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Show c "So artist is ahead of his time. He is his time. It is just that Martha Graham ( 893-- 99 ). others are behind the time. " 1 1 1 Monday, April 1, 1996 MiMves, BYNs work for same goal By DEANNE FRANCS I am a registered nurse with 35 years experience in obstetrical and neonatal nursing, having worked 30 of those years in a newborn intensive care unit in Utah County. I am also an ASPOLamaze certified childbirth educator and have taught approximately 5,000 couples since 1963. I have lived with a fatherobstetrician for the first two decades of my life and a husbandobstetrician for the last three and a half decades. I have had 1 1 pregnancies and six live babies, all born in Utah. I would like to comment on Dr. Marsden Wagner's assessment of obstetrical care, at 1 least in Utah County. First of all. Dr. Wagner did not define the term "midwife." I think this is a disservice to the highly-trainecompetent with and compassionate advanced degrees and skills. There are a out there lot of "granny" or and who do who are basically some things which are really scary. One lay midwife told me that she had done 1,500 deliveries at home without a complication. I told her I didn't think it was possible, even in a low-ris- k population. In asking her about how she handles volume-deplete babies following a cord a being tightly around the neck, she didn't know what I was talking about. I can only conclude that she has had 1 ,500 uncomplicated deliveries because she doesn't recognize a complication when she sees one. Second, with regard to the Caesarean section rate. Dr. Wagner says that the, "World Health Organization recommends that rates in the U.S. never be above 10-1- 5 percent, with the 15 percent being reserved for university hospitals that deal with the most difficult pregnancies." I would like to point out that, according to the article, of the four hospitals in Utah County, only Mountain View has a Caesarean rate higher than 15 percent. American Fork Hospital (where all the rate practice) has a only 0.7 percent lower than Utah Valley the high-ris- k Regional Medical Center rate facility. (The current 1995 for UVRMC is 14.7 percent.) UVRMC, as a level HI facility, cares for the highest-ris- k mothers and babies. At 14 percent, the Caesarean rate is lower than the World Health Organization's definition of "appropriate" for comparable facilities. For the people in Utah County, this may be nice to know in view of the negative article on Utah in general. Third, let's spread out the blame to include all those responsible for the increase in Caesareans and epidurals. I agree with Dr. Wagner that doctors bear some of the responsibility, but not all. My father was an obstetrician at the Br ner Clinic in Salt Lake for many years. He never had a single lawsuit, which is not to say that I think he was perfect. People simply did not sue their doctors. When my husband started his obstetrical practice in Utah County in 1963. his malpractice insurance cost SI 25 per year (about the cost of one delivery.) Today, care by an OBGYN costs around $1,500. Malpractice insurance for that doctor in Utah County now runs about $40,000 a year, the cost of about 27 deliveries. In spite of decreasing morbidity and mortality rates from the time my father was in practice, obstetricians in the U.S. now average one lawsuit every three years, and it takes three years to get one through the courts. In most, the doctor is acquitted. However, his insurance provider still must pay the costs of his defense. The not plaintiffs, however, pay nothing even ice, because the attorneys take the cases on a contingency basis (no win, no pay). I believe this is an incentive to sue without due cause. Dr. Wagner's statement that "any doctor who says litigation is a reason for is a doctor willing to pick up a knife and cut open a woman's belly only for fear and greed," is not reasonable. I know a few money-hungr- y doctors but there are easier ways to make money than facing a life of sleep deprivation and being "on-callno matter what else may be in on their own lives. going Fear, however, is a very viable reason. Obstetricians know that they stand a better chance of being "hung" by a jury if they and the outcome did not do a was poor. Even if the doctor is found innocent (and they usually are) their malpractice premiums go up, simply because somebody filed suit. Yes. obstetricians feel fear, and are practicing defensive medicine. If 3.000 women in Utah "had their bellies cut open for nothing." it is a testimonial to the fact that hindsight is better than foresight, and doctors aren't taking any chances in our y society. Further, in those cases where a doctor has truly been guilty of malpractice or negligence, only 29 cents of every dollar collected actually goes to the injured party. The rest goes to pay legal and court fees. This seems exorbitant to me. and is surely part of the reason malpractice premiums are high. Doctors and insurance providers stand to lose, whether they win or lose in court (both monetarily and in d, nurse-midwiv- nurse-midwiv- ," suit-happ- win. Sympathy is always with an injured party, especially if the injured person is a baby. The assumption is made that in this day of advanced medicine, all birth outcomes should be perfect, and when they are not, there must be somebody to blame. The perfect person to blame is the doctor with an insurance company at his back. No one ever considers that the responsibility for the choices made does not lie totally with the doctors. In fact, malpractice and health insurance providers are Jte am' Louie an' k Couple NEWIY Bo M IfiUSE WEEPS I W6lNE RUNNtN '. . . 