What OHLA Doesn’t Know Could Hurt You

I heard a nasty rumor for the third time yesterday: that the Legacy hospital system and Legacy Emmanual in particular have an unwritten policy of refusing to report sentinel events resulting from homebirth transfers and that they discourage their nursing and medical staff from doing so as well. Now, the first time I hear a rumor, I can ignore it. The second time it sticks in the back of my mind. And the third time? I start to think there may be something to it. Obviously I haven’t substantiated it, but when I hear something from three different people? Someone with sharper sleuthing skills than me needs to look into this.

Let’s take a step back for a minute. The history of reporting negative outcomes that end up at hospitals in Oregon has been fraught with drama. In 2010, a group of Portland midwives decided they didn’t want their bad outcomes reported and sued OHSU, a large Portland hospital, for reporting and their own licensing agency, OHLA, for investigating the reports.  Apparently these midwives are not big fans of having their inappropriate care of laboring women exposed. And apparently they don’t want to be held accountable for poor outcomes like health care workers in hospitals are.

See, hospitals are overseen by the Joint Commission, which mandates that all sentinel event outcomes (death, severe morbidity, transfusion, hemorrhage, etc.) require an investigation. Any outcome meeting certain criteria triggers intense scrutiny, evaluation, and assessment to determine if it was preventable or if standards need to be changed. The hospital system requires and ensures a thorough investigation to establish if there are systemic problems, problems with a specific practitioner, or problems with a policy or protocol that needs to be changed. ANY sentinel event results in multiple layers of meetings and discussions designed to prevent a recurrence. Not only that, in the hospital, no one works alone — there are many eyes watching each patient, which can seem intrusive, but this is part of what keeps women and babies safe and holds care providers accountable.

Where is that reflection and accountability for licensed midwives in Oregon? It simply doesn’t exist. And the only way that the Board of Direct Entry Midwifery and OHLA know of poor outcomes is if they are reported by hospitals, medical professionals, or other community members.

Back to the lawsuit.  If you google it, you can come up with all sorts of midwifery propaganda alleging that the big bad hospital is trying to put the tiny helpless midwives out of business. In reality,  the case was eventually settled with no wrongdoing found on the part of OHLA or OHSU. In any case, the argument that doctors are reporting for monetary gain is ridiculous. Homebirth accounts for a mere 1% of births overall, and HBACs and home breech births, which were the apparent basis for the lawsuit, account for even less than that. More likely, medical staff report such outcomes for the same reason any sane person would do so: they have a goal to keep  women and babies in the state of Oregon safe.

Not only that, but healthcare workers are mandated by law (Oregon HB 2059) to report “unprofessional conduct,” which means

conduct unbecoming a licensee or detrimental to thebest interests of the public, including conduct contrary to recognized standards of ethics ofthe licensee’s profession or conduct that endangers the health, safety or welfare of a patientor client.

And there are legal repercussions for not reporting! The same house bill requires that

(5) A licensee who fails to report prohibited or unprofessional conduct as required by subsection (2) of this section or the licensees conviction or arrest as required by subsection (3) of this section is subject to discipline by the board responsible for the licensee.

(6) A licensee who fails to report prohibited conduct as required by subsection (2) of this section commits a Class A violation

If this is the case, why would Legacy be declining to report such outcomes to the licensing board? One of my sources gave me a warm and fuzzy reason: if they report, midwives won’t bring potential bad outcomes to the hospital, or they’ll wait until it’s too late to do any good. If they have a policy of non-reporting, it’s actually safer for Portland families. That’s all well and good, though it doesn’t reflect well on Portland homebirth midwives.

Another person I spoke to offered a more sinister explanation. This individual thinks that Legacy is making a lot of money on NICU stays as a result of homebirth transfers, and they’d rather that other area hospitals don’t get that business. It’s true that one stay in the NICU is going to bring in a heck of a lot more money than a whole bunch of successful VBACs. Really? Maybe I’m not cynical enough, but I was shocked to hear that even floated as a scenario. I can’t imagine this could possibly be true.

There’s a third possibility as well: they’re afraid of lawsuits. These midwives have already proven themselves a litigious bunch, and even though no wrongdoing was found in the last lawsuit, I’m sure it cost a pretty penny (In a fantastic irony, legal fees were named as a reason for the need to increase midwifery licensing fees in a recent BDEM meeting. I guess that’s what happens when you sue your own board). No doubt Legacy wants no part of that hot mess.

But does fear absolve them of their duty to their patients and to the public to do the right thing? The LEGAL thing? I don’t think so.

Again, I don’t know if these allegations are true. I’m sure that Legacy has never put such a policy into writing, as it is illegal. However, I just can’t get past the fact that three different people would separately bring it up. If it is true, it is horrifying to me and something needs to change.

