Is It Dobbs or Malpractice?

I’m a retired OB/GYN. Make no mistake about it, I don’t like Dobbs, but not for the reasons you might expect. There is a difference between cowering in fear over the threat of Dobbs and malpractice. We see the confusion between Dobbs and malpractice every time we read about another pregnant woman dying because physicians refuse to treat a pregnant woman in the emergency room (ER) for any problem associated with pregnancy. When laws and federal agencies begin to practice medicine without a license and threaten physicians, patients die. Government belligerence puts doctors in fear of their licenses and jail time. That's a serious problem. But I consider the root of the problem to be the destruction of the patient-physician relationship. What’s needed for good patient care is the sanctity of the exam room. In other words, nothing should distract a physician from focusing on the person in the exam room.

The FLCCC Alliance (Front Line Covid-19 Critical Care Alliance) was formed by physicians and journalists about the angry government and media responses to alternative perspectives in response to the public health Covid-19 rulings. Many physicians were sanctioned by medical boards at the encouragement of the Federation of State Medical Boards (FSMD). In one of the FLCCC Alliance's podcasts, the sanctity of the patient-physician relationship is discussed: "Censoring Doctors: Is Your Health at Risk" In this podcast, Dr. Scott Jensen talks about government agency censorship of what physicians may talk about with patients. Jenson calls this agency weaponization. When a physician is prevented from discussing all treatment options with the patient, whether because of fear for speaking out or a lack of understanding malpractice by refusing to treat, a physician can no longer get informed consent from the patient. Jensen says: "When I am censored, you are censored." This destroys the physician-patient relationship which is the foundation of good healthcare.

As Jensen notes, scaring doctors who are trying to take care for pregnant women is regulation belligerence. The Texas law prohibits abortions in nearly all circumstances. The penalties include criminal, civil and professional charges for performing prohibited abortions. Physicians who violate the law face fines of $100,000, and lawyer’s fees and court costs, and first-degree felony charges punishable by up to life in prison. The law makes no exception for pregnancies resulting from rape or incest.

However, Dobbs neither requires nor mandates malpractice, even in Texas. The Texas law allows for treatment to save the life of the mother. The Texas law also allows for treatment saving the life of the mother and the child.

I have written before here about the unnecessary deaths of women who turned up in the emergency room (ER) with pregnancy emergencies. When I look at the two women who I think died of sepsis as the pathology report says, there were three opportunities for each one to be correctly diagnosed and correctly treated. That has nothing to do with Dobbs and everything to do with malpractice. As much as some might hate to admit, there is nothing in Dobbs that prevents the treatment of sepsis or the events leading up to it or saving the lives of the mothers. We should not be seeing pregnant women dying from sepsis because hospitals or physicians refuse to treat pregnant women for fear of Dobbs. Letting pregnant women die from sepsis is malpractice.

The times these women presented to the ER, the doctors likely failed to understand the infections and therefore weren’t bothered enough to retain the patients in the hospital or to treat the womens’ conditions. The denial of access to healthcare has forced many pregnant women to go to the ER when their pregnancies require medical attention. When pregnant women come to the ER, an on-call obstetrician should be brought in to examine them. When I was in residency, any time a pregnant woman came into the ER, the ER doctor was required to call an on-call OB/GYN to take care of the patient. The problems with pregnancy are often very subtle. When I was in practice, I was always called if my patients came to the emergency room and I always saw my patients in the ER.

I don’t mean to sound arrogant, but OB/GYNs are trained to find the subtleties and nuances of pregnancy at a time when conditions like sepsis are treatable. What looks normal in pregnancy may not be normal. This makes diagnosing and treating a pregnant woman in the ER particularly difficult. We understand that in a pregnant woman, a white count somewhere between 10,000 and 14,000 might be normal when usually a white count of around 4,000 would be considered normal. Pain will be different in pregnant women. Exam pains are less reliable in pregnancy because women have less inflammation, plus there will be some increased pain with an enlarged uterus. Then there's bronchitis in pregnancy which is very hard to diagnose, but very serious. Uterine and intrauterine infections are really hard to diagnose! All labs might be considered to be normal since the white count is normally slightly elevated in pregnancy and then elevates slowly in intrauterine infection. Infection is very confusing for those who don't know what to anticipate in pregnancy.

The Texas legislators, the attorney generals, judges, hospital CEOs, doctors and nurses need to be trained to tell the difference between obeying Dobbs and malpractice. It is extremely arrogant for legislators to pass legislation affecting patient healthcare and not be required to document the results of these laws on patients. It's time for regulatory agencies to let doctors be doctors and allow physicians to practice in the exam room without censorship, restoring the doctor-patient relationship.

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