Yahoo CAM Region 3 group -- Emails about CCM //  Standard of Care // controversy

From:  Diane Holzer <midwife@l...>
Date:  Mon Dec 13, 2004  9:16 pm
Subject:  faith

Well i spoke with Faith and she is not really open to editing her document. She feels that we really don't have that option at this point. I pointed out to her that CAM could propose anything that they wanted, she doesn't see it that way.

She is interested in hearing about our edits however, so we could send them to her. I described a few of the things and she said that we are just reading the document wrong that if a client doesn't want to consult for say thyroid then we just document it in her chart and that is all. she says that having the right to refusal covers us on everything. she says it is not worth risking Figueroas support to change the document or not support the one we have.

So not sure what our next step should be. do we want to edit it anyway? I mean i was thinking the other day that actually if the medical board puts this out as the document, then it is not "faiths" document anymore right? it is from the medical board and then i think we would have the
right to edit what we want...........? not sure, question for our lawyer I guess.

Or do we just fight the whole thing? Faith points out to me that the Medical Board doesn't have to do anything we say anyway and will do whatever they want. so............I need to think about all this a bit to know what i think. I just talked to her today cause i ended up at a long birth..........

Ideas?? Diane

 

Date: Mon, 13 Dec 2004 18:33:29 -0800
From: Carrie <carrielm@s...>
To: president@m...
Hi
I have a call from Faith to call her back which I will attend to tomorrow. I spoke to Anita Scury today for a short time because I am in the middle of a medication change due to a drug interaction and didnít feel able to be very on top of the conversation. She understood and told me to call her this week when I felt better, even gave me her cell phone. So I will get back to her later in the week to discuss the protocol issue.
She informed me that the regulation has gone out for comment already, on the 8th, if you donít get a copy from the MBC call them and ask them to send it to you. It is too late to amend Faiths document now, even if she were willing. What we can do is comment on the document as it is and the regulation in general during the comment period. What I would prefer is that all regions come together individually and create a list of blocking concerns re: Faiths stuff, so we have something to work off of. Then, since we wonít have a CAM BOD meeting within the 45 days each region will submit a list of those concerns to me. After this I would like you, me and possibly Tosi to meet with Tim to draft our rebuttal/ comments to the regulation on Timís letterhead. I will then poll the regional reps to get the response to the comments and hopefully it will go smoothly.
>We will need to get this moving very quickly now since it is out for comment. I think it is very important to continue the work you are doing in region 3 but instead of trying to rewrite the thing only highlight those areas that we truly canít live with.

Could you please try again to get a response from Tim on the issue of sub section b superceding sub section a? I will try as well.

Tell people not to despair, the worst that can happen is that the MBC doesnít get their way and we're back to where we are not. The best that could happen, of course, is that they make all the changes we want. My guess is that we'll end up somewhere in between. Remember also that Ed
Howard of Senator Figueroa's staff only advised us not to object during the adoption of the regulation, but felt it fine and appropriate to comment during the comment period. I think we also need to work very closely with him through this as well as Anita Scury.

I also had a speaker phone call with region 7's peer review group this after noon and cleared up a lot of questions for them.
Hope I've addressed everything, if not feel free to call me on my cell phone, I just wont pick up if I am unable to converse at that time, leave me a message and I'll get back to you latter in the day. cell # 530-902-2962
Blessings
Carrie

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From:  Diane Holzer <midwife@l...>
Date:  Tue Dec 14, 2004  9:27 pm
Subject:  Fwd: GOP

Hi, just got a call from Alison trying to convince me to support Faiths document, but she says she really would rather have her documents accepted, they are shorter, 10 pages and more to the point so i will pass them on to you all just so you have them............

love diane

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From:  Diane Holzer <midwife@l...>
Date:  Wed Dec 15, 2004  12:02 am
Subject:  Fwd: Re: faith

Actually it hasn't gone out yet, is still in the office of administrative law..........but will go out soon.......diane

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From:  Sarah Ridge <truebeautyiseverywhere@y...>
Date:  Fri Dec 17, 2004  8:21 pm
Subject:  Standards Language

I want to voice in as a student midwife - I have been reluctant to do so as a beginner but feel that my level of commitment to midwifery is sufficient to allow me to do so now.
I want to wholeheartedly agree with you Maria Elena re your last email - I believe that we must go for what we want with the medical board and with the specifics of the language. I do not think that settling behooves anyone and will ultimately result in division amongst midwives and leave us open for liability.

