision to take away her walker is inconsistent with Lakay's medical needs, her educational needs, your school system's values, Lakay's best interests, the law, and common sense. I look forward to your convincing me that my beliefs are incorrect. However, until I am convinced, my conscience will not allow me to remain silent. 

 

Lakay is an inspiring role model of determination. She has much to teach all of us. If we could all do our jobs with as much determination as she shows when she takes steps with her walker, the world will be a better place.  As human beings who care about our role models, we must do all we can to celebrate, and not frustrate, such role models.

 

I have made it my personal goal to be worthy of having Lakay as one of my role models. I am simply trying to show the same level of determination in supporting her as she shows in walking. I hope that I will not disappoint you in this regard. 

 

Please help me understand your decision.  

You can e mail me at either   letlakaywalk@gmx.com or peoplematter@gmx.com. 

You may fax me at 877 793 2177. 

I look forward to hearing from you. 

Lee Tilson

Detroit, MI  48208

 

 

 

Patient Safety Awareness Week by guest author Brooke Kerwin

Patient Safety Awareness Week

by guest author:   Brooke Kerwin

Attention in the health care and medical industry has been focused this week, as Patient Safety Awareness Week is taking place throughout the United States. Lasting from March 4-10 and led by the National Patients Safety Foundation, the theme for 2012 is “Be aware for safe care.” The week is aiming to highlight awareness from all parties in an effort to improve safety for patients and coming together on efforts to improve visibility.

One of the highlights of this year’s Patient Safety Awareness Week will be the establishment of a board certification which will serve to acknowledge patient safety as an official field within the medical community. The requirements to receive a Certified Professional in Patient Safety (CPPS) credential have been in development for nearly a year now.

Aside from establishing the new credential in patient safety, the week will also celebrate the launch of an online curriculum for patient safety. The curriculum will serve to provide ease of access to a number of important principles, general knowledge and credentials relating directly to patient safety. The online curriculum will serve as a self-use type guide, meaning that you can go at your own pace in learning important principles about patient safety.

The curriculum itself consists of ten different sections and was started by Lucian Leape MD, who completed the foreword. It will serve as an option for those who are generally interested in information about patient safety, as well as those looking for initial resources to prepare themselves to try and get certification.

National Patient Safety Awareness Week has worked since 2002 to try and involve different medical organizations to help raise the conscious of patient safety. This effort has stretched from both a local level onto a larger role in its nearly 10 years of existence so far. On the local level, hospitals and health care locations are planning their own spin on awareness week by having different styles of events and information sessions throughout the week.

In Pennsylvania, there has been heavy attention and hype focused on NPSA week in 2012. The Pennsylvania Patient Safety Authority has been a large backer of the week, by increasing communication about what’s going on with both local health care professionals, as well as other patients. There is hope that patient safety awareness week can increase in attention just as other causes such as distracted driving and medical malpractice have picked up in the past few years.

While a number of health care resources around the country already put a lot of time and effort into NPSA Week, there is hope that this awareness and recognition can really begin to take off. Organizers would love to see the attention paid throughout Pennsylvania be equaled in other states across the nation. Even as patient safety and awareness is starting to grow, there is still plenty of time to educate yourself and spread the word to help keep knowledge of this safety at a maximum.  

 

 

About the guest author

Brooke Kerwin is a recent graduate from Central Michigan University looking to excel in creative writing post-college. Her writing topics often span subjects such as community and health issues, as well as technology. Brooke has taken specific interest in patient safety because of past experiences with family members in the hospital and the growing importance of awareness on the subject.

Patient Safety Medical Articles 8 20 2011

http://1.usa.gov/LeeTilsonPatientSafetyArticles820

According to the National Library of Medicine, "Patient Safety" is not a Medical Subject

My recommended medical articles for today:  

http://1.usa.gov/LeeTilsonPatientSafetyArticles819

__________

 

We organize and express our thoughts with words, verbal labels. As parameters of thought, those labels are both helpful and limiting. 

At the repository of medical articles maintained by the National Library of Medicine, PubMed  ( http://www.ncbi.nlm.nih.gov/pubmed),  the medical literature is indexed using "Medical Subject Headings," sometimes referred to as "MeSH" headings or "mesh" terms. You can search for MeSH labels here http://www.ncbi.nlm.nih.gov/mesh. One of the ways to search for articles is to search for articles to which particular labels have been attached. If you find an article addressing a subject of interest, you can click on "related citations" to find similar articles. 

