Informed Financial Consent in Obstetric Emergencies

The AMA and Federal Government have both put strong emphasis on the need for informed financial consent for private patients. Difficulties arise when this information cannot be given prior to admission. Emergency admissions and obstetric anaesthesia are cases in point.

Most private hospitals have an on-call anaesthetic roster so that a patient cannot know in advance who the anaesthetist will be in the above situations. For an elective caesarian section there should be no problem but as patients go into labor at a time which cannot be predicted, the on call anaesthetist will be used.

Anaesthetic fees for the same service can vary widely, for what ever reason, so that it is impossible to predict in these circumstances the "gap" between fees and rebate. Further, the ACCC regulations prevent a specialist group agreeing on a fee structure as Townsville obstetricians will attest. In some instances these gaps will be as little as zero, but they can be quite significant in others. After-hours emergency services such as emergency caesarian section and after-hours epidurals generally attract significantly higher rebates than those for office hours services but the "out of pocket" moiety can still be significant. A patient in labour is not in a position to consider proffered fee advice or to shop for another anaesthetist. If proper informed consent has not been obtained, anaesthetists find themselves in the awkward position of asking patients to agree to a fee after the event.

Anaesthetists (and patients) would benefit if private obstetric hospitals, well before confinement, would provide patients with a range of fees. This should prevent later disputes as well as unpleasant surprises for patients, who are in no condition during labor to be realistically making informed financial decisions. If your hospital does not provide such estimates, it should be encouraged to do so. Ante natal classes provide a suitable forum.

In addition, patients should be encouraged to consult "Epidural anaesthesia and you" at http://www.asa.org.au/page.aspx?A=5463

Dr. Michael van der Griend & Dr. Richard Grutzner
Invivo Medical Advisers