Clearly, there is no magical safety in informed consent - that has been proven time and again
in this highly litigious society. Regardless of whether or not the Medical board thinks midwives are wishy-washy, amendments are the norm and I think probably expected.

The medical board is not unfamiliar with this type of process and certainly gets it that within
organizations there is a spectrum and that a consensus must be met through argument /debate/ discussion. So now the door to that discussion with them is opened and the debate needs to occur. So, whatever I can do to help Maria Elena or anyone else, let me know.

Sarah Ridge

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Carrie 12/23/2004:

Dear Leah
I am glad that your region is taking the standards issue so seriously.  We did not have a very good turnout in our region. 

I would like to clarify some things though that are expressed in your e-mail.  Faith has no ability to edit this document, unless she were to comment against it during the comment period like all the rest of us.  Please pass this along, it isnt fair to Faith to consider her unwilling to do something she cannot do.  This document was decided upon in a rather short amount of time during a meeting Faith thought was a working meeting to begin to develop standards and did not think for a minute that her document would be adopted or have her document put forth as the one to be used.  She has told me and Tosi and I imagine others that she was quite surprised when Dr. Fantozzi  decided to use it at the Oct 8th meeting at the medical board. 

At the meeting we had in our region on Monday, Tosi and I came with comments we had prepared to share and Claudia, Tosi's partner and Reg 5 rep was also there.  Additionally, Heather Wiley the PhD student and another 2 midwifery students where there.  So it was mainly a discussion between Tosi, Claudia and myself.  Tosi as you know helped with the writing and implementation of our law and is the only one on the CAM legislative committee, and Claudia (who is an LM) was president of the Tenneesse Midwives Assoc for 2 terms during which she helped gain licensure for that state. 

What we ultimately decided was:
were there things we wanted re-written?  yes
were there things we would have left out?  yes
were there things we would have added?  only a few
were there things we absolutely couldnít live with? no

What we decided was that we would be best served, as midwives, if we first praised the efforts that got us the document in the first place (mainly the MBC since Faith doesnít really need that) and then politely commented on the few things that really needed either to be changed to agree with other areas of the document, things that needed to really be left out and things that we really couldnít live with.  We also agreed that this list should be short and we should be able to back it up either with evidence or according to regulation making  rules (see attached).

I did not get your file of edits, so if you could send them to me directly that would be great.  I did find them on Faith's website, as CAMs version with strikeouts, but when I talked to her she wasnít sure she had gotten it completely right.

What I know is best for California licensed midwives is for us to come together as a unit.  This means that if we provide numerous requests and evidence for the kind of edits I saw from Faiths version, that we MUST be ready to possibly lose Senator Figueroa's support, be ready to have the medical model possibly be our standard, and be ready to completely derail what the medical board has adopted.  I am not trying to scare people, but I think it is really important to discuss, beforehand, the realistic consequences of our actions. 

When we say we want a clause taken out, that would by removal suggest we should provide care for a woman with essential hypertension, (without even a physician consultation) we convey to the medical establishment that not only are we potentially dangerous, but that we don't know enough physiology to know that this is a potentially serious situation that could worsen during pregnancy 

(8. Essential hypertension (BP >140/90 on two or more occasions six hours apart)).  I use this as an example because it illustrates 2 points.
1. most of us donít or wouldnít take on a client we knew ahead of time had hypertension (prior to pregnancy) so why delete this clause
2. there are a lot of similar strikeouts that really arenít worth "throwing the baby out with the bath water" over

Some of the things I saw as strike outs are things reg 5 also had concerns about, not being sure what the language actually meant, and on talking to Faith I was able to clear it up and consider it actually good language.  I think it is particularly important to keep the section on definitions intact.