1U rFiTOsSfauS. vJ Gaost opinion es self-traine- d, rv bad publicity). Plaintiffs have nothing to lose except the financial windfall if they es now dictating many medical decisions, taking choice from both health care consumers and prov iders. And finally, the epidural rate. It is high sky high. As a childbirth educator who has seen the change in obstetrical analgesia and anesthesia over 35 years, I w ill say that the only benefit I can see from the rise in epidurals is a awake delivery, and the ability to avoid general or spinal anesthesia for most pain-fre- WE WGIB0W BKKTbttoCAR tM VVE SCKW OUT MPUfAPlTIN TXTRUNK PENE, SEE ... NuniN io ii. e, in most normal births, the probably outweigh the benefits. Although I have spent thousands of hours of my life teaching couples about both the risks and benefits of chemical as well as nonclwrnical pain relief and stress reduction for labor, and preparing them for low levels of medication during birth, it is the women themselves who. fully informed, choose epidurals over the However, risks and less-sur- e, side-effec- ts more safer g, alternatives. nation of people We are a who like "quick fixes." The idea that one might have to prepare and practice and work together w ith a support person, and still experience some pain, is not attractive in our society. drug-orient- ed The responsibility for g making sure that women are correctly and honestly informed lies with health care providers and educators at all levels, but the final responsibility for becoming informed and making decisions as to what may be done (or not done) lies with the mother of the baby. child-bearin- one-fift- h obstetricians. Dr. Wagner's comments to the Utah Midwivcs Association w ere inflammatory. Obstetricians and are not, or should not be, adversaries. The goal is the same: To have healthy mothers and babies at the end of pregnancy and birth, and to assist in making that process as safe and satisfying as possible. Both have appropriate roles as caregivers. The responsibility for making sure that childbearing women are correctly and honestly informed lies with health care providers and educators at all levels, but the final responsibility for becoming informed and making decisions as to w hat may be done (or not done) lies with the mother of the baby. es I asked 348 women in Utah County to list, according to priority, the things they considered important in choosing a health care provider and hospital. "Want a facility where good anesthesia is available" was fourth on the list. "Would like to avoid on a list of surgical delivery" was flat-laseven items. Apparently, women's priori-tic- s are not the same as Dr. Wagner s. Contrary to Dr. Wagner's portrayal, the majority of professional people who I have known who are involved in perinatal medicine are caring, concerned, individuals who love (and are what they do; not just at) good greedy, frightened scientists making decisions based on money or expediency. st well-train- ed cold-bloode- Deanne Francis is an R.N., and CLE. In the March 25 issue of The Daily Herald, under the headline, "Flat Tax, No Thanks." Mrs. John Brinkerhoff made some interesting, but erroneous, calculations on the effects of the 17 percent flat tax on earnings of $30,000. $40,000 and $50,000. Mrs. Brinkerhoff apparently does not understand the flat tax. She neglected the dependent deduction. For a familv of four, it is $36,800. or $13,100. for each parent and $5,300 for each child. Thus, a family w ith an income of $30,000 would pay no lax under the flat tax. versus $2,100 in the current system. HSN, ACCE ment, under pressure from some of its citizens, has instituted controls and regulation which have weighed heavily on the ability of the natural resource industry to be productive. Thus, what has been and is happening is that the cycle of capital distribution is not being increased at the rate it enjoyed earlier in the century. As the population grow s, our demand for capital and products is increasing, while the ability to produce these products and thus, create wealth. I is being decreased. (In recent years, for example, Utah has had zero or minus growth in all natural resource The bill's sponsor. Sen. Black, believed by making July I. 1997. as the effective date, that the governor would be required to budget for the bill in the IU97-9budget. In no way was there an intent "to lie to the legislature and retirees." Z, the fiscal note would have Yes required a $7 million annual increase in the state's contribution to the systems.Ja industries.) believes that the most in economic growth is factor important technical innovation. In my opinion, that idea takes a second place to the fact that real economic growth comes from creating new wealth through the production of metals and animal, forest and energy producing products for distribution. No one denies that at one period in time, the natural resource industry 's drive to generate wealth took its toll on the environment. Today, the trend is reversed, to protect the environment, natural resource industries are being decimated at an alarming rate. Through the technology spoken of by Sen. Howell, better use is being made of the limited resources being produced, but I would propose to you that the decline in America's liv ing standard is proof that an economy cannot continue to grow without the creation of new wealth through production of our natural resources. This is our country 's real dilemma: To provide a balance between env ironmental concerns and use of our natural resources. Only then will the principles Sen. Howell puts forth be of any real use. Valerie Mason Sen. Howell If they earned $40,000, they would pay $544 v ersus $3,600 under the present system If they earned $50,000. under the flat tax the would pay $2,244 versus $5,000 under the current system. It is estimated 10 million people would be taken off the tax rolls under the flat tax. In static analysis, the flat tax would reduce tax revenues by about $40 