NBC medical expert: Joan Rivers’ emergency a reminder on importance of admitting privileges
Comedienne Joan Rivers remains in critical condition today after going into respiratory and cardiac arrest August 29 during what has been described as a “routine throat procedure,” a “minor procedure,” and “outpatient surgery.”
Rivers was rushed by ambulance from Yorkville Endoscopy to Mount Sinai Hospital, located nine blocks apart.
We pray the 81-year-old is restored to health, although there are concerns “the part of the brain that controls motor skills may have been compromised, leaving her as either a vegetable or in a wheelchair,” according to New York Daily News, in which case Rivers allegedly “would not want to live unless she could enjoy ‘a full and active life'” because she “would not want to be a burden on anyone” – a topic for another post.
What connects this to the abortion issue is what NBC News’ chief medical editor, Dr. Nancy Snyderman (pictured below right), said we could learn from this tragedy on The Today Show on August 29:
The really important thing here is that every time you think you’re going to have a procedure, no matter how minor, you have to constantly remind yourself that although these things are rare, they can happen. And one more thing I should say, make sure your doctor has admitting privileges to the local hospital, because in this case it may well have saved Joan Rivers’ life.”
This is logical and sound medical advice, right? Noncontroversial… except when it comes to abortion, when common sense is thrown out the window.
The issue of abortionists having admitting privileges at nearby hospitals has become huge in recent years, and even recent days, as several states have moved to enact such laws. Abortion proponents always oppose these as an “undue burden,” “medically unnecessary,” and even an “assault” on women – a backdoor attempt by pro-lifers to shut down clinics.
In fact, for many, including myself, this is indeed a backdoor attempt to shut down clinics.
But so what. This should be separated from the fact that such laws do indeed protect women’s health and safety. Who wants to go to a doctor who can’t get hospital admitting privileges? And why should abortion clinics be allowed to operate as substandard medical facilities simply to protect abortion? Abortion most certainly isn’t a benign procedure. Since abortion was legalized in 1973, at least 411 mothers (CDC Table 25 - as of 2009, the latest figures available) have died due to abortions at legal clinics. That’s just deaths.
Only hours ago a federal judge issued a temporary restraining order to block enforcement of Louisiana’s admitting privileges law, due to take effect today.
And on Friday a federal judge blocked Texas from enforcing a law forcing abortion clinics to adhere to the same standards as ambulatory surgical treatment centers, which is related since some of these regulations ensure halls and doorways are wide enough to fit gurneys and wheelchairs.
These are just two examples of the”abortion distortion” we see in U.S. courts, of which Joan Rivers’ tragedy reminds us. Such irrational legal decisions kill not just children but their mothers.
[HT: Saynsumthn blog]
Jill Stanek is a nurse turned speaker, columnist and blogger, a national figure in the effort to protect both preborn and postborn innocent human life.
Do we have any legit medical personnel or lawyers on this board? I’m interested in this subject, and would like some insight.
I can’t personally find much information on why admitting privileges are needed in an emergency situation. EMTALA mandates that a facility has to treat somebody – so it isn’t like Rivers would have been left in a back room. She could have been taken anywhere, and they would have treated her. I don’t think the privileges speed up the process of getting her care either – not sure though.
So what were the benefits to Rivers, or any patient, in an emergency situation?
We need to think clearly about a this:
Laws that require abortion clinics and doctors to comply with reasonable, universally applied medical standards are for the safety of women. Admitting privileges, hallways adequate for gurneys, defibrillators, sterile equipment, trained staff — these are minimum standards that adequate facilities should be expected to meet.
It is a tremendous shame how the abortion industry disrespects their patients by persisting in sub-standard care. Women have noticed.
We are not “anti-abortion” activists when we are fighting for standards that the abortion clinics ought to have been keeping, all along. We are simply “women’s healthcare advocates,” and authentically so, up to this point. We are not forcing any clinics to close by applying universal medical standards. The clinics could easily choose to get into compliance, be modern and be safe. The clinics owners make the choice.
We become “anti-abortion activists” when we lobby hospitals to deny or revoke admitting privileges to abortionists. But not until a clinic owner attempts to be modern and safe, and we work to frustrate his efforts.