I would love to talk to you regarding your feel for the meeting in your region and am wondering if maybe we could have a teleconference meeting for your next regional meeting (although the 4th wont work for me, I have a mandatory MD visit for my lawsuit)  I'm thinking you could all gather and I could take part via speaker phone.  530-902-2962, my cell which is the best way to reach me.  I am considering this for all regions because this e-mail thing really doesn't work quite right or fast enough.

Let me know if that's possible.  The new pain medication I'm on doesnít allow me to drive (major bummer), but this is really important to me.  If not by phone maybe with enough planning Tosi and I could come together to at least your region.  I am really committed to not only making this work, but having consensus in the way we make it work.

Blessings
Carrie

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At 06:19 PM 12/23/2004,

Leah Redwood wrote:

I just got off the phone with Faith.  We spent many hours going through her document and creating a document with the track changes function for our edits.  I was very amazed that she was willing to do this - she has even posted the resultant document on her website.  She is an incredible source of knowledge and I got quite an education.  I agreed to removing some of our edits based on the explanation of why she had included something, where it came from or how the wording actually was helping us get more freedom and latitude than what the LMPA specifies

These were unilateral decisions and some in our region may not agree with them, so you should all review the final result and make sure it is still something you agree with.  Sometimes we put some amount of explanation in the document as to why I decided to leave things in, but if you want to hear more of an explanation on certain items feel free to call me and I will do the best I can, or feel free to call Faith - I am sure she would be willing to share her rationale.  One thing I want to be sure to point out is that in all the sections where consultation or referral are discussed Faith has included consultation with another professional midwife as an option along with physician consultation and it seems to have been accepted by the Med Board which is a great benefit to us.

Anyway, there are probably several other items like that that I should tell you about, but my brain is a little fried and yes I still have Christmas preparations to finish - Yikes!  So, you can access the document from the home page of her website a little ways down in the purple box where it says CAM Region #3 proposed changes to CCM Standards.  When you click on that link it will download a Word file to your computer that should appear on your desk top where you can open it (our edits are in red).

http://www.goodnewsnet.org/

I also received an e-mail from Carrie today which I will include below to show you what her thinking currently is.  She included an attachment which I have pasted in below her e-mail.  I'm not sure why she wrote only to me and I don't want to be the spokesperson for our region unless people empower me to do so and give me their input first.  I am assuming our reg. reps will do that.

I'm not sure where we will go from here.  I won't be checking e-mail for the next few days.  See you all at the next CAM Meeting.

Love, Leah
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At 08:39 AM 12/24/2004, you wrote:

Hi Diane,
Unfortunately I was left out of the info loop on the revision process of Faithís stuff (Iím still not on the e-list and canít access the document on the yahoo group site). But I have a copy, and have seen your revisions, which I agree with.

However, I want to make sure you got my former note about Faithís definition of referral, and how important it is to include the definition section in the final document. I have read the memo from the lawyer re: clientís right to decline treatment not providing protection from liability, and frankly, this is beside the point. We have liability for all we do≠ thatís the way the system works≠ but in this case, we are concerned not with liability but scope of practice. A clientís right to decline and our right to continue care (which Faithís definition of referral essential provides in EVERY aspect of our care, not just VBAC and breeches and twins) is the giant loophole re: scope that we can hold on to. It is important that we be aware of this, and do nothing in our rewording that might undermine it.

Please let me know you received this, and Iíd love to know your thoughts.
Happiest holidays,
Elizabeth

Visit our NEW website at http://www.birth-sex.com for more information on women's blood mysteries, sexuality, current publications, and the National Midwifery Institute, Inc.

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From:  Diane Holzer <midwife@l...>
Date:  Tue Dec 28, 2004  3:31 pm
Subject:  meeting with Carrie

So I am talking with Carrie and Tosci about going up to Davis to work on a final edited version of the document on Sunday the 2nd. Does anyone want to come up there with me?

I am assuming that our plan is still to edit Faiths document. It seems she is considering edits, but really it is not up to her, it is up to the medical board..........

We could also try and just create our own document, we could use BAGOMs old stuff and work from there, I sent you Alisons stuff which is based on that. it is much easier to read, ten pages, etc........