billion, but since taxpayers will save billion in expenses, $100 billion-S20interest rates will go down and the economy surge tax revenues will rise. With a flat tax of 17 percent and filling your taxes out on a postcard, hundreds of thousands of tax attorneys, accountants and revenue agents will be out of a job. These are intelligent people and w ill help our country much more in useful occupations. There are over 5.000 pages in the federal tax code. would dearly love to see it disappear. Finally, about half the corruption and lobbyists in Washington will be eliminated. There are enormous benefits to be derived from a flat tax. Robert Petersen Provo 0 We don't want labor to be labor. It's harder to learn to use natural, inborn resources than chemical "quick fixes." Doctors do not tie women dow n and force epidurals on them. The women must give their consent, and at UVRMC. as Dr. Wagner points out. fully 82 percent do. I noticed that Dr. Wagner did not comment on Utah's very low infant mortality rate. The neonatal mortality rate in 1995 for UVRMC was 2.3 babies who died for every 1,000 live births. In spite of the low rates in the rest of the world, our neonatal death rate was half the international rate. It is the death rate from the time my father was practicing (and not sued). One wonders how we achieve that success with such "obsolete" nurse-midwiv- Flat tax faux pas 1 Natural resources Hinckley In a recent edition of a Utah business magaine, Utah Sen. Scott Howell discusses several ideas to improve the economy. His article, "The Potential Economy," has me wondering where the increase in income is supposed to come from and how he suggests we get rid of the deficit. He states. "The capital growth is by If potential growth only on increasing best way to increase reducing the deficit." in the economy rests income (I'm for it) and reducing the deficit, let's do it. What are we waiting for? Sen. Howell also points out that in the last 25 years, investment, productivity and overall output grew at about half the rate of the previous 25 years. He says the reason for this is because what really drives the economy and generates wealth capital investment, the skills of the work have all force and new technology fallen behind. I would like to suggest that something more crucial is affecting our ability to increase capital supply and generate wealth. For the past 25 years, the govern Rotireo letter errors On March 7. The Daily Herald printed an article by Ed Haroldsen regarding the struggle of some 8.000 state retirees to gain equity in their retirement. Rep. John Valentine felt obligated to respond to that editorial on March 15. As president of the Utah Retired School Employees Association and one who was a significant player in the efforts to pass S B. 29. 1 feel obligated to inform Herald readers of "the other side of the story." In a sweeping generalization. Valentine stated that Haroldsen's editorial "w as so full of errors." but then he proceeded to make several misstatements of his own. Haroldsen did erroneously list Valentine as chair of the legislature's joint appropriations committee. I take full responsibility for that error, as that is the position I told Haroldsen that Valentine held. That is the only error in Haroldsen's editorial. S mere .43 basis points. Local government!, would have had to increase their contributions by .30 basis points. These figured pale in comparison with the amortized millions that the state committed to whe$ retirees from 1990 on were granted a j percent serv ice factor. Additionally, all Utah citizens should be aware that because of the growth Ti the retirement systems' assets ($2.3 bil lion in 1987 to approximately $8 billiod in 1996) the state of Utah, since 1979; has been able to utilize over $1 billion according to Utah State Retirement Sysfor "other state protems officials grams:" Monies that would have otherwise gone into the retirement systems to maintain the systems' actuarial soundness as required by law. The phrase "fancy parliamentary maneuvering" was Haroldsen's polite way of say ing that a lot of "arm tw isting" look place with representatives who had expressed support for S B. 29. Thai "twisting" started in the Rules Committee and continued behind the scenes as the House Leadership did everything it could to return ihe bill to rules. All of these actions were done in spite of the promise of House Speaker Mel Brown to representatives of the Utah Retired School Employees Association and the Utah Association of Retired Pub-li- e Employees that. "If you can gel the bill out of the House Rules Committee. I promise you that the bill will receive a full hearing on the house floor" Valentine disclaims that the ball diamond is not in his constituency. Voting constituency, yes; however, all of his geographical constituency (Utah County) will benefit from ihe diamond. Rep. Valentine threw in some "complexities" that didn't even exist when he inferred that ROPE and noncontributing retirees would be hurt by passage of S B. 29. The bill's wording was as follows: "...whose retirement allowance when calculated amounts to less than the allowance provided by using a 2 percent per year of service factor..." So, in actuality, all retirees not receiving the 2 percent factor would hav e that factor used to bring their retirement up to that 2 percent level, not cut anyone. s, Rep. Valentine stated that he has supported 2 percent legislation for several y ears. If so. then may be he ought to sJftiC-so- r next session's bill (there will bejpjvc) and use his considerable influences to' "prov ide equity at last." Korman D. Riff Utah Retired School Employees Association West Jordan -- : Doonesbury BY GARRY TRUDEAU I THANKS FOR N0PQQB-COMIN- UMB&N- uRMim. G - whavsurt GOT A PftXUM. 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