Here’s my point: Do not let anyone say that we are trying to “close the clinics” by demanding that they clean up to normal medical standards. We just want them to stop hurting and killing women. Remember Karnamaya Mongar, Tonya Reaves, Jennifer Morbelli, and over 400 other women killed by legal abortion since 1973.
EGV,
I hope I qualify as legit.
Having admitting privileges allows Joan’s doctor to treat her at a hospital where he is credentialed and on staff. It enables him to interact with other physicians involved in Joan’s care. He provides valuable information needed for her assessment and treatment. Information can be exchanged and shared without violating Joan’s confidentiality. He continues with follow up. He is her physician, he knows her and her health history.
Not being on staff severely limits what he can do or even be informed of. Nothing strikes terror in the hearts of hospital personnel like the words “HIPPA violation” and these rules will be strictly adhered to.
At any other hospital where he doesn’t have privileges, other physicians would have to assume Joan’s care. Yes this does happen, i.e. out of town accidents, etc., but if the personal physician can be involved, it certainly helps. When I worked ER, personal physicians were always notified of their patient’s admission and consulted. Contrary to popular misconception, most ER patients, including myself recently, have personal physicians.
Ex-GOP — The problem is one of continuity of care.
“No admitting privilege” means that the doctor who is familiar with the patient and the procedures done to her is not present for the patient’s complicated emergency care.
The standard that women deserve is one in which the same skilled doctor stays with his patient from the outpatient facility into the hospital when complications demand it.
The point of requiring admitting privileges is this: Any person who cannot handle the complications he causes ought not to be doing abortions. Hospitals vet their doctors; they don’t want quacks bringing liability. (This is why most states do no allow nurse-midwives to do surgical abortions. Makes sense.)
===========================
Second trimester abortions are dangerous enough to deserve a hospital. Too dangerous for outpatient. Madison had a well-qualified obstetrician (Dr. Caryn Dutton) who bought the Madison Abortion Clinic (operating within the Planned Parenthood facility) — after she had secured agreements with Meriter and UW-Hospital brass so she could operate there. She refused to do late-term abortions at the outpatient facility.
No one anticipated the size and persistence of Madison’s pro-life community. Dr. Dutton finally gave up when she was offered a hospital management position in Boston.
Planned Parenthood hired the former quack and some circuit riders, who do late-term abortions at the out-patient facility. They do not have hospital admitting privileges.
Ex-GOP: I can’t personally find much information on why admitting privileges are needed in an emergency situation. EMTALA mandates that a facility has to treat somebody – so it isn’t like Rivers would have been left in a back room. She could have been taken anywhere, and they would have treated her. I don’t think the privileges speed up the process of getting her care either – not sure though.
So what were the benefits to Rivers, or any patient, in an emergency situation?
Ex-GOP, I think Mary has a point that it could be valuable to have one’s personal physician involved. It obviously would matter on a case-by-case basis, i.e. sometimes there could be “unknown” information that the “family doctor” could supply, and other times it’s not going to make any difference. It depends on what the problem is.
Thanks for the input/thoughts –
So admitting privileges appear useful depending on the type of procedure. Joan River’s case – maybe, if the doctor is useful and an expert. Second trimester abortions seem to make sense – I don’t know if it’s second tri, or after some certain week. First trimester sounds a little less so – that seems to be the bottom line.
In all cases though, if the privileges aren’t there, is the only care that is compromised if the external doctor is a specialist?
Thanks to all for the thoughts – great summation Mary.
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Thanks for the great review, Mary. It totally makes sense.
Not sure why Jill wouldn’t be legit medical personnel in the first place, Ex…
Del: We are not “anti-abortion” activists when we are fighting for standards that the abortion clinics ought to have been keeping, all along.
I disagree, Del. There is a lot of “smokescreen” stuff going on. For one thing, the requirement isn’t being applied evenly, nor even requested on an even basis. A former president of the American College of Obstetricians and Gynecologists notes that, “As an example, the mortality rate associated with a colonoscopy is more than 40 times greater than that of abortion,” yet gastroenterologists who perform such procedures outside of the hospital setting do not face similar requirements “in the context of safety.”
Admitting privileges are usually tied to the expectation that a doctor will bring in a minimum number of patients to a hospital in a year, and thus abortion providers and many other types of doctors are not routinely given them, because they won’t be bringing in many patients.