It may be easier to edit Faiths document because it is the one up for review at this point. I have a call in to Tonya to have her send us edits also. I believe that the deadline for written comment is January 8 so if we want to have something by then we have got to boogie. We still can comment in person at the meeting regardless.......Still trying to get Carrie to arrange the meeting with the lawyer for the medical board and our lawyer....

Let me know if anyone wants to come on Sunday!! i can drive.

Diane

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From:  Diane Holzer <midwife@l...>
Date:  Wed Dec 29, 2004  7:48 pm
Subject:  Re: [camregion3] meeting with Carrie

Well, interesting, Carrie and Tosci were both wrong about the date!! Well that is actually a big relief because we are no where near ready to come up with a final document. So i am going to cancel that meeting on Sunday until we get some more input from Tonya etc.....and region 7. Maybe a few of us could go up to Carrie when we are ready. From what i understand most of the regions are working on Faiths document so it seems that this is the document that we may have to work with rather than trying to edit the old Bagom stuff or create something new...

Maria, i think it would be good for us all to strategize on what is the best commentary for everyone to make rather than everyone for their own. For once CAM midwives really need to get together and get behind something and make a concerted, harmonious effort. It will pay off in the long run.

We could decide to argue the standards issue, but i think that Janice kalman is right that we won't win with that argument because it was the intent of the law to write regulations (she was very involved at that time for those of you who don't know Janice) even if it got called standards in the actual language of the statue. If we argue on that point and we have a good chance of winning the point at the medical board meeting if we bring in MEAC, educational experts etc....but it is a lot of energy to spend on something that will eventually go back to OAL who will look at the intent of the law and say that the intent of the law was to have regulations. Then we are back to writing regs. She may be wrong but usually she isn't. It would stall things to argue that point but it won't make us any friends in the long run............

Tonya and i have been playing phone tag, i will see what they are up to down there......Have people looked on Faiths website at all the changes that we gave her to see what it looks like? See you all soon.

Happy new year!!

Diane

From:  Diane Holzer <midwife@l...>
Date:  Wed Dec 29, 2004  8:35 pm
Subject:  Re: CAM standards...good work

Hi Elizabeth, sorry it took so long to get to this, i will forward this email to the group, the edits are on going, so if you have more there is still time to let them be known.  Some time soon a few of us will go and finalize the document in Davis with Tosci and Carrie.  

I am in discussion with Tonya brooks and a few other of the regions, so when we get all the edits, we can go over them once more and get them in and discuss it  with Faith etc..........Faith has put up a lot of the edits that she has recieved on her website at goodnews.net, you can see the changes etc..........you can look at it there.

Hope all is well with you, happy new year!!      love Diane

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from:  Diane Holzer <midwife@l...>
Date:  Wed Dec 29, 2004  10:53 pm
Subject:  Re: [camregion3] our edits to Faith's document

Thanks Leah for doing this,  i finally got to look at them. So in general what did Faith think about the changes?  did it seem that she would be open to implementing them?  or was she still not in agreement with amending the document?        Diane

I didn't go through this and compare with our notes, is there anything big that we had said we wanted that you changed?  i didn't note anything but is there something that comes t your mind that was?  don't worry about it if you can't think of it, just wondering............

di

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From:  Leah Redwood <leahmidwife@m...>
Date:  Thu Dec 30, 2004  4:12 pm
Subject:  Re: [camregion3] our edits to Faith's document

Hey all,

I just spoke to Faith again and she seems open to the idea that we may all be able to come to agreement, or at least we should try to find a way to support this document and not lose this opportunity. She has now put up on her website two additional documents to demonstrate where the material came from, and what it actually means, that she used tocreate this document. I really recommend that everyone read these documents before the meeting on Tuesday. Also, I did leave out some of our edits because of discussion with Faith and feeling that from my best judgment it made sense to leave them out or alter them. So, I can review those from our original list at the meeting on Tues., but all of us should review the version Faith and I created and see if there is anything we particularly need that didn't get included.

Faith can be available by phone on Tues. for us to ask further questions if we need, so hopefully we can come to a final decision about what our mandatory changes to the document would be.

I think it is important for all of the licensed midwives to make it to this meeting so we can make a decision and move forward to get ready for the upcoming meetings.
Love,

Leah

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