---------- Forwarded message ----------
From: Lily Beck <international@ican-online.org>
Date: Fri, Jun 12, 2009 at 8:36 PM


Please blog about this and distribute far and wide!


http://ican-online.org/news/ican-online

*AMA Resolution Would Seek to Label “Ungrateful” Patients*

 *Redondo Beach, CA, June 11, 2009* - At the American Medical Association’s
(AMA) Annual Meeting next week, delegates will vote on a resolution which
proposes to develop CPT (billing) codes to identify and label
“non-compliant” patients (1) <http://www.ican-online.org/#1>

The resolution complains:

*“The stress of dealing with ungrateful patients is adding to the stress
of    physicians leading to decreased physician satisfaction.”  *

“This resolution is alarming in its arrogance and its failure to recognize,
or even pay lip service to, patient autonomy,” said Desirre Andrews, the
newly elected president of the International Cesarean Awareness Network
(ICAN).

If approved, the resolution could hold implications for women receiving
maternity care.  For pregnant women seeking quality care and good outcomes,
“non-compliance” is often their only alternative to accepting sub-standard
care.  Physicians routinely order interventions like induction, episiotomy,
or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by
cesarean and was told by her obstetrician that she needed another surgical
delivery.  “My doctor told me that I needed to have a cesarean delivery at
39 weeks, or my uterus would rupture and my baby would die.”  She sought out
another care provider and had a healthy and safe intervention-free {home}
birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund,
called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,”
(2) <http://www.ican-online.org/#2> shows that the state of maternity care
in the U.S. is worrisome, driven largely by a failure of care providers to
heed evidence-based care practices.  For most women in the U.S., care
practices that have been proven to make childbirth easier and safer are
underused, and interventions that may increase risks to mothers and babies
are routinely overused.  The authors of the report point to the “perinatal
paradox” of doing more, but accomplishing less.

The resolution proposed by the Michigan delegation of the AMA could threaten
patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of
autonomy on the part of the patient as “non-compliance” “abuse” or
“hostility” could create a  pathway for insurance companies to deny coverage
to patients
• Use of these labels fails to recognize patients as competent partners with
physicians in their own care
• Tagging patients as “non-compliant” fails to recognize that there is not a
“one size fits all” approach to care, that different opinions among
physicians abound, and that patients are entitled to these very same
differences of opinion
• Labeling patients as “non-compliant” may, in fact, be punitive,
jeopardizing a patient’s ability to seek out other care providers

The resolution also fails to address how it would implicate patients
navigating controversial issues in medical care, like vaginal birth after
cesarean (VBAC).  While a substantive body of medical research demonstrates
that VBAC is reasonably safe, if not safer, than repeat cesareans, most
physicians and hospitals refuse to support VBAC.
(3)<http://www.ican-online.org/#3>  The language in the resolution
suggests that patients who assert their
right to opt for VBAC could be tagged as non-compliant, even though their
choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient
relationship is decidedly tipped towards physicians.  The least patients
should have is the right to disagree with their doctors and not be labeled a
‘naughty’ patient,” said Andrews.

*About Cesareans: When a cesarean is medically necessary, it can be a
lifesaving technique for both mother and baby, and worth the risks
involved.  Potential risks to babies from cesareans include: low birth
weight, prematurity, respiratory problems, and lacerations.  Potential risks
to women include <http://ican-online.org/ican-white-papers>: hemorrhage,
infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous
placental abnormalities in future pregnancies, unexplained stillbirth in
future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to
improve maternal-child health by preventing unnecessary cesareans through
education, providing support for cesarean recovery and promoting vaginal
birth after cesarean.  ICAN has 110 chapters in North America and Europe,
which hold educational and support meetings for people interested in
cesarean prevention and recovery.*



(1) Resolution 710 “Identifying Abusive, Hostile or Non-Compliant
Patients”<http://www.ama-assn.org/ama1/pub/upload/mm/475/refcomg.pdf%20>

(2) Evidence-Based Maternity Care: What It Is and What It Can
Achieve<http://www.childbirthconnection.org/article.asp?ck=10575%20>

(3) http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans