Originally Posted by
CenterField
Would you please elaborate more on this "factual record"? Because frankly, I have trouble believing that the intent of this law is to "protect women's safety" - I'd rather suspect that the intent was to make the abortionist's practice something more inconvenient and impractical so that many clinics that provide abortion would be discouraged to do so given the hurdles in obtaining "admitting privileges."
In what way does the fact that her abortionist doctor does not have "admitting privileges" in a nearby hospital, jeopardize the woman's safety?
Say, a woman is having an abortion, develops a complication, starts to bleed profusely, needs to be rushed to the nearest ER for blood transfusions and possible life-saving hysterectomy. Do you suppose that when that woman gets to the ER, referred by her abortionist doctor, there is someone there screening the patients who will say, "nope, this lady here who is about to die of hemorrhage, won't be admitted; we'll just let her bleed out to death because the doctor who referred her here doesn't have admitting privileges here!"
Uh, nope. This has never happened, and never will. Admitting privileges for the referral source have never been a criterion to grant or deny an emergency hospitalization.
Do you guys actually realize what admitting privileges are? Hint: look at the second word in this expression: "privilege." That's right, it is a tightly controlled privilege granted by the accreditation committee of the medical staff of a hospital, to doctors the hospital WANTS to practice there (salaried employees who beef up the hospital's bottom line and abide by the hospital's profit-sharing provisions, and owners/partners who want to make money out of the hospital's operation).
Do you all think that a hospital would be willing to open up their wards to just about any practitioner in town, for people to admit their own patients to the hospital and profit from the inpatient care fees? Uh nope. They want to keep those fees for themselves.
"So, we build our hospital at great cost for the owners/partners/shareholders but then, cool, we'll let any Dr. Joe Doe come in from the street and use our facilities, our resources, our equipment, our nursing staff, etc., to make money on our back, by collecting from his patient or his patient's insurance, the inpatient care fees, while he never contributed a cent to our hospital and is not one of us who collective get this place going every day."
Uh, nope. No can do, Dr. Joe Doe.
But the hospitals are MORE THAN HAPPY to accept the patient referred by Dr. Joe Doe for services. Just, the attending physician will be one of their own, rather than Dr. Joe Doe.
The HUGELY AND VAST MAJORITY of hospital admissions are for patients referred to the hospital by practitioners who DO NOT possess admitting privileges in that hospital. I repeat, that is NOT a criterion for emergency admission.
You guys seem to think that "admitting privileges" mean that the abortionist Dr. Joe Doe can force the hospital to admit his patient, maybe to the detriment of others if there aren't enough beds? Again, nope. That's not what it is for and not how it works. Even if someone has admitting privileges, if the hospital is full, the patient referred by that practitioner will be diverted to the next hospital that has an opening... where typically... that referring doctor doesn't also have admitting privileges for.
Or, maybe the argument is that the hospital might be full with the patients admitted there by their attending MDs who have privileges there so the woman is left out. Again, no. If the hospital is full, it is full. The woman arriving to the ER referred by a doctor with admitting privileges won't magically make one of the existing patients be kicked out to open room for her. And if there is an opening and she has an emergency, she will get in, regardless.
In summary, the presence or absence of "admitting privileges" by a referring doctor in no way, shape, or form, ensures the safety of the woman. If that's what the law tried to accomplish (I doubt it), it makes no sense whatsoever.
So, again, what's this factual record you and the Alabama legislation are talking about? I strongly suspect that it is some distorted, twisted bending of how things work. "Woman X was bleeding from a botched abortion and because her abortionist didn't have admitting privileges she bled to death." I'd doubt that she bled to death truly because of the lack of the privileges... more likely, because the condition went undiagnosed for a while, the damage was too big, she lost too much blood before getting to the ER, etc., all regrettable but having nothing to do with the presence or absence of "admitting privileges."
The one thing one might argue for, is that "the doctor who performed the procedure has familiarity with the case and for the sake of continuity of care should continue to assist the patient."
Well, that's a bit more valid but also very relative.
For one thing, that familiarity is not usually the rule in an abortion clinic. It's not like the women who show up for an abortion were OB-GYN patients of that doctor for years. More often the doctor has met the woman that day for the first time.
Second, it is standard in medical care to be able to accurately transmit to EMS and to an ER attending, what is going on with the patient, in precise medical terminology that perfectly conveys to the next doctor, what the issues are. It's actually something we're trained to do, in medical school and residency training, by exercising extensively the ability to summarize the main issues in a case, during shift change.
Third, that continuity of care may not be desirable, as the skills needed to continue successfully the inpatient care may be very different from the skills needed for outpatient care. So, an outpatient doctor will typically not be as fast and agile in providing emergency care as the ER attending who specializes in... emergency care. Not to forget, that ER attending is familiar with where the equipment is stored, what capabilities the various members of his team have, what's the formulary for the hospital, and so on. You don't want an external doctor with "admitting privileges" to be running around yelling "where are the freaking intubation kits stored in this ER? Who the hell in the this team is able to get a central line installed and going while I do the intubation? What is the formulary here; is medication X available and in what forms; if not, what do you have that is roughly equivalent?" As opposed to the experienced ER doctor saying, "Peter, you're good at this; get a central line going. Mary, get me the intubation kit from that blue cabinet there. John, get from the emergency supply a dose of medication X that I'll be delivering next to this patient." Not to forget, if the woman needs a hysterectomy, the doctor performing it needs to have pelvic surgery skills, which is not necessarily the case for the outpatient abortionist.
Fourth, past the ER stabilization and with the patient admitted, there is a reason why we call an inpatient practitioner, a "hospitalist." That is, a doctor who is used to and experienced in inpatient care, which is not exactly the same as outpatient care (for example, there needs to be more awareness of that hospital's pattern of hospital-acquired infections, the local safety protocols, the quality-control measures, the adequacy of the hospital formulary, the interaction with PharmDs, the supervision of medical students and residents who may participate in the care, etc.
No, the safety of the woman will actually be in better hands if the outside doctor merely refers her, and the hospital staff, the ones with the "admitting privileges," take over. Which is the case in the overwhelming majority of cases.
If "admitting privileges" were important to ensure any patient's safety, then the Alabama legislature should rule that all doctors practicing in the state would need to have "admitting privileges" somewhere. Why stop at patients having abortions? Doesn't the Alabama legislature care for the safety of other patients? Why don't they do that? Answer: because it would be absurd. Admitting privileges are an economic tool to ensure the livelihood of the hospitalists, not a safety device. This would result in the collapse of the Alabama hospital system. Who would want to go through the trouble of building up and operating a hospital, if you could just poach what the next hospital already has in place and was paid for by other people? And how would you manage to credential the entire set of Alabama-licensed physicians to become hospitalists (despite many lacking the skills and experience to manage an inpatient population)?
Absurd, I say.
Obviously the intent here wasn't the woman's safety.