Sunday, August 23, 2009

Another Dr. Wonderful needs your help!

Just a few weeks after I posted about litigation and the obstetric mindset, I heard that a wonderful obstetrician, Dr. Stuart Fischbein, is being threatened with disciplinary action by his hospital "for violating hospital policies." The hospital has already suspended the privileges of the two CNMs he works with, and now he faces a possible loss of his livelihood.

His crime? Supporting women's right to informed consent and to having a say about happens to their bodies. In the past few months, he attended 3 VBACs and 3 vaginal breech births, all successful and with healthy outcomes.

Dr. Fischbein is a vocal supporter of midwifery and home birth. His collaborative midwife practice had a primary c-section rate last year of only 5% (compared to his colleagues' primary CS rate of 20%) and an overall rate of 12% (including repeat CS), compared to his colleagues' 29%.

To learn more about Dr. Fischbein's case and how to lend your support, please visit his blog and his website. He has been forced to start a legal defense fund in order to defend his right to continue practicing obstetrics.

So what can you do to help?

1. Contribute to Dr. Fischbein's Legal Aid Fund. Make Paypal Payment to or mail a check payable to Alan J. Sedley, Attorney at Law to: 1234C Westlake Blvd., Westlake Village, CA 91361
2. Write a Letter to: Mr. Michael T. Murray, President, St. John's Regional Medical Center, 1600 Rose Avenue, Oxnard, CA, 93030 and copy to: angelfischs at
3. File a complaint with the Joint Commission.
4. Spread the word. Blog, tweet, link, email. Share the button on my sidebar. Flood his hospital with letters.
5. Buy a Second Womb Sling. I will contribute $5 to his Legal Aid Fund for every sling purchased from now until the end of this year.

Below is a summary of Dr. Fischbein's situation. Visit his blog regularly for updates about his ongoing battle to keep his hospital privileges and to offer women vital choices such as VBAC and vaginal breech birth.
I am an obstetrician who collaborates with midwives and believes strongly in the midwifery model of obstetrics and the right of a woman to true informed consent and refusal in the birth process. The hospitals I work at have a malicious attitude towards me and those things I believe in. They have created policies that seem to violate basic human rights, patient autonomy, possibly EMTALA and may very well be illegal. They do not seem to care that these policies violate their own mission statement, as well. Policies such as "banning" VBAC are becoming pervasive. They also have a policy denying a laboring woman an epidural who chooses to violate that policy as well as one that says a woman transferred from a home birth no matter what the reason for transfer must not go to one of the two sister hospitals. This is just the tip of the iceberg of the extent to which the hospital committees, administrators and their lawyer have gone. Their malice and pettiness now threatens my privileges for allowing 3 women this year the informed choice of refusing a repeat c/section, 3 more for having a breech delivery and for allowing a woman to choose what hospital she feels most comfortable at. They have suspended the privileges of my 2 CNMs for the pettiness of reasons and when I was able to refute that one they came up with something else. Clearly we believe this is a combination of a witch-hunt against midwifery, personal animosity towards me and what I believe and, most significantly, an assault on a woman's right to self determination, likely for economics, expediency and litigation mitigation and not for their standard line "patient safety." Feel free to ask me about that one.

This country now performs c/sections on nearly 1/3 of all pregnant women. Major surgery that carries significant short and long term risks to them and their babies of which they are rarely informed. VBAC is successful over 73% of the time and carries less morbidity that repeat c/section but all these women are told is that if they try a VBAC they could rupture their uterus and their baby could die. Thus skewing them into a choice the doctor or hospital wants them to make. Easier on the doctor, more money for the hospital. Using the midwifery model last year my collaborative midwife practice had a primary c/section rate of 5% compared with 20% for the rest of the doctors at this hospital that only does low risk OB. (Overall rate 12% vs. 29% includes repeat c/sections). All 6 of my VBAC and Breech deliveries this year went well with great outcomes, bonding and patient satisfaction. These six women would all have had c/sections against their desire if I was not in the community. Now the doctors on the OB committee, the anesthesiologists and the hospital administration are going full bore to eliminate us from that community. I would not doubt that this sort of bullying goes on under the radar in numerous communities around the country and pregnant women are the real victims.

In order to defend myself and my support of women's informed birth choices against the actions of the Hospital, I have had to retain legal counsel. I find myself in a situation I had never imagined I would be in, where I must ask for financial help for my legal defense. Please consider contributing to my legal defense fund via PayPal.


  1. Rixa,

    You and your readers should be aware that Dr. Fischbein is already on probation for sexual exploitation of a patient.

    Ventura County Star:

    "A Camarillo obstetrician-gynecologist who had sex with a patient was sentenced Monday to seven years of professional probation and restrictions on his practice by the state Medical Board.

    Dr. Stuart Fischbein was disciplined for having consensual sex with a Camarillo woman 12 days after performing surgery on her in 2005. The 50-year-old doctor, who has offices in Century City and The Woman's Place for Health and Midwifery Care in Camarillo, was also convicted in Los Angeles Superior Court last year after pleading no contest to a misdemeanor charge of sexual exploitation involving the same patient.

    The Medical Board filed accusations against Fischbein last year. After a hearing in Los Angeles, Administrative Law Judge Samuel D. Reyes recommended in February the board revoke Fischbein's license, but set aside the decision in favor of placing the doctor on five years' probation."

    I don't know what is going on in the current disciplinary action against him, but you should check to be sure that it is not related to the previous findings of sexual impropriety.

  2. Whew, I can breathe a sigh of relief now that I know Amy is looking out for us.

    Amy is referring to that old law on the books out in California that says you’re guilty until proven innocent. They do everything differently out there.

