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About The daily Astorian. (Astoria, Or.) 1961-current | View Entire Issue (July 22, 2015)
4A THE DAILY ASTORIAN • WEDNESDAY, JULY 22, 2015 C-sections: The operation can be life-saving Continued from Page 1A Congress of Obstetricians and Gynecologists, questioning why the cesarean birth rate has jumped during the past few decades and what can be done to safely lower it to the bene¿ t of women, who often experience longer re- covery periods, a increased likelihood of complications in future pregnancies and other disadvantages after the sur- gery. Contributing factors Cesareans can be life-sav- ing procedures in some cases, but the WHO recommenda- tion for the optimal C-section rate is important. It indicates that among health providers who have a rate higher than approximately 10 to 15 per- cent, there is no evidence to support that it is bene¿ cial for either mothers or infants , ac- cording to Dr. Aaron Caughey, who is chairman of the depart- ment of obstetrics and gyne- cology and associate dean for women’s health research and policy at the Oregon Health and Science University. Maybe the high rate “is preventing bad things from happening, but we don’t really have any evidence to support that,” he said, which leads to suspicion there are thousands of babies being born through C-sections who don’t need to be. When sorting through the factors contributing to high cesarean rates, the primary one seems to be pressure from the medical profession’s law- yers, Caughey said. As of 2011, according to the American Congress of Ob- stetricians and Gynecologists, more than 90 percent of OB- GYNs had been sued for mal- practice at least once during their career, with an average of 2.7 claims per ob-gyn. Claims related to a neurologi- cally impaired infant made up 30.5 percent of the obstetric claims, and of those, 49 per- cent were closed with some payment made to the plaintiff, “either settled with payment, closed by way of jury or court award, or closed through some other dispute-resolution mechanism,” the association states. The average payment for claims involving a neuro- logically impaired infant was $1,155,222 Even years down the road, if an infant or child’s neuro- logical issues can be linked to their perinatal care or method of delivery, a doctor or hospi- tal can be sued. It is much less likely a woman can or will sue because she had a C-section. “It just doesn’t happen,” Caughey said. “People don’t get sued for doing C-sections; they get sued for not doing C-sections.” As a response to the risk of liability claims and be- cause of insurance costs and availability, doctors began making changes to their prac- tice, including decreasing the number of high-risk obstetric patients, no longer offering or performing vaginal births after C-sections — referred to as VBACs —and increasing the number of cesarean deliv- eries, among others, accord- ing to the OB-GYN group . Cesareans have become “very, very safe” to perform, which can lead to some doc- tors opting for that route sooner, rather than later, when complications arise to prevent %LUWKPHWKRGVLQ&ODWVRS&RXQW\ According to State records, Cesarean births at Columbia Memorial and Providence hospitals made up more than 30 percent of births at each institution respectively in 2014. By comparison, the World Health Organization recommends the C-section rate should not be higher than 15 percent. &0+ 3URYLGHQFH 9DJLQDO &VHFWLRQ 9DJLQDO &VHFWLRQ 9DJLQDOLQFOXGHVYDJLQDOELUWKVDIWHUFHVDUHDQV potential infant injuries and decrease liability, Caughey said. The pressure from liabil- ity is often not predominant- ly economic, Caughey said. Doctors purchase insurance for the sake of being ¿ nancial- ly covered in such instances. Rather than an economic cost, it’s “the act of being sued or having people around you being sued,” Caughey said. Most doctors enter medicine “because they thought they could make a difference in people’s lives,” he said. To be dragged through the court system, negatively labeled and personally blamed for something bad happening — “that’s pretty demoralizing,” Caughey said. “It’s probably one of the strongest negative outcomes a physician can experience,” he added. Paying the bill As for other economic considerations, Caughey said, &VHF 9DJLQDO 6RXUFH,GDKR'HSW RI+HDOWKDQG:HOIDUH <HDU 6RXUFH2UHJRQ+HDOWK$XWKRULW\ 1RUWKZHVW &HVDUHDQELUWK UDWHVFRPSDUHG (20HGLD*URXSJUDSKLF “there is a lot of