Sadly, there is no MeSH label for "patient safety." By way of contrast, there are MeSH subject headings for:

  Legal Liability    http://www.ncbi.nlm.nih.gov/mesh?term=%22legal%20liability%22

  Malpractice    http://www.ncbi.nlm.nih.gov/mesh?term=malpractice

  Insurance Liability    http://www.ncbi.nlm.nih.gov/mesh/68007351 

  Professional Misconduct    http://www.ncbi.nlm.nih.gov/mesh/68028743

A search of Pubmed for "patient safety" as a phrase identifies articles dating back to 1960 containing the phrase in the title of an article. http://www.ncbi.nlm.nih.gov/pubmed/14411970. The phrase "patient safety" appears in the titles  of over four thousand articles and identifies over ten thousand articles in the PubMed database. http://www.ncbi.nlm.nih.gov/pubmed?term=%22patient%20safety%22  Still, there is no MeSH subject heading. When you search the MeSH headings for "patient safety," the result is a heading for "Travel Medicine." http://www.ncbi.nlm.nih.gov/mesh?term=%22patient%20safety%22  According to the MeSH index, "Travel Medicine" is the:

Multidisciplinary field focusing on prevention of infectious diseases and patient safety during international TRAVEL. 

This may be historically interesting, but it is less than helpful for those working on making care safer for patients. 

Here are today's articles published on "patient safety."  http://1.usa.gov/LeeTilsonPatientSafetyArticles819  None have "patient safety" as a MeSH label. 

A search of PubMed for articles in which "patient safety" appears in the title generates over four thousand articles.    http://www.ncbi.nlm.nih.gov/pubmed?term=%22patient%20safety%22%5Btitle%5D  "Patient safety" might be important enough to include in the title, but not in the index. 

The label "patient safety" is not used to index the medical literature. It is not a concept recognized by the National Library of Medicine. Our concepts govern how we think and how we organize information. The concepts determine the information we can find, or, as is true for so many, the information we cannot find perhaps because we don't think it exists.

 According to the MeSH subject headings, "patient safety" is not a concept. 

This is not an idle concern about indexing or the appropriate concepts labels that are used. The indexing structure used makes it easier, or more difficult, to find the information needed. Clearly, the goal of an indexing system should be to make finding literature easier. The MeSH labeling system fails to meet that goal. 

It is so bad that even leading experts in the field who are preparing review articles have to devote enormous time and energy to locating relevant information. Karimi et. al (2010) explain the problem in the article's abstract:

The process of constructing a systematic review, a document that compiles the published evidence pertaining to a specified medical topic, is intensely time-consuming, often taking a team of researchers over a year,with the identification of relevant published research comprising a substantial portion of the effort. The standard paradigm for this information-seeking task is to use Boolean search; however, this leaves the user(s) the requirement of examining every returned result. Further, our experience is that effective Boolean queries for this specific task are extremely difficult to formulate and typically require multiple iterations of refinement before being finalized.

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966450/pdf/1472-6947-10-58.pdf. If the experts who are asked to prepare review articles encounter so much difficulty, one can only guess how clinicians treating patients fare in their literature searches. The time devoted to such searches is an enormous waste of time that could be spent researching, writing, or treating patients. Making literature difficult to find does not benefit patients. 

It seems strange that in our digital era, we continue organizing information in such a clumsy manner that it takes months before even experts can find the information they need. The sad irony is that people cannot find the information then need simply because the indexing system fails. The information is, as a practical matter, unavailable to them. 

The current indexing system needs to be replaced with something that works. 

Dear Candidate Romney: Should Michigan corporations be treated like people and have to pay taxes?

Presidential Candidate Mitt Romney has generated significant controversy with his recent statment that  "Corporations are people." Yesterdays' blog was devoted to this subject.  http://bit.ly/DoesMittRomneyReallyBelieveThatPayToiletsArePeople    

Some have e mailed me that Romney was not making a statement about metaphysics, but about tax policy.  Let's consider the implications of Romney's statement that "corporations are people" if it is limited to tax policy.  http://www.huffingtonpost.com/social/LeeTilson/colbert-defends-mitt-romney-corporations-are-people_n_925277_102432693.html

 

Michigan recently eliminated income taxes for most corporations. According to the State of Michigan's website:

Under H.B. 4361:
 The Michigan Business Tax is replaced by a 6 percent Corporate Income Tax. The corporate tax applies only to companies that file as "C" corporations - typically, those that issue stock - and means that nearly 100,000 businesses no longer have to file returns.

http://www.michigan.gov/snyder/0,1607,7-277--256823--,00.html 

It follows from Romney's statement that Michigan lacks the authority to do this. 

