WOMEN & HEALTH

State and Federal Federal Legislation

The following four articles are reprinted from "Women's Information Center Status Report", Columbus, Ohio. "

STATE LEGISLATION ON HEALTH CARE

The controversy of a woman's right to make decisions about her own body (i.e., sterilization, home birth, abortion) has been highlighted, but the problem of inaccessible health care is often overlooked.. Many women cannot afford adequate health care and/or health insurance coverage. This limits their choices for gynecological care and family planning help in whether or not to bear children. While an Ohio insurance company must offer discriminatory coverage, an employer may select a discriminatory health care policy, and supplemental individual policies may be too costly. More comprehensive health coverage may be provided for male needs (vasectomy, prostate problems) than for female needs (gynecological-obstetrical care, sterilization).

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Ohio Senate Bill 202, sponsored by Sen. Valiquette, includes stipulations for hospital patients' rights, including the right to privacy, the right to treatment regardless of economic status or source of payment, and the right to ownership of patient records. This bill is under consideration in the House Judiciary Committee.

House Bill 1027 would provide that health insurance coverage be made available to divorced and former spouses previously covered under an individual policy or contract of insurance. This bill is assigned to the House Insurance, Utilities, and Financial Institutions Committee. A new informed consent law became effective in November of 1977. Now, patients must be informed in writing of reasonable risks associated with the medical treatment or surgery they are to undergo.

A State Task Force for Women in Treatment in Drug Abuse was founded to propose treatment and services to meet the unique needs of female drug abusers. For information, write Marsha Brown, State Planning Coordinator, Bureau of Drug Abuse, State Office Tower, 13th Floor, Room 1352, Columbus, Ohio 43215.

HOME BIRTH RESTRICTIONS IN OHIO

Ohio law does not require a woman to give birth in a hospital. If a woman decides to have her baby, at home, the only health professionals who can legally assist in the birth are a physician or certified nurse midwife. However, finding a willing and qualified birth attendant is difficult in Ohio. Some obstetricalgynecological professional groups have discouraged their members from attending home births and providing prenatal care to mothers planning home births. Some hospital administrators have denied these physicians the right to admit their patients in local hospitals.

Midwives face limitations on types of birth assistance they may provide. To become licensed, certified nurse midwives must receive training which is available only outside of Ohio. Once licensed, they must find a physician willing to act as their supervisor and sponsor. Unless in an emergency, licensed audwives may not use instruments, treat abnormal conditions of pregnancy, or perform abnormal types of deliveries. They may perform episiotomies and cut umbilical cords, but they may not perform other types of surgery. Licensed midwives are few in number, and the risk of not having back-up hospital and physician assistance results in a curtailment of a woman's choice in childbirth.

While some physicians state that home births create unnecessary risks for the mother and child, health care critics claim that the reductions of income due to home births and the lowering birth rate has

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resulted in peer pressure being applied to physicians supporting home birth. These critics feel that specialists want only specialists to deliver babies. For more information about home births and pregnant women's rights, send $.80 in check or postage to:

CHOICE

Woodward Park Medical Center

1300 Morse Road

Columbus, Ohio 43224

FEDERAL LEGISLATION DER

S.940 would provide for coverage under Medicare for routine tests for the diagnosis of uterine cancer. This bill is under consideration in the Senate Finance Committee.

S.2755 (HR.11611) would increase incentives for the development of new drugs and would protect the public from the distribution of unsafe and ineffective drugs. Populations targeted for surveillance and protection include women and the elderly. The Senate version is under consideration in the Senate Human Resources Committee, and the House version is being reviewed in the House Interstate and Foreign Commerce Committee.

S.2910 (HR.12146) would establish a program for developing networks of community based services to prevent initial and repeat pregnancies among adolescents and to provide care to pregnant adolescents. The Senate version is assigned to the Senate Human Resources Committee, and the House version is under consideration in the House Interstate and Foreign Affairs Committee.

