PA ACOG Testifies in Support of Pennsylvania House Bill 804
The following text is taken from the testimony of Holly Cummings, MD, who represented PA ACOG at the April 2, 2014 Pennsylvania House of Representatives Insurance Committee Hearing on House Bill 804.The testimony was co-written by Dr. Cummings and PA ACOG lobbyist Andy Sandusky of Milliron & Goodman, LLC.
Good morning Madam Chair Pickett, Chairman DeLuca, and the members of the House Insurance Committee. Thank you for the opportunity to speak with you today in support of an important piece of legislation, House Bill 804, introduced by State Representative Bryan Cutler.
My name is Dr. Holly Cummings. I am a physician licensed in Obstetrics and Gynecology and am an Assistant Professor of Clinical Obstetrics and Gynecology practicing at the University of Pennsylvania in Philadelphia. I am also the Young Fellow Representative in the American Congress of Obstetricians and Gynecologists, Pennsylvania Section (PA ACOG.) This morning, I speak on behalf of not only myself and my patients, but also the 2,700 PA ACOG members throughout the Commonwealth.
I am here on behalf of PA ACOG to voice our support of House Bill 804. House Bill 804 amends the MCARE Act to increase the burden of proof in a medical professional liability action when a physician or health care provider is providing emergency care to a patient with whom they have no preexisting physician-patient relationship or knowledge of that patient’s pertinent medical history. In our opinion, this legislation provides much-needed leeway for physicians when they are responsible for treating a patient whom they have never before seen and, often, saving the life of that patient or her baby.
To understand why HB 804 is needed in the case of an obstetrician/gynecologist, it is important to first understand the expected course of a normal pregnancy, which spans up to 42 weeks over the course of three trimesters. A pregnant patient generally establishes prenatal care with her obstetrician in the first trimester of pregnancy and has multiple regularly-scheduled prenatal visits. The importance of these visits cannot be overstated; they help the physician and healthcare team monitor the patient and ensure that all indicators point toward a normally-progressing healthy fetus.
However, even if everything happens “routinely,” complications may affect a patient’s pregnancy. During the course of the pregnancy, we take steps to ensure that even in the face of these complications, we provide the best care for the patient when she arrives to deliver her baby. So whether the delivery goes as anticipated or an emergency arises, the physician and the rest of the healthcare team are able to provide the best care for the patient with all of her nine months of medical information readily available to them.
Unfortunately, this is not always how things happen in Pennsylvania. Some women are unable to seek prenatal care, or choose not to, and they therefore show up to a hospital to seek emergency care or delivery with no pre-existing physician-patient relationship established. Other women who are traveling during their pregnancy may develop emergent complications that require them to seek care at a hospital at which they were not planning to deliver. These patients often arrive to the closest hospital, brought by the ambulance, and may be in serious danger. In many of these cases, the lives of both the mother and baby may be in jeopardy, and time is of the essence. With no prior records or history available to them, the obstetricians have to make the best decisions they can with limited information. In a best-case scenario, the patient is able to communicate her medical history to help the physician make a treatment plan; in a worst-case scenario, the mother is unconscious and bleeding and the physician has a matter of minutes to prevent tragedy. In these situations, an obstetrician must use the information available in order to make the best possible decision at that time.
For example, at my hospital we took care of a woman pregnant with her second baby, who had established medical care in another county. She was visiting family in Philadelphia, developed acute, severe pain, and presented to our Labor and Delivery unit in the middle of the night. She told us that she was 34 weeks pregnant, or about six weeks away from her estimated due date, and her previous baby had been delivered by Cesarean section. She was unable to answer any other questions due to her immense distress and became unconscious. We called the hospital where she planned to deliver, but in the middle of the night, no records were available. By all indications, the most likely and concerning diagnosis was a uterine rupture – the uterus had opened up at the site of her prior C-section, causing internal bleeding affecting both the patient and the fetus. The patient was rushed into an emergency C-section and we delivered the baby quickly and safely. Unfortunately, as it turned out, she did not have a uterine rupture, but had a stomach perforation related to a prior gastric bypass surgery of which she was unable to inform us. She was stabilized but had a prolonged admission to the hospital while she recuperated, and her premature infant also required a long hospitalization in the neonatal intensive care unit. Had the patient been an established patient at our institution, had we had her medical records, we would have had more information at our disposal; instead, we made the best possible decision with the information available at the time, but her baby was born prematurely as a result.
The good news is that physicians and healthcare teams in Pennsylvania hospitals are often able to keep patients, even under the worst circumstances, alive and healthy. However, the question that begs an answer is whether these healthcare teams should be held to the same standard of liability when emergency services are provided as when a pre-existing physician-patient relationship exists. PA ACOG believes the answer is to this question is no. This is why PA ACOG supports House Bill 804 and asks for favorable consideration of the legislation from House Insurance Committee members.