In Wisconsin, people are still wrangling about all this, correct? There was an attempted law, a judge or two suspended it, the Supreme Court chose not to hear the case…..right? I don’t know where it’s all at, right now, but for sure, some hospitals are telling abortion doctors that they aren’t getting admitting privileges because they won’t bring in enough patients. Aurora Health Care, for example, has a quota of “of at least 20 patients.”
The federal Center for Disease Control and Prevention says that “99 percent of the abortions performed result in no complications that would require a trip to a hospital.”
Noting some of the “sly” pretenses involved on the part of the state in the Wisconsin case, one of the judges hearing the case last year said, “On this record, the admitting privileges requirement is a solution in search of a problem.”
In the course of that case, Dr. Douglas Laube, a board-certified obstetrician and gynecologist since 1976, said the law’s attempt was “medically unjustified and will have serious consequences for women’s health in Wisconsin.”
He further explained that, “The risk of death associated with childbirth is 14 times higher than that associated with abortion. The risk of death related to abortion overall is less than 0.7 deaths per 100,000 procedures. (As a point of comparison, Dr. Laube states that the risk of death from fatal anaphylactic shock following use of penicillin in the United States is 2.0 deaths per 100,000 uses.) Less than 0.3% of women experiencing a complication from an abortion require hospitalization.”
Don’t most hospitals have resident and attending doctors that direct the care of patients in that hospital? In the very rare case that a woman would need to go to the hospital due to having an abortion, isn’t there going to be one of the area hospitals that’s best-suited to caring for her? I would think this is the case, regardless of the abortion provider having admitting privileges or not.
In Wisconsin, the judge also said, “There is little likelihood that a doctor’s admitting privileges to a hospital located within 30 miles of the clinic where the abortion is performed will have any substantial impact on that doctors ability to affect the patient’s treatment once admitted to treating hospital.”
The court also made it clear that during the whole time that the law had been in formulation, submission, etc., there were no medical experts at all who spoke in its favor, nor that provided a decent medical reason for the admitting privileges requirement.
Faced with all the evidence contrary to its position, the state admitted that pre-viability abortions rarely mean a trip to the hospital, yet still argued for the admitting privileges requirement.
The judge wrote, “counsel was unable to offer any support for this position, which does not bear even superficial scrutiny on the current record.”
Hi EGV,
Thank you. I appreciate that.
I would say admitting procedures should be a given whatever the procedure. Our dentists have admission and surgical privileges. Of course if their patient is admitted a physician takes over, but the dentists are credentialed and arrangements have been made with our hospitalists in the event of an emergency admission.
I can think of a number of scenarios where there can be complications in a first trimester abortion. I would also think a patient should be very concerned if their doctor can’t get admitting privileges. A specialist may have to take over, or the abortionist may be able to manage the problem at the hospital. Either way, he is there to provide information and contribute what he can to the patient’s care, i.e. take responsibility for his patient and not dump his mistakes on a physician who knows nothing about the patient.
As for specialists, a specialist may have to take over. For instance if a patient suffers a heart attack in the plastic surgeon’s office, it would require a cardiologist or internist to care for the patient in the hospital. The plastic surgeon can follow his patient, provide valuable information, and be involved in the care to what extent he is able.
Mary Ann
Jill certainly could have chimed in – but I had questions that weren’t answered in the post – see my first post.
Doug,
Abortionists have gotten admitting privileges. They may also make arrangements with doctors on staff to manage their complications.
Our family practice docs also have privileges, though they are seldom used. Same with our plastic surgeons and podiatrists. They need to follow with their patients even if other specialists are caring for them.
Ex-GOP: So admitting privileges appear useful depending on the type of procedure. Joan River’s case – maybe, if the doctor is useful and an expert. Second trimester abortions seem to make sense – I don’t know if it’s second tri, or after some certain week. First trimester sounds a little less so – that seems to be the bottom line.
In all cases though, if the privileges aren’t there, is the only care that is compromised if the external doctor is a specialist?
I’d say whether “specialist or not,” the bottom line is if that one given doctor will make a difference or not. Sometimes yes, sometimes no.
Not a doctor and I don’t know all the complications that can occur with abortions. Obviously, hemorrhaging would be one, and there I’d think a surgeon familiar with stopping internal bleeding would be the deal.