 

8 thoughts on “What OHLA Doesn’t Know Could Hurt You

  1. The issue is that the bill says “prohibited or unprofessional conduct”. Some anti-homebirth advocates interpreted that to mean home breeches, twins, and HBACs, because their interpretation is that attending those births at home is prohibited and unprofessional. When those complaints come to OHLA and are investigated, in most no wrongdoing is found, especially if the basis of the complaint is that a midwife was attending those births at all. Breeches, twins, and HBACs are still legal for licensed midwives to attend (with certain restrictions) and therefore, filing a complaint that it was “prohibited and unprofessional conduct” is not effective.
    My understanding about Legacy Emanuel’s role in this was that they chose not to use this bill as a way to file complaints against midwives practicing within their professional standards of care. That doesn’t mean that they don’t file complaints if a sentinel event happens, it just means that they may not be filing claims against midwives for simply attending a breech, HBAC, or twin birth who transported to the hospital appropriately and experienced no negative outcome.

  2. Ya, except if you read through the lawsuit settlement information, that’s simply not the case. And even if it were, to be quite honest, it IS unprofessional for CPMs to be taking on high risk cases like breech and VBAMC at home. They don’t have the training (CPM training and requirements are laughable) or the equipment to do it safely. They’re putting women at risk for the sake of their egos.

  3. i agree with jane. midwives need to know when to draw the line with high risk clients. telling women that they are safe doing a breech/twin/vbmc with a midwife at home is overstepping their bounds. sure its legal, but that doesn’t make it right. and the hospitals do have a duty in reporting how many high risk home birth scenarios result in transfer to hospital, as well as what the overall outcome of those births are.

    for the safety of mamas and babies, these risky birth scenarios need to be overseen in a hospital with a cnm/ob combo. its not about taking away birth choices for women, its about safeguarding them.

    its all fun and games until a mom and/or baby is hurt or dies.

  4. “When those complaints come to OHLA and are investigated, in most no wrongdoing is found …”

    Show us the numbers, SkepticalMidwife.

    “My understanding about Legacy Emanuel’s role in this was that they chose not to use this bill as a way to file complaints against midwives practicing within their professional standards of care. That doesn’t mean that they don’t file complaints if a sentinel event happens, it just means that they may not be filing claims against midwives for simply attending a breech, HBAC, or twin birth who transported to the hospital appropriately and experienced no negative outcome.”

    Oh, so you are privy to the rumor the writer has heard three times from three different sources? Are you even addressing that rumor (the subject of this post, in case you missed that) here?

    That rumor again: “I heard a nasty rumor for the third time yesterday: that the Legacy hospital system and Legacy Emmanual in particular have an unwritten policy of refusing to report sentinel events resulting from homebirth transfers and that they discourage their nursing and medical staff from doing so as well.”

    Sorry if that rumor goes against your agenda, SkepticalMidwife, but if you don’t have evidence to refute it, maybe you should stay out of the conversation.

    Pro-homebirth advocates have dominated the public conversation about midwifery for long enough. If you’re so sure high-risk births are so safe (as victims of “low-risk” births grow in number, whether OHLA makes it public or not), why don’t you sit back on your laurels and let someone else have the floor? You just might learn something about your profession — something that (if miracles exist) might actually disturb you.

  5. SM says: “You have no idea who I am… or have anything else of value to say.”

    Seriously? You come here claiming to support women. This is what you send into the world?

    Everyone has value. Even you, SM. If you believe in the model of midwifery care, you must believe this as well. Please re-read your NCB handbook and find the part about diversity and acceptance of every person and their words. Commit it to heart, and act on it. Do not deny another human being their value.

    SM says: “Some anti-homebirth advocates interpreted that to mean home breeches, twins, and HBACs, because their interpretation is that attending those births at home is prohibited and unprofessional.”

    Do you mean the U.S. federal government when you say “anti-homebirth advocates”? If so, you are correct. They interpret high-risk births as home breeches, twins, and HBAC (among other things). The feds refuse to use public money to pay midwives for high-risk deliveries at home. Why? Because it is a misuse of public money to pay for unsafe services. Please look up Oregon’s Medicaid reimbursement policies for midwives (all public and on the web) and you’ll notice the very clear distinction between what is and is not considered low-risk.

    http://www.oregon.gov/OHA/healthplan/tools_policy/stateplan.shtml

    The Centers for Medicare and Medicaid Systems (CMS) approve Oregon’s Medicaid waiver. Therefore, the feds determine what is considered low-risk for Medicaid reimbursement.

    It may be that in your opinion, SM, home breeches, twins, and HBAC are variations of normal. But it is just your opinion. The “official” opinion doesn’t agree – in fact, the feds refuse to pay midwives to perform high-risk deliveries at home. It is fact that our government considers certain conditions to be too risky for home birth. It is your opinion versus a fact. Opinion. Fact. Do you see the difference?

  6. Wait… Does that mean OHP would deny reimbursement for VBACs at home? Because my CPM was reimbursed for my hbac… Does anyone know?

    Or am I just totally confused (very likely).

  7. I filed a complaint for the birth of my son (born April 2010) in September 2010. It took OHLA until April of 2011 to even ask me any questions. I have heard nothing as of yet. What review? OHLA does nothing.

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