HR.8459 would amend Title XIX of the Social Security Act to require states to reimburse health facilities on a pre-established all-inclusive rate for comprehensive routine maternity services provided by nurse-midwives. This bill is under consideration in the House Interstate and Foreign Commerce Committee.

MEDICAL MALPRACTICE

Black's Law Dictionary defines malpractice as "...any professional misconduct, unreasonble lack of skill or infidelity in professional or fiduciary duties, evil practice, or illegal or immoral conduct." Medical malpractice may occur through a doctor's negligence, poor diagnosis of a situation, or through a lust for money. Medical specialists usually use selfreferral in scheduling surgery, and they exercise much freedom in determining the type of surgery necessary. This differs from general practitioners who tend to confer with a specialist regarding a potential surgery. Unfortunately, women are exposed to malpractice due to their dependence on gynecologists and obstetricians. These specialists are

Our Bodies Ourselves

feeling the financial pinch of the lowering birth rate. Some critics fear that some physicians elect to do lucrative surgery rather than the simpler form of surgery to compensate for the slackened business. It

is also feared that drastic forms of surgery are sometimes used as a training ground for new doctors. Possible types of malpractice include:

-hysterectomy performed instead of tubal ligation, as a form of sterilization.

-unnecessary Caesarean section performed as an alternative to natural childbirth.

-questionable surgical removal of a breast as a treatment of a very small cancerous lump.

-poor regulations regarding informed consent which resulted in requesting a woman's consent to sterilization which she was in labor,

How can women avoid being victims of malpractice? Consult with more than one doctor before consenting to surgery. Be fully informed of other treatment alternatives and their side effects.

Ohio law requires that claims for medical malpractice be filed within one year of the act which caused the injury. (An additional 180 days are provided in which to file an action if the physician is notified within the one-year statute of the pending action.) Courts have interpreted this law to mean one year from the time at which the physician-patient relationship terminates or, in limited instances of a foreign object being negligently left in the patient's body during surgery, to one year from the discovery of the object. The statute places an absolute limit of four years upon the filing of such an action except that a minor under ten shall have until her/his 14th birthday to file such an action.

Pill Linked to Skin Cancer

New York (LNS)-Another "side effect" can be added to the already lengthy list of warnings about the birth control pill; this time it's fatal skin cancer.

According to a December 1977 study recently made public, women who use birth control pills for more than four years face almost twice the risk of developing malignant melanoma, or skin cancer, than non-pill or short-term users.

The study, which monitored 17,942 patients on the Kaiser health plan in Walnut Creek, California, is among the largest and longest ever conducted on the effects of the pill. It found a 79 percent rise in the incidence of melanoma among women in the San Francisco Bay Area from 1970-1975. Half of those cases occurred in women of child-bearing age.

As early as 1968, a psychiatrist at the Metropolitan State Hospital in Los Angeles theorized that the pill might cause melanoma. Even though the Kaiser study was begun at the same time, women were not warned of any suspected dangers. In fact, doctors lauded the pill for its dermatological value, claiming it helped clear up skin disorders like acne.

Pill-related melanoma is thought to occur when progesterone and estrogen, two hormones used in the pill, stimulate the over-production of skin cells. According to the authors of the study, the pill possibly increases sensitivity to the sun's rays, thereby increasing the probability of skin cancer.

Despite the latest evidence about skin cancer and other proven links between use of the birth control pill and increased incidence of gall bladder diseases, cervical cancer and circulatory diseases, many women are still encouraged to take the pill over other means of birth control. Some doctors have even recommended that women use it to regulate their menstrual cycle.

Head of the California Tumor Registry at Berkeley, Dr. Donald Austin attempted to provide a "scientific" explanation for the relationship between skin cancer and the pill. "It might be a false alarm.' There's a good possibility that women on the pill may have more sun exposure than women not on the pill. We know that women who choose the pill are different from other women in other ways."