 

Premise: Aristotle's law of non contradiction. Sentences are not both true and false at the same time. 

A and B cannot both be true

A. Corporations are people.    

B. It is false that corporations are people.  

Either corporations are, or are not, people. One or the other.  Not both. 

Suppose we even limit this conversation to tax policy.                

C. For the purposes of tax law, corporations are people.      

D. It is false that for the purposes of tax law, corporations are people. 

C and D are not both true.

 

If Romney is saying that for the purposes of tax policy, corporations are people, that statement has implications. If corporations are people for the purpose of tax law, then they must be treated as people. Michigan Governor Rick Snyder believes otherwise. 

 

If corporations are people, then they must file the same tax returns that people file, and pay the same taxes that people pay. This contradicts Michigan law recently signed by Michigan Governor Rick Snyder.  http://www.michigan.gov/snyder/0,1607,7-277--256823--,00.html

 

According to candidate Romney's recent statement, Michigan must treat corporations as people. Michigan cannot treat them differently. 

 

Romneys' statement requires that  Michigan repeal  H.B. 4361 and re instate the business tax. 

Does Romney really think that pay toilets and soda machines are people ?

          link here:  http://bit.ly/DoesMittRomneyReallyBelieveThatPayToiletsArePeople 

I just became aware of these rather interesting comments by Mitt Romney reported in the Washington Post: 

“Corporations are people, my friend,” Romney said.

Some people in the front of the audience shouted, “No, they’re not!”

“Of course they are,” Romney said. “Everything corporations earn ultimately goes to people. Where do you think it goes?”

http://www.washingtonpost.com/politics/mitt-romney-says-corporations-are-people/2011/08/11/gIQABwZ38I_story.html

 

No, he could not have possibly said that. Or did he. Let's go to the video: 

http://www.youtube.com/watch?v=KlPQkd_AA6c

 

While I will defer a detailed analysis of Romney's metaphysics, perhaps I can be forgiven making a few comments on his logic. 

Romney offers one reason for saying that corporations are people: "Everything corporations earn ultimately goes to people." Is that a reason for saying that a corporation is a person? That does seem to be what he said. His logic appears to be this:

 

Premise:  Everything   X   earns ultimately goes to people.

Conclusion:  Therefore,  X  is a person.

 

Of what other entites can it be said that  "everthing  it earns ultimately goes to people"? If Romney's logic is correct, then does it follow that these entites are also people? 

 

Soda machines

Pay toilets

State lotteries

Poker tables. 

 

Just imagine what will happen when college philosophy professors teaching metaphysics ask this question on an exam: 

What is a 'person' ?  

 

The student submits an essay citing this comment by Mitt Romney, and argues that pay toilets, soda machines, state lotteries and poker tables qualify as "persons" because the money they earn ends up in the pockets of people. 

 

What grade do you assign?

 

What else might be a "person" under Romney's metaphysics? 

 

What is next on the Republican agenda? Banning human beings from marrying pay toilets?   And now, since pay toilets are now people, do we need to have statutes banning "people" from marrying toilets?  Should we now argue that there should be equal opportunity toilets?

 

Egads, we do not have to use logic for the next step. Romney said it himself in his own words that "Corporations are people."   Does there need to be a statute barring people from marrying corporations, or does that offend the traditional concept of marriage?  

 

Now I get it. Is Romney's claim that corporations are people just to make him feel OK about spending so much time in bed with them??

 

From www.TheUnnecesarean.com - - The Necesarean: The Perspective of a Plaintiff's Birth Trauma Attorney

http://www.theunnecesarean.com/blog/2011/1/11/the-necesarean-the-perspective-of-a-plaintiffs-birth-trauma.html

 

For too many families, delays in performing Cesarean sections have transformed the most joyous occasion in the life of a family, the birth of a child, into a tragedy. Like other human beings, fetuses need a constant supply of oxygen, a supply that can be compromised during labor and delivery. Delays in restoring the oxygen supply by performing a Cesarean can cause brain damage or even kill the child. The daily struggles of the survivors, and that of their families to support them, are heroic. Sadly, the debate has become complicated by misinformation about risks and benefits of Cesarean sections.