On the timing of abortion in gestation, the risk does increase markedly after viability. Incredibly miniscule early on, it actually surpasses that of giving birth if we look at late enough in gestation.
Mary: Abortionists have gotten admitting privileges.
Okay, Mary, but that could be true if there were only two of them that did, and meanwhile the points remain, i.e. the fact that many hospitals do have an expected quota of patients to be brought into the hospital, and that unless the doctor will reasonably be expected to bring in that many patients, admitting privileges won’t be normally granted; and also the fact that many higher-risk providers are not required to have admitting privileges.
The example I posted above is:
A former president of the American College of Obstetricians and Gynecologists notes that, “As an example, the mortality rate associated with a colonoscopy is more than 40 times greater than that of abortion,” yet gastroenterologists who perform such procedures outside of the hospital setting do not face similar requirements “in the context of safety.”
This was the final nail in the coffin for Cleveland abortionist Martin Ruddock. He DID NOT have emergency transfer agreements with surrounding hospitals. He just thumbed his nose at rules and regulations yet the ambulances were seen in his parking lot more frequently. They finally shut him down and Ive read he now practices in Michigan. Hes in his 70s.
Well put Mary. I really like Joan Rivers. Ive read shes on life support but then Id also read that shes improving. May the good Lords will be done.
Hi Doug,
However “miniscule” you consider the risk it is nonetheless there.
I would question admitting privileges based on admissions as I know of many doctors who rarely admit, seldom perform procedures at our hospital, yet have privileges. GPs for example, even if they don’t perform procedures they refer and follow up.
If a doctor never intends to use a particular hospital, then of course it makes sense he not bother with privileges.
You have to keep in mind that the ACOG are big supporters of abortion and I would be curious if they are referring to admitting privileges, which all our GI docs have BTW, at more than one hospital.
Hi heather,
Thank you, and good point about the emergency backup. All the outpatient facilities in our city are staffed with docs who have admitting privileges. We have hospitalists, and as far as I know podiatrists and dentists with admitting privileges avail of their services, as do all our surgeons.
Doug,
Another thing, the GI docs work on referral, not people who walk in off the street. So there is physician referral and follow up.
Mary: I would question admitting privileges based on admissions as I know of many doctors who rarely admit, seldom perform procedures at our hospital, yet have privileges. GPs for example, even if they don’t perform procedures they refer and follow up.
I can’t find any answers to “what percentage of US hospitals have quotas for admitting privileges” or the like.
Mary, yours does not, okay. Only other ones I know of are Stanford Hospital, in CA, Detroit Medical Center, and the 15 hospitals within the Aurora Healthcare system in Wisconsin. They do have quotas.
Doug,
Interesting. Thank you.
Doug,
While quotas may be an issue at some hospitals, could lack of credentials be the real issue abortion advocates are concerned about?
Also, does a circuit rider like Carhart really want to bother with meeting the requirements at various hospitals, assuming he can?
Was it really necessary to springboard off a national and international time of worry for Joan Rivers to make your point about abortion?
I think not.
I think your choice to not run your topic in its own space is unbelievably tasteless and insulting to the roller coaster so many of her fans are going through.
Not even touching on her family.
You suck!
jrfan,
Has anyone on this site said one disrespectful thing about Joan?
The point was made, not by us, how important admission privileges are where Joan was concerned. We couldn’t agree more.
I know I speak for everyone on this thread when I say our thoughts and prayers are with Joan and we are thankful she got immediate care. We all wish her a full recovery.
Jrfan What on earth are you even talking about? I said in my above post that I like Joan Rivers. Ive been laughing with her for years. I am also a nurse ( since 1988 ) and I cant seem to get an accurate update on JR. May the good Lords will be done. Not a single soul has bashed her here. Chill out would ya??
And to be fair to me, I didn’t know she was still alive anyway, so this is all very shocking.
Mary: While quotas may be an issue at some hospitals, could lack of credentials be the real issue abortion advocates are concerned about?
Also, does a circuit rider like Carhart really want to bother with meeting the requirements at various hospitals, assuming he can?
Mary, I think the obvious fact that the admitting privilege laws are really just anti-abortion, rather than based on any demonstrable need relating to the health of women – confirmed by doctors and courts viewing the evidence – is the concern.
