Reporting
Inappropriate or Unsatisfactory Medical Interface, Unwarranted
Disciplinary Actions, etc
Please fill out and return the
LM questionnaire ASAP.Photocopy
the parents questionnaire and distribute that ASAP and return to CALM any
responses as quickly as possible.
Questionnaire
for Midwives
Name
___________________________________________, License Number
____________
Years of Practice_________ Average Number of client families served annually
__________
Check One:
Professional Liability
Insurance ~ I have (or had) professional liability insurance covering
community-based midwifery _____
During the time that I was
covered by professional liability insurance I found my ability to make
appropriate medical arrangements for my clients was substantially: (1)
improved ______
(2) unaffected ______ (3) I was able
to find legally-mandated physician supervision ______;
(4) I was NOT able to
secure the cooperation of a physician supervisor despite insurance ______:
(5) I have been unable to
find affordable malpractice insurance during the last 12 months ______
Physician Supervison ~
___ I am a provider of home-based birth service and I am able to meet
technical requirements for physician supervision
___ As a provider of home-based
birth service I am unable to find a physician supervisor but have
appropriate alternative plans for medical interface in place
Physician Supervision is non-applicable
due to (1) _____ inactive status (2) _______ Employed by a physician in a
medical setting; (3) other _________________________________________
Check any/all of the
following that apply to you:
(1) _____Before passage of the
LMPA I was able to make satisfactory “back-up” arrangements for client
families;
After passage of the LMPA my
ability to provide appropriate medical interface (arrange diagnostic
testing, consult with a physician on a specific client/situation, refer to
medical providers for care, transfer to hospital care) (2) _____ has
improved greatly; (3) _______ is about the same; (4) _____ has gotten much
harder, less satisfactory Brief Comment:_______________________
Do you think that licensing
under the current provision of the LMPA, which mandates physician
supervision, serves to improve midwifery care and afford additional
protection to consumers?
(5) Yes_____; (6) NO _____(7) can’t say, undecided, etc ______________________________
Since the implementation of the
LMPA (Jan 1997) I have observed or been directly involved in patient care
situations that were rendered unsatisfactory/unsafe due to the
philosophical/political differences between Obstetrical Medicine and
Community-based Midwifery by LMs:
(1) yes ____ (2) No ______ (3)
can’t answer because ____________________________
If yes, this has occurred
(4) _____ once or twice (5) ______3
to 5 times (6) ______ 6 to 12 times (7) _____ greater than 12 Xs (8) _____
estimate of the times this included actual harm or introduced unnecessary
or unnatural danger to mother or baby:
Please give 1 to 3 examples of
this type of problem, focus on the most “usual” &/or most harmful:
(Add as many lines as necessary)
____________________________________________________________________
Since the implementation of the
LMPA (Jan 1997) I have observed or been directly involved in patient care
situations that resulted in threats against myself or my midwifery partner
(1) ____ yes
(2) _____ NO; (3) Can’t
say/doesn’t apply because ___________________________________
(4) _____ Estimate of times this
included threats or reprisals against the LM
Have you had a physician or
hospital employee (i.e. non-family members) file a complaint with the
Medical Board relative to home-based birth services (1) ____ yes (2) ____ NO
(3) _____doesn’t apply
If yes:
(1) _____
Involved appropriate and timely hospital transfer with good outcome
(2) _____ Involved a problematic
outcome that was not, in your judgment, the direct result of midwifery care
in a domiciliary setting or a “quality of care” issue
(3) _____ Involved
a difference of opinion about “appropriate” scope” of midwifery care
(for example a VBAC mother with appropriate informed consent/decline of
standard medical care)
Describe / Comment:
_____________________________________________________________(add lines as
needed)
Since the implementation of the
LMPA have you observed or been directly involved in providing care to a
family that either had or planned to have a home birth in which the
obstetrician or pediatrician was hostile to them, punitive in his/her
treatment, triggered reprisals such as reporting the parents to CPS or
refused to provide care due to their home birth plan?(1) _____ yes; (2) ___ NO; (3) _____ Can’t say / doesn’t apply
________________
If yes please relate the
specific of 1-3 of the most “usual” situation or the most egregious:
(add lines as necessary) __________________________________________________________________________
Do you have any specific
suggestions on how to improve the interface between midwife and physicians
and between physicians and midwifery clients planning home-based birth care?
(Add lines as needed) __________________________________________________________________________
Mail to: CALM, P.O. Box
620191, Woodside, CA 94062-0191