To properly address the issue, a few truths must be acknowledged. Clearly, Cesarean sections are not inherently good. Cesareans have risks and some may not be medically justified. Surgery carries with it inherent risks and can never be taken lightly. Many significant complications are associated with Cesareans in the medical literature (wound infection, hemorrhage, skin lesions, urogenital fistula, gastrointestinal problems, omental masses, pelvic lesions, hematoma, urinary tract infection, infertility and death. See http://3.ly/ReThinkingPatientSafetyCesareanRisks. ) Some of these issues were recently addressed in a conference in Ethiopia: “Human Resources for Maternal Survival: Task-Shifting to Non-Physician Clinicians.” (see http://www.ijgo.org/article/PIIS0020729209005311/fulltext ). There has to be a sufficient medical reason in order to justify exposing the mother and fetus to those risks,

Here is a second truth: Cesareans are not inherently bad. Some Cesareans have benefits and are medically necessary. Every human, including a fetus, needs a constant supply of oxygen. The fetus depends entirely on oxygen that passes through the placenta and umbilical cord. (Think of the fetus as a deep-sea diver, and the placenta as the oxygen tank.) Events which impair the function of the placenta (e.g. placental abruption) and umbilical cord (e.g. cord compression) threaten the oxygen supply necessary for fetal metabolism. Without oxygen, the baby’s brain cells can be injured or die within minutes. Restoring the oxygen lifeline to the baby may require a Cesarean.

Deciding when to perform a Cesarean in some deliveries requires analyzing the facts, and balancing risks and benefits. The decision makers must decide which route of delivery is the best for both patients after considering all relevant details. They must consider the desires and wishes of the mother, the details of the mother’s medical history, and the risks and benefits to the mother of performing a Cesarean at that time. They must also consider the available staff and facilities,, the condition of the fetus, the risks and benefits to the fetus, the progress in labor, the prospects for vaginal delivery, and any other risks or benefits for the fetus.

A Cesarean delivery during labor could be considered “unnecessary” under several scenarios. In the most extreme case, if all the relevant factors weighed against the decision to opt for a surgical delivery, and in favor of proceeding with a vaginal delivery, the Cesarean would be contraindicated and should not be performed. Similarly, if some important factors weighed against a surgical delivery, and no relevant factors weighed in favor of a decision to operate, the Cesarean would not be indicated and should not be performed.

Abdominal surgeries carry inherent risks and should not be performed unless there is sufficient reason. We do not hear of abdominal surgeries performed arbitrarily, e.g. the patient wanted a photograph of her small intestines. Like other abdominal surgeries, Cesareans have inherent risks and should not be performed arbitrarily. Unindicated Cesareans, i.e. those lacking surgical justification, are unnecessary and should clearly be avoided. These cases likely represent, at most, a tiny fraction of Cesareans if any.

The interesting cases are the ones in which competing considerations must be balanced. Surgeons must compare Cesarean risks and benefits in particular cases as the labor progresses and the calculus evolves. Thoughtful decisions will consider the availability of staff to administer anesthesia and resuscitate the newborn as well as the potential impact of intervention and non-intervention on two patients. These decisions that balance risks of fetal brain damage and maternal hemorrhage are difficult enough without misinformation.

Sadly, the debate has been clouded by medical literature written to defend birth trauma lawsuits. Many opinions expressed in the public arena about how many and which Cesareans are unnecessary rely on that literature. Some of the misinformation comes from respected sources of medical information including researchers at the National Institutes of Health, of the New England Journal of Medicine, and the American College of Obstetricians and Gynecologist. The misinformation usually appears in articles about whether events in labor and delivery cause, or a Cesarean might prevent, fetal oxygen deprivation and resulting cerebral palsy. Failures to perform and delays in performing a Cesarean are frequently cited as the basis for medical malpractice cases against obstetricians. One of the elements of such cases is that the child’s injuries, the cerebral palsy, could have been prevented with a timely Cesarean. If there was scientific evidence that events in labor and delivery, and particular fetal asphyxia, did not cause cerebral palsy, that evidence could be used to defend malpractice cases.

What is the purpose of the misinformation? In February 2003, NIH scientist and author Dr. Karin Nelson told Marie McCullough of the Philadelphia Inquirer that one of the major pieces of literature on the subject, ACOG’s Neonatal Encephalopathy and Cerebral Palsy:          

 

         “It’s intended for litigation.”