I doubt Carhart, or most doctors, who are out-of-hospital providers, would want to bother with the requirements. Complications from abortions that require hospitalization are so rare – this is why the hospital quotas wouldn’t be met, in the first place – that in no way is it like there is some great need that is not being met.
In trying to find out about hospitals and quotas, I see quite a few doctors saying that having admitting privileges is a chore. It means being called at 2 a.m. if your patient wants a sleeping pill or has elevated blood pressure, for example. This is with internists and other resident doctors in the hospital being better trained and already present, and better able to care for the patient than the admitting doctor.
Some doctors that already have admitting procedures say it’s best to co-admit or admit under the doctors who are going to be on duty in the hospital. This avoids needless bothering of the offsite doctor. Should there be a situation where the offsite doctor can help, then the resident can always call them anyway.
I have a medical condition that has required emergency hospitalization 3 times. When the ambulance has to be called, I go to the nearest hospital. All three times I was transported from my home tonthe nearest hospital per medical protocol. I see an awesome doctor through another health system than the one I am automatically transported to. I have always been treated by ER staff and hospitalists during these stays. Should my doctor be required to have admitting privileges at every one of the 20 hospitals in the city? Should I only be allowed to see doctors who have admitting privileges within so many miles of my house? Are ER docs and hospitalists so incompetent they can’t handle a variety of emergency conditions that may come in? I am just glad my medical issues dont involve my reproductive system so nobody cares.
Not being on staff severely limits what he can do or even be informed of. Nothing strikes terror in the hearts of hospital personnel like the words “HIPPA violation” and these rules will be strictly adhered to.
I bet that the words “HIPAA violation” are much more terrifying. However, HIPAA does not restrict sharing information for coordination of patient care. It prohibits things like a hospital employee giving details of an abortion patient’s treatment to some jackal posing as a blogger who wants to gloat about a woman’s death, but it does not prevent a hospital from discussing information relevant to a patient’s treatment. Patients should be very concerned about being treated at a hospital that doesn’t know that.
Relevant federal law may be found here: http://www.gpo.gov/fdsys/pkg/CFR-2002-title45-vol1/xml/CFR-2002-title45-vol1-sec164-506.xml
LisaC,
A patient’s physician of record can certainly have information shared with them and do, admitting privileges or not.I know because I routinely sent reports from ER visits and am well aware that my physician was made aware of the details of my recent ER visit. Certainly information shared for coordinating patient care is acceptable, but you had better exercise extreme caution. HIPPA does not compromise and more than a few hospital employees have faced termination for “coordinating” when they should’t have.
The abortionist who has no privileges and is not the physician of record is another matter. Yes he may provide info about the patient, but accessing her records in the hospital if he is not on staff and what info can be shared with him by the staff will be severely limited. I can tell you that I would not give him info. He would likely be relegated to sitting in the lounge with the family. Even when I access patient records I have to be extremely careful. If I’m looking for information not pertinent to my work or I’m just nosy about a particular patient, I face immediate termination. In fact I know a nurse who was fired for checking her mother’s chart to see if her mother’s lab results had come back yet.
As an APN, I can’t access my patient’s chart once they leave my care to check on them. I can’t go to a hospital where I am not credentialled and access patient records, even if it was someone who had been under my care. I am extremely careful about who I share information with. I have told doctors I couldn’t share certain info with them.
Hospital people live and breathe HIPPA and as I said, nothing strikes terror in us like the words “HIPPA violation”.
Tenn,
Since you have a medical condition I will assume you have a personal physician. Obviously doctors can’t be credentialled at every hospital on the planet.
Actually your being treated in the ER in this manner isn’t at all unusual and it really doesn’t matter if your doctor has admitting privileges or not.
Your physician is able to provide the needed information for your care, the ER docs can consult him/her and he/she will receive a report of your visit and provide your follow up care. If you must be admitted and your doctor doesn’t have privileges, you can either be transferred or a doctor will take over your care and keep your physician appraised.
If I’m looking for information not pertinent to my work or I’m just nosy about a particular patient, I face immediate termination.
I should hope so.
Actually your being treated in the ER in this manner isn’t at all unusual and it really doesn’t matter if your doctor has admitting privileges or not.
Yes, that’s why no legitimate medical organization agrees with the anti-abortion movement’s claim that the absence of admitting privileges endangers women’s lives. Admitting privileges are not necessary for the abortion provider to convey information, and the woman will be referred to her GP for follow-up care.
