(07-18-2022 02:42 PM)Rice93 Wrote:  

Quote:I am not reading the letter, which is fashioned by an advocacy group against the law. They aren't going to tell the truth about what is happening. Here is the best example... from your letter:

From MY letter? I couldn't find the letter.

93... we've mostly had very cordial conversations despite not seeing eye to eye on lots of things... I'd hope that you'd extend me a little common courtesy and understanding here...

I'm not reading the letter... I'm referring to the article you posted that purports to be quoting the letter. I mis-spoke, clearly... but I would think you'd understand what I was saying and not choose to argue immaterial language.

The article DOES regularly refer to and even supposedly quote 'the letter'.

Quote:The Ob's that I've talked to discussed other types of ectopics that are non-fallopian (like on a C-section scar) which create more complex situations with respect to these laws.

No, it really doesn't. While different, they still fall into the same category. If they are medically not ever viable due to their location, there is a procedure code for their treatment that is not an abortion... and if they are not, then once again, assuming they are not within the window..... the OBs you talk to should be sending these people to the ER and not performing 'life saving' surgery unless they are willing to state on the record that this was medically necessary. It's the same algorithm... with the same complexity.

A c-section ectopic mostly describes the where and why, but the rules are almost identical, despite your repeated insistence that these somehow make it impossible for them to know that someone's life is at imminent risk.

Again, an OB doesn't want this situation... so they would be calling for an ambulance EVEN IF they for some reason felt that it couldn't wait.

That's all they need.

Quote:I don't understand this really. What's "the procedure" that you refer to in the bolded.

Sorry, accidentally deleted the bold... essentially it is 'what is the procedure' for an ectopic pregnancy...

z33.2 is an elective abortion
p95 is a stillborn
o03.9 is a non-elective abortion
o00.9 is an ectopic pregnancy
o04.80 is an 'induced termination of pregnancy'.

they are different codes. There are different subcodes for more specificity, but these are the codes. I could be wrong, but the term 'ectopic' seems to mean 'not in the Uteris', which would include them being anywhere else... with tubal being the most common subtype.

My point is that they're already documenting a whole lot of specificity that most probably aren't aware of.

ETA... I am not a certified coder. There are numerous codes that are 'close' to the same things but have different medical meanings. My only point is that 'inducing an abortion' and 'treating an ectopic pregnancy' are not the same thing... and have different codes and 'things you do' for that.

You can't just claim an ectopic pregnancy, you have to code it, which likely required corroboration from a radiologist... etc. or at least images. Are we really suggesting THAT LEVEL of conspiracy to commit abortion?? I'm not... but that is what would be required to 'game the system'.

Quote:

Quote:ONLY if you are at risk of an imminent, like so imminent that you can't get them to an ER, burst of the fallopian tubes are you authorized to perform that abortion in a 'non-emergency' setting. This protects the hospital AND the doctor because the ER doc makes these decisions all day long and has no previous contact with the mother to bring their decision making into question. The 'trauma surgeon' we previously discussed certainly knows what 'life threatening' means. So does an ER doc.

What do you mean by the bolded? Like a free-standing clinic not associated with a hospital?

That's one example, but I also gave an example of someone already on a hospital floor with their care being immediately transferred to a specialist 'crash' team.\... even with the OB or PCP right there. more in a second

Quote:The issue, to me, has nothing to do with performing this in an outpatient setting versus a hospital.

Who do you think is making the decision for the need for immediate "life-saving" procedure in your example? The ER doc or the patient's OB?

It really doesn't matter what the issue is to you though. What matters is 'how this happens'.

Which example? In the hospital, it would likely be the ER doc... and your doc would be off the hook, depending on how it manifest. If they're in the hospital and crash, it would be the crash doc, who is likely an ER doc.... of they're in the hospital and aren't crashing, it might be the hospitalist who might consult with your doc... As I said, the odds that a patient walks into an OBs office with an undiagnosed ectopic pregnancy beyond the cut-off date but also at imminent risk of rupture (no time for the ER) such that the OB has to do something right then and there is close to zero.

Let me get more to the important part of this....

If a doctor (not to mention the patient) is willing to cut open a patient who doesn't need to be cut open... in an environment not designed to cut people open... to falsify medical records to claim some sort of 'exception' that they don't have, to take life saving efforts like CPR or intubation or any of a myriad of things to save someone's life... etc etc etc... in other words, to actually MEAN that they have to do this 'now' without any ability to consult anyone else in order to facilitate an elective abortion, then more power to you. Who the hell is going to do that? Nobody

The OB who has a very sick, about to die patient is going to send them to the ER, and not direct admit them and try and manage them themselves. They just don't do that. Their phone messages even say that, I bet.

I'm sorry, but this fantasy where they are in this unusual situation and can't tell if someone is really at risk, but they can't wait an hour (in a bad case scenario, probably more like < 30 minutes in most cases) for the patient to get to the ER, be diagnosed and assessed independently just isn't reality. If they have a patient about to die, they will be able to show the EXTREMELY distended area about to burst and measure it and the 'baby' on the ultrasound, and that baby isn't going to grow much in 30 minutes. Even then, there will be a call to 911 and paramedics showing up attesting to the blood and the patient will have a scar and ALL SORTS of evidence that this doctor really felt they had no choice and no time.