 

(“Doctors dispute their role cerebral palsy role” by Marie McCullough, Philadelphia Inquirer, February 10, 2003. Also see Billings Gazette, March 24, 2003,  http://www.utsystem.edu/news/clips/dailyclips/2003/0323-0329/UTMB-BG-DoctorsDipute-032403.pdf)   Dr. Nelson should know: she is one of the authors. Dr. Nelson has been a central figure in the body of misinformation on the subject.  

One of the first pieces of misinformation on the subject was published over two decades ago. In 1986, Dr. Nelson was the lead author for a major article in the New England Journal of Medicine that has been was cited as proof for the proposition that events in labor and delivery did not cause cerebral palsy. (See “Antecedents of Cerebral Palsy: Multivariate Analysis of Risk,” 315 NEJM 81-86 (1986)). The article was heralded as proof of the proposition that The article was cited repeatedly in Peter Huber’s 1991 book Galileo’s Revenge (See “Chapter 5: Gadgets and Knives,” pages 78 - 88) as proof that cerebral palsy is not caused by events in labor and delivery. The United States Court of Appeals for the Fifth Circuit cited this 1986 article prominently in Tanner v Westbrook, 174 F.3d 542 (5th Cir. 1999), an opinion that threw out a verdict for a birth trauma plaintiff.

Unfortunately, Yet the conclusion for which that article is celebrated, that events in labor do not cause cerebral palsy rests on a logical fallacy. (See  Shier and Tilson, “The Temporal Stage Fallacy,”Medicine, Health Care and Philosophy (2006) 9:243–247.)  The 1986 article offers no evidence for the conclusion that events in labor and delivery do not damage fetal brains. Instead, through a novel form of argument that compares rates of cerebral palsy associated with various temporal stages of labor and delivery, it creates the impression that events in labor and delivery do not contribute significantly to that condition.

In January 1992, The American College of Obstetricians and Gynecologists contributed a second entry to the body of misinformation when it promulgated ACOG Technical Bulletin 163. That bulletin defines the circumstances under which perinatal asphyxia might be said to cause cerebral palsy. Based on 28 medical articles cited in the footnotes, Technical Bulletin 163 sets forth four criteria (A. pH < 7.0,     B. low Apgar,  C. multiorgan injury, and  D. seizures etc.) that must be satisfied before one can conclude that perinatal asphyxia caused cerebral palsy in a newborn. However, on careful examination, the 28 articles cited in the footnotes fail to support its conclusions. Some articles contradict the very propositions for which they are cited. For instance, the bulletin cites an article by Ruth and Ravio (see ACOG Technical Bulletin 163 footnote # 12:  Ruth VJ, Raivio KO. “Perinatal Brain Damage: Predictive Value of Metabolic Acidosis and the Apgar Score,” BMJ1988;297(6640):24-27) for the proposition that a newborn’s pH must be below 7 in order to show that events in labor and delivery may have contributed to a child’s cerebral palsy. However, the article discusses 14 cases, of which two have some indication of asphyxic brain injury. In both cases, the pH is above 7.0 ( See p 26, Table IV, “Clinical Data on Infants who died or who were Clearly Abnormal at 1 year of age;”  case #1 is described “asphyxia” with pH = 7.11; and case #11 is described as “Hypoxic-Ischaemic Encephalopathy, Seizures” with pH = 7.15.) (See Lee Tilson, “Exposing Manufactured Scientific Literature,” MTLA Quarterly, Summer 1994, Page 12.) Thus, the evidence in the Ruth and Raivio article contradicts the proposition for which it is cited.

Similarly, in footnote #17,  Technical Bulletin 163 cites an article by Perlman and Tack for the proposition that on needed multi organ injury to have asphyxial brain injury. (J Perlman “Renal injury in the asphyxiated newborn infant: relationship to neurologic outcome,” Journal of Pediatrics,1988, vol. 113, no. 5, pp. 875-9). However, in Table 1 “Short- and long-term outcome in term infants with and without oliguria,” the next to the last row indicates that 2 out of 7 term infants with abnormal long-term outcome had normal urine output. Thus, Technical Bulletin 163 cites an article in which about 30% of asphyxiated term newborns have normal urine output and abnormal CNS (Central Nervous System) exams. And the bulletin cites if for the proposition that normal urine output rules out a connection between asphyxia and CNS abnormalities. The evidence in the Perlman and Tack article contradicts the proposition for which it is cited.  One would think that with only 28 articles cited in the footnotes, the authors should have been aware of these problems.

Eleven years later, with great fanfare, ACOG published Neonatal Encephalopathy and Cerebral Palsy in January 2003. With more organizational endorsements, ACOG again weighed in on the subject with a visually impressive eight chapter booklet with over 400 footnotes. Sadly, the logic of the publication is just as flawed as its predecessors. Even the executive summary contains contradictions (about whether perinatal asphyxia causes “dyskinetic” cerebral palsy).

Less than two weeks after publication, Dr. Karin Nelson, one of the authors, was quoted in the Philadelphia Inquirer as admitting that the booklet was “intended for litigation.” (“Doctors dispute their role cerebral palsy role” by Marie McCullough, Philadelphia Inquirer, February 10, 2003, and Billings Gazette, March 24, 2003, see http://www.utsystem.edu/news/clips/dailyclips/2003/0323-0329/UTMB-BG-DoctorsDipute-032403.pdf)

Much of the literature on the causes of cerebral palsy including the 1986 New England Journal of Medicine article cited above and many of the footnotes in ACOG’s 2003 Neonatal Encephalopathy and Cerebral Palsy are based on conclusions drawn from analysis of the National Collaborative Perinatal Project. That data was collected from over 50,000 deliveries between 1959 and 1965 at 12 major university hospital systems in the United States. That project is the basis for much of the medical literature purporting to show that fetal heart monitors do not reliably identify the labors and deliveries in which Cesareans should be performed. Many authors cite articles based on this project for the conclusion that Cesarean deliveries have no benefit. The argument claims that the promise of fetal monitoring has not been realized.

The flaw with this argument? Dr. Hon did not invent fetal heart monitors until the 1970’s. Not a single one of the 50,000 +  deliveries in the National Collaborative Perinatal Project used a fetal heart monitor. The results of that study are irrelevant to whether the information from fetal heart monitors should be considered in deciding on whether to perform a Cesarean during a delivery. Indeed, the 1986 New England Journal of Medicine article discussed above was based on the National Collaborative Perinatal Project. Fetal heart monitors were not available.  Yet this body of literature is cited repeatedly for the propositions that performing Cesareans based on fetal heart monitor tracings has no benefit.

When are Cesareans indicated? Providing an overview of the thousands of medical articles on when Cesareans are indicated would be an enormous undertaking. In the alternative, let me offer a thought experiment for discussion.

Most birth asphyxia cases with which I have been involved share a common pattern. After fetal heart monitors display an abnormal fetal heart pattern, the nurses and staff undertake what is called “intrauterine resuscitation.” Procedures such as giving the mother a flow rate of oxygen higher than normal, turning the mother onto her left side to hopefully increase circulation of oxygen to the fetus, turning off hormones that strengthen contractions, or other procedures are sometimes taken to restore the fetal heart rate to normal. Everyone is relieved when the fetal heart pattern returns to normal. The indications of possible asphyxia are gone, the problem is solved. Even if the earlier abnormal fetal heart pattern correctly identified fetal asphyxia, it is now gone. The fetus is not longer asphyxic. Therefore, it is reasoned, there is no longer any reason to expose the mother to the risks of surgery by performing a Cesarean.

Typically, in the birth asphyxia cases I have litigated,  there are several episodes of abnormal fetal heart rate patterns that are relieved by intrauterine resuscitation. At some hours in labor, an abnormal fetal heart pattern indicating possible fetal asphyxia appears. The medical staff and nurses use intrauterine resuscitation to relieve the distress and the pattern will return to normal. Labor will progress for some time before a second episode of abnormal tracings. When the second episode of abnormal tracings appear, the staff again uses intrauterine resuscitation to restore the fetal heart tracing to normal. Abnormal patterns indicating possible asphyxia continue to appear a third, fourth and fifth time. Each time, the patterns are relieved each time with intrauterine resuscitation. The medical staff repeats this intrauterine resuscitation so long as it works.

The thought process seems to be that since Intrauterine resuscitation carries no risks  and surgery carries potentially significant risks, intrauterine resuscitation is  the preferred method of relieving signs of fetal asphyxia. When fetal asphyxia appears, undertake intrauterine resuscitation first. Perform surgery only if and intrauterine resuscitation fails. This prevents unnecessary Cesareans. Cesareans are not performed unless intrauterine resuscitation no longer relieves fetal distress.  