He DID NOT have emergency transfer agreements with surrounding hospitals.
IIRC, Ohio passed a law that no public hospitals could make transfer agreements with abortion clinics, based on some blather about taxpayers only having to pay for things they like. It really puts the lie to the anti-abortion movement’s claim that admitting privileges are about women’s health.
Hes in his 70s.
Your point being what? That it’s time to pack him onto an ice floe and shove him out to sea?
LisaC,
You seem to miss the ER point. Of course info will be shared with your physician. The ER and the patient’s physician work in tandem. The personal physician can have access to the patient’s info. An abortionist who is not the patient’s physician, but someone at the clinic who operated on her and sent her home, is not her physician. For example, had Carhart stuck around and accompanied Jennifer Morbelli to the ER, after giving what info he could he would have been relegated to sitting in the lounge. Information would be given to her husband and family, they could share it with Carhart if they want. Understand my point? Yes the ER called Carhart because they were frantic for info. They had a dying woman on their hands and only a distraught family to provide information. Maybe you can see why admitting privileges are important, if nothing else so that the ER and doctors on call don’t get some fly by night abortionist’s mistakes dumped on them.
The woman will be referred to her GP for follow up care. Sure, if she survives the emergency situation. Likely the OB/GYN on call will have to treat her. I know because I have been involved in such situations. The woman was critically ill, the abortionist apparently took no reponsibility for his patients once they left the clinic, and the OB/GYN, who’s partner had to take care of another of this abortionist’s botched operations before, had some very heated words for this guy. Thankfully the woman recovered.
Doug,
I think my posts to Tenn and LisaC addressed some of the issues you raised in your post.
Why shouldn’t abortionists have to take responsibility for their patients?
Physicians are allowed to share information with each other for continuation of care. HIPAA wouldn’t come into play at all in this case. So again, I ask the question, must my specialist have admitting privileges at any hospital I could possibly end up at?
Doug, I think my posts to Tenn and LisaC addressed some of the issues you raised in your post. Why shouldn’t abortionists have to take responsibility for their patients?
Mary, if there is a legitimate “should,” there, that’s not getting taken care of, then obviously the hospitals should quit with the quotas, for one thing, and that would apply to all such doctors who provide off-hospital procedures, not just those who do abortions.
From what I have seen, doctors are quite consistent in saying that is not the case.
Additionally – if a doctor is not going to bring in any patients, in a year, or not above a certain number, what is the downside for the hospital to grant admitting privileges to them? What are they losing?
Tenn,
I don’t understand what your HIPPA comment is in reference to. Please clarify. Again sharing of information between physicians is not without restrictions and depends on the circumstances.
I told you doctors cannot possibly be credentialed at every hospital on the planet. You could be admitted, but a specialist with admitting privileges would take over your care and he/she would work in tandem with your specialist.
Or your could be transferred. Either way.
I’m certain your specialist has admitting privileges and does not dump his/her mistakes on other physicians to care for. If this is not the case, I would strongly advise you seek a different specialist.
Doug,
I would suppose its the hospital’s option who they want to credential, fair or unfair as we may think it is, and what is most feasible for them.
From what I’ve seen of abortionists I would suspect its reasons other than quotas, like lack of credentials, felonies, and no continuing education, to name just a few.
We have several outpatient surgery centers, including plastic, eye, orthopedic, and the physicians operating in them have privileges at one, some, or all of the city hospitals. They are responsible for their patients and don’t operate and then skip town, leaving patients to fend on their own or dump them on the local doctor on call.
Hi LisaC, 10:08PM
If I’m looking for information not pertinent to my work or I’m just nosy about a particular patient, I face immediate termination.
I should hope so.
LOL(at myself), nothing like pointing out the obvious!
I should have specified that our usage of patient records is strictly and continuously monitored and we have been advised that we receive only one warning concerning patient records and our usage of them. I’m sure this strongly discourages a lot of nosy people.
That’s why I’m surprised that people are foolish enough to check out the medical records of celebrities. Talk about stupid. These are the people, along with VIPs, who’s records will especially be closely monitored.
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[…] distasteful fodder to the pro-life movement. I was struck by the distorted logic that blog writer, Jill Stanek, presented in her article about the comedienne’s tragic event, where she laments the recent […]
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