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Women in labor regularly ‘denied pain medication’

HAGÅTÑA, Guam (Pacific Daily News, April 12, 2012) – An incident last week in which a physician allegedly received cash in return for providing pain relief to a woman in labor is being investigated by Guam Memorial Hospital (GMH), said Sen. Dennis Rodriguez Jr. The investigation spotlights a larger issue of women in labor being denied pain management at the hospital, physicians said.

GMH's investigation is linked to an email sent by a physician to the acting hospital administrator detailing an incident involving two physicians and a desperate couple.

"These allegations allude to extraordinary actions and raise the potential of... improprieties," Rodriguez said in a letter.

But Dr. Jeffrey Gabel, author of the email, said in a phone interview yesterday that he was trying to make a larger point about the hospital's "disorganized approach to labor pain management." The physician said for years, the hospital has not required anesthesiologists to perform services in an organized way.

Gabel said he doesn't believe the doctors involved in the cash payment incident intended to do wrong. Rather, the issue he wanted to address was that women are denied pain medication on a regular basis, he said.


Gabel's April 6 email has prompted responses from officials and hospital employees. Gabel said the email was never intended to be leaked to the public.

The email stated that one of Gabel's patients, a woman who was in labor, requested an epidural but was told that epidurals weren't available, Gabel said in an interview with the Pacific Daily News. The woman was told she could have an intrathecal injection for pain instead.

As far as Gabel knows, another physician talked to another doctor who allegedly agreed to do the injection as long as he was paid upfront, Gabel said.

The woman's distressed husband, who didn't speak English well, was "waving cash" -- $600, Gabel was told -- and trying to pay for the medicine, Gabel said.

He said a second party allegedly accepted the cash for the doctor who later performed the injection.

Gabel said he arrived in the middle of the incident, and did not witness everything.

"The guys involved were not trying to pull anything under the table," said Gabel, in a phone interview. "They didn't think they were doing anything wrong."

The alleged cash transaction involving the woman's husband and the doctor may have been over a misunderstanding over conducting private anesthesiological services, Gabel said.

Labor analgesia

The cash payment incident "may look bad and it may be sensational, but it's not the problem," Gabel said.

In yesterday's phone interview Gabel said anesthesiologists don't feel that it's their responsibility to provide services for labor pain. He said anesthesiologists don't want to be constantly on call for labor anesthesia.

On the other hand, the hospital has not acted on the pain management issue, he said.

The recent incident with the woman was "simply an outpouring of that attitude," he said.

Chris Bieling, chairman of obstetrics and gynecology at GMH, said in an email yesterday that the hospital administration was correct to investigate the cash incident, but "it is important to remember that the issue is lack of epidural anesthesia and analgesia."

"The time has come where we at GMH need a full-time obstetrical anesthesia service that includes availability of epidural anesthesia 24/7," he said.

In response to the alleged cash payment, Rodriguez said he has spoken to Guam Police Department Chief Fred Bordallo and requested an investigation. The hospital administration also has launched an investigation, but didn't confirm whether authorities were alerted to the incident.

For the time being, investigations should be conducted by "the appropriate law enforcement authorities" and not through a legislative oversight hearing, Rodriguez said.

He said he has scheduled a regular quarterly oversight hearing of GMH later this month.

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