misunder- standing about how hospitals and physicians are paid.” C-sections are more costly for patients. Doctors, however, do not make signi¿ cantly more money from a C-section than a vaginal delivery. Hospitals also tend to lose money from the “birth business” in general, Caughey said. The one area hospitals make money through births is from charges relating to care for the newborns, who along with the mothers, are not discharged for a few days after a C-section. Also, if com- plications led to the C-section that may indicate the infant or mother needs further post- partum care, which chalks up more hospital charges. “Safe Prevention of the Primary Cesarean Delivery,” a research paper developed by the OB-GYN association and the Society for Maternal-Fetal Medicine in 2014, suggest- ed alternative causes behind the increasing cesarean rate could be “modi¿ able factors,” :DVKLQJWRQ RU RU 7RWDO 2UHJRQ RU RU 7RWDO ,GDKR RU RU 7RWDO $ODQ.HQDJD(20HGLD*URXS such as “patient preferences and practice variation among hospitals, systems and health care providers.” Research has found maternal characteristics — such as age, weight and ethnicity — do not account fully for the increase in the C-section rate or its regional variations, the paper state d. Local hospitals Columbia Memorial Hos- pital Community Outreach Manager Paul Mitchell said the hospital was part of the na- tional Partnership for Patients initiative through the Oregon Association of Hospitals and Health Systems, which start- ed in February 2013 and went through 2014 . The was aimed toward reducing patient harm by 40 percent and readmis- sions by 20 percent. The ini- tiative had 10 focus areas, in- cluding birth-related injury to babies, Mitchell said. Data from Oregon Health Authority shows the hospi- tal’s C-section rate increased from 2013 to 2014. Mitchell said he believes the hospital has seen a de- crease in its C-section rate . “The hospital has reduced early elective deliveries by developing criteria for de- termining when delivering a baby before 39 weeks of ges- tation is medically warranted and educating patients on the bene¿ ts of allowing babies to gestate,” Mitchell said. At Providence Seaside Hospital, C-sections “are per- formed for many indications/ reasons that may occur during pregnancy or labor, includ- ing the position of the baby and arrest of labor,” Public Affairs Manager Paulette Mc- Coy said. “C-sections can be scheduled procedures or un- scheduled during the hospi- talization, due to events that occur in labor.” Providence Seaside does not have a high-risk birthing facility, but collaborates with Providence St. Vincent and Northwest Perinatal Center for high-risk patients, McCoy said. CMH does offer care for women with high-risk preg- nancies as part of its mission to provide care close to home, Mitchell said. Mitchell and McCoy did not provide information on their hospitals’ liability man- agement frameworks. Coming Thursday: What are the alternatives? Power: A balloon from a nearby celebration caused the outage Continued from Page 1A Seaside, Gearhart and parts of Warrenton were without power from about 440 to 1020 p.m. as Paci¿ c Power employees replaced the damaged equipment. The outage was caused by a me- tallic-skinned helium balloon that got away, according to Paci¿ c Power. “We found unmistakable red, white and blue Mylar shreds when we did the re- pairs the evening of July 4,” Steve McGrorty said. He is Paci¿ c Power’s operations manager for the North Coast The balloon from a near- by celebration caused a main substation transformer to short circuit near Seaside Factory Outlet Center. Other equipment also was damaged on nearby poles. “Balloons may seem like small things,” Paci¿ c Power Safety Manager Gene Mor- ris said. “But when escaped balloons touch power lines or substations, even the smallest amount of metal content ma- terial can conduct electricity. This can interfere with lines, causing power À uctuations and outages.” Emergency response When the power went out, the city went into response mode and activated its Emer- gency Operations Center, headquartered at Seaside Po- lice Department. All the city’s department heads collaborat- ed on how to collectively re- spond , Seaside Division Chief Chris Dugan said. Usually a power outage is not a huge safety concern and does not activate the Emer- gency Operations Center, Seaside Police Chief Dave Ham said. Because it was Fourth of July, however, and there