Many litigated birth asphyxia cases involve repeated attempts at intrauterine resuscitation. The Cesarean is not performed until the fourth, fifth, or sixth attempt at resuscitation relieves the signs of fetal distress on the fetal heart monitor. Unfortunately, when the fetus is compromised, sometimes a Cesarean cannot be performed quickly enough. After the fetus is stressed to its limits of toleration and beyond, after all the fetal reserves have been depleted, the fetus may not have the ability to wait for the surgical team to be assembled. At some institutions, assembling a team may take fifteen to twenty five minutes before a Cesarean can be attempted. How many humans can hold their breaths this long? Hypoxic stress is apparent. Should the fetus be exposed to hypoxic stress beyond the capabilities of Olympic athletes?  

The proposition that intrauterine resuscitation must fail before Cesareans are indicated and before surgical teams can be assembled creates an unconscionable risk of fetal asphyxia, injury and death.

Consider an alternate approach. In this sequence of events, when do we know that we have a problem? When do we have a good reason for assembling a team to perform a Cesarean? Let’s consider the same set of circumstances in a different light.

The first episode of intrauterine resuscitation was successful. The nursing and medical staff were concerned enough about an abnormal fetal heart tracing to perform an intrauterine resuscitation. There was a reason for believing that an abnormality on the fetal heart monitor strips indicated that the fetus needed oxygen. More oxygen was delivered to the fetus. The abnormal tracing disappeared. What can be deduced from these events?

The medical and nursing staff are concerned that the fetus needs oxygen and administers intrauterine resuscitation. More oxygen is delivered to the fetus and the problem disappears. This is good evidence that the cause of the abnormal tracings was a lack of oxygen. If oxygen solved the problem, eliminated the abnormal tracing, it is reasonable to infer that a lack of oxygen caused the problem.

The second intrauterine resuscitation is also successful. Twice, oxygen has relieved  an abnormal fetal heart tracing. The evidence that the fetus is not receiving enough oxygen has become obvious. Twice, oxygen has cured problems on the fetal monitor strip. Is it possible that the abnormal fetal heart tracing might occur a third time? If the abnormal tracing occurs a third or fourth or fifth time, are we sure that each occurrence can be cured by intrauterine resuscitation? If the fetus is going to be exposed to the risk of additional episodes of asphyxia, should the health care team be in a position to relieve it before the fetus is injured or killed?

Given these circumstances, shouldn’t the obstetrician be notified immediately? What reasons are there for withholding the information from the obstetrician? Shouldn’t a surgical team be assembled and available in case subsequent problems on the fetal monitor strip are not relieved by intrauterine resuscitation?

Everyone should be concerned about mothers exposed to the risk of an unnecessary Cesarean. Similarly, everyone should be concerned about the risks of brain damage and death when  a fetus is exposed to unnecessary asphyxia while a surgical team is assembled.  

When a surgical team is not assembled, a gamble is placed. The medical staff gambles that the next time there is a problem on the monitor indicating asphyxia, yet another round of intrauterine resuscitation will solve the problem and relieve the asphyxia. Every time this gamble is made, the fetus faces significant stress and an uncertainty as to whether it can be relieved. At some point, after enough episodes of stress, the stakes are raised. The stakes become the baby’s brain and life. The gamble is that a surgical team can be assembled fast enough to prevent brain damage or death.

I submit that we need to rethink the evidence. A successful intrauterine resuscitation strongly indicates that the fetus needs oxygen. A successful intrauterine resuscitation is not an “all clear” sign, but a warning sign. It is as clear of a warning sign as nature can give us that the fetus is not getting enough oxygen. If oxygen solves the problem, a lack of oxygen might have caused it.

A successful intrauterine resuscitation does not mean that subsequent Cesareans are unnecessary. The opposite is true. A successful intrauterine resuscitation confirms that the fetus did not receive enough oxygen and is at risk of suffering asphyxia for the rest of that labor and delivery.

Unnecessary Cesareans are bad and to be avoided. They expose the mother to unnecessary and significant risks.

The failure to perform a timely Cesarean should also be avoided. That failure exposes the fetus to the risk of unnecessary brain damage and death. Unfortunately, the misinformation injected into the debate has made it more difficult to recognize when Cesareans are necessary.

 

Sebelius Urges IHI Attendees to ’Work Harder’ Toward Quality

Sebelius Urges IHI Attendees to ’Work Harder’ Toward Quality.