were throngs of people on the beach , it caused some concern. “You have an enormous amount of people trying to get off a relatively small space, with limited avenues to À ood out,” Ham said. Additionally, city staff wanted to have a contingen- cy plan for the anticipated, post-¿ reworks heavy traf¿ c when no traf¿ c lights were in operation. As part of its response, the city got several large light structures to set up at key locations throughout town . Fortunately, power was fully restored at an optimal time — just as the ¿ reworks show ended. Before the show, the ¿ re department also strategically stationed crews at three loca- tions to respond to calls, since traf¿ c becomes gridlocked once the ¿ reworks are over, Dugan said. Overall, during Fourth of July weekend, the department had 39 documented runs Because of how dry this summer has been, Dugan said, he expected more brush ¿ res, but there were only two. He said he believes people were aware of the heat and dryness and stayed alert and conscientious to decrease the risk. Courtesy of Pacific Power The rather charred remains of the balloon that caused the power outage on the North Coast on the Fourth of July. Unemployment rate rose in June The Daily Astorian Seasonally adjusted unem- ployment rates in northwest Oregon continued their upward march through June, according to data released Tuesday by the Oregon Employment Depart- ment. Clatsop County Clatsop County’s seasonally adjusted unemployment rate was 5.5 percent in June, up a third of a percent from May but still down more than 1 percent from a year ago. Clatsop Coun- ty had the ninth-lowest unem- ployment rate in Oregon in June, while matching the state- wide average and coming in just above the national average. The county added 440 jobs in June, 70 fewer than the state expected. That left total non- farm payroll employment at 17,350, 260 more than the year prior for a growth rate of 1.5 percent. The private sector added all 440 jobs in June, including 260 in leisure and hospitality; 90 in food manufacturing; 50 in other services; and 30 in retail trade. Over the past year, leisure and hospitality have added 270 jobs; education and health ser- vices 80; state government 70; -REOHVVUDWHV IRU-XQH $UHD &ODWVRS -XQH 0D\ \U DJR &ROXPELD 7LOODPRRN 2UHJRQ 86 3UHOLPLQDU\VHDVRQDO\DGMXVWHGUDWHV 6RXUFH2UHJRQ(PSOR\PHQW'HSDUWPHQW 'DLO\$VWRULDQJUDSKLF and professional and business services 60. Meanwhile, retail trade has shed 150 jobs; non- durable goods manufacturing 120; and local government, ex- cluding education, 60. Columbia County Columbia County’s season- ally unemployment rate in June was 6.9 percent, up slightly from May but 1.5 percent lower than the year prior. The county has 29th-lowest unemployment rate of Oregon’s 36 counties. The county added no jobs in June, although the state had expected a gain of 40. Total nonfarm payroll employment remained at 10,220, 250 more than a year prior, a growth rate of 2.5 percent. The private sector lost 10 jobs in June, and government added 10. Retail trade added 30, the only industry to register a signi¿ cant change. Over the past year, the pri- vate sector has grown by 180 positions, including 140 in du- rable goods manufacturing and 60 in retail trade. Construction has cut 50 jobs, while govern- ments have added 70, mostly at the state level. Tillamook County Tillamook County’s season- ally adjusted unemployment rate in June was 5.7 percent, up 0.4 percent from May but 1.3 percent lower than a year prior. It had the 11th lowest unem- ployment rate of Oregon, tied with Morrow County. The county added 170 jobs, as the state projected. That left nonfarm payroll employment at 8,630, 20 more than the year prior, or a 0.2 percent growth rate. The private sector added 160 jobs, including 120 in lei- sure and hospitality. Govern- ments added 10 jobs. +L]VU>LH]LY5\YZL /VTL/LHS[O/VZWPJL `LHYZH[*4/ Our people make The Planetree Difference 7LVWSL*LU[LYLK8\HSP[`+YP]LU:LY]PJL-VJ\ZLK Devon is one of the caregivers at CMH who exemplifies our Promise of Excellence: t t t t t t Respect Integrity Compassion Leadership Safety Teamwork Caregivers like Devon make your community hospital one to be proud of. “To me, patient- centered care means involving the patient and his or her family as partners and primary decision makers to help enhance their care experience.” – Devon Weaver, Nurse &YDIBOHF4U"TUPSJB0SFHPOt XXXDPMVNCJBNFNPSJBMPSHt"1MBOFUSFF%FTJHOBUFE)PTQJUBM