    We’ve all read this old article. I have an idea. Rather than being cowardly in your backhanded accusations that Dr. Fischbein is going to use legal fund donations for something other than he says he is, why don’t you go leave your concerns on HIS blog? Go get ‘em, Super Sleuth! Find out what's really going on and report back.

    Otherwise, it looks like you're trying to smear a fellow doctor. You wouldn't want that, would you?

  3. Donation sent. I hope he is able to fight it successfully.

  4. i wanna file a complaint but don't know how. any info on how to do that? thanks.

  5. Hey, I really don't like this name calling Becky. Let's remain civil please.

    I don't know if this old case is at all involved with the VBAC/breech issue. I imagine not but can't offer any commentary because I just don't know at this point.

  6. Unfortunately, we can't know the basis of the hospital action because they are bound by strict confidentiality. It could be exactly as Dr. Fischbein states, since violating hospital policy repeatedly is certainly grounds for revoking privileges. However, it is possible that there is more to the story and there is no way to know for sure.

    If Dr. Fischbein did violate hospital policy, the hospital really has no choice. Policies about VBAC and breech protect the hospital and its employees from legal action.

    If the hospital has determined that it cannot or will not meet the ACOG recommended guidelines for safe VBAC, they can't have individual practitioners violating the policy. That exposes the hospital and the other nurses and doctors to legal liability.

    There is no question that both VBAC and breech vaginal delivery pose additional risks. In the case of a bad outcome, everyone gets sued, not just the obstetrician, but also the nurses. So Dr. Fischbein is putting nurses at risk, nurses who may not wish to undertake those risks.

    If Dr. Fischbein doesn't like the hospital policy, he can move his practice to another hospital. In addition, he can fight to change the rules. However, violating hospital policy is not a noble enterprise when it involves other medical professionals who don't want to undertake the risk.

  7. One thing that is conspicuously absent in most conversations about reforming health care is tort reform that would limit the liability of the various players involved. I remember seeing one story years ago (20/20 or Dateline NBC or something) in which a doctor was sued merely because he was in the hospital at the time, although I don't think he had even seen the patient. It took the lawyer two seconds to add his name to the lawsuit, but the doctor had to spend a lot of time and money proving his innocence.


  8. "Unfortunately, we can't know the basis of the hospital action because they are bound by strict confidentiality."

    Amy, you can ask HIM. There is more than one way to gather evidence. You can go ask directly and report back.

    There is nothing noble in expressing fake concern, either. Thought I'd point that out. It's cheesy.

    Sorry for the "super sleuth" comment, Rixa.

  9. You are a wonderful Doctor, Iff all were like you we would have such a better Maternal Health care system in this country!..

  10. I would welcome a dialogue with Dr. Tuteur. Her position about the fears of other professionals being sued has been raised as an argument for not allowing VBACs and Breeches. However, skewing informed consent and denying patients their rights of self determination do not justify the means. Our responsibility to our patients supercede the medico-legal anxieties of colleagues based on anecdotal stories and in defiance of evidenced based medicine. We must maintain the principals of a higher calling. Dr T. suggests attempting to work within the system to change hospital policies. That we are doing but the administrative process is long and tedious and met with much cost and resistance by those benefitting from the status quo. I would remind Dr Tuteur that it may be semantics but in actuality, I am not violating the hospital policy, the patient choose to. I am simply upholding my ethical obligation to let them know their options. And since we can all agree that the American tort system is at the root of so many problems we face as health care providers, maybe we can join together and speak as one loud voice for reform that will really benefit our patients. As for past errors in judgement, we all make them, hopefully learn from them and then move on. All the parties involved with the previous allegations have done so. Hopefully, for the benefit of our patients, you can, too. For it is about them and not for me that I speak out. Dr. Tuteur, you may not agree with my position but you should defend the rights of women to have all the information needed for them to make an informed choice. Sincerely, Stuart J. Fischbein, MD FACOG

  11. Dr. Fischbein,

    I would welcome the opportunity to discuss or debate any aspect of the current situation. I would disagree, though, on your contention that it is acceptable to violate hospital policy and acceeptable to force nurses and other hospital personnel to undertake liability risks that they have not chosen to undertake themselves.

    On the nature of mistakes, I'm afraid we're also going to have to agree to disagree. In all honesty, I do not consider sexual exploitation of a patient by a gynecologist to be a simple "mistake." It is a very serious violation of trust and an egregious breach of professional conduct.

    I also take a dim view of soliciting money from patients and supporters for a legal defense when those patients and supporters have no way of knowing what the actual charges are. It seems only reasonable that if you are asking for money from individuals that you should waive the hospital's mandated confidentiality, so that they can tell their side of the story.

    I am a strong proponent of VBAC and I strongly disagree with ACOG's recommendations. And I can certainly understand principled opposition when it only involves yourself. I cannot support opposition that involves the hospital, nurses and anesthesiologists in that opposition without their express consent.

  12. "I also take a dim view of soliciting money from patients and supporters for a legal defense when those patients and supporters have no way of knowing what the actual charges are. It seems only reasonable that if you are asking for money from individuals that you should waive the hospital's mandated confidentiality, so that they can tell their side of the story."
    SOOO perfectly put. It just sounds WAY too fishy to me that the only information is coming from this doctor's blog. I find it troubling that Stand and Deliver, a blog I respect and enjoy reading, is advertising collecting money for a doctor where little is known about the allegations (except from the person asking for money). Come on!! There are so many other good causes!!

  13. As a mom active in the VBAC community in SO Cal, I know that Dr. Fischbein is a great support for VBAC moms here and is a care provider that truly believes in informed consent and letting moms choose what is best for them. I wish all care providers were like that.

  14. Wow, I am reeling over seeing this on your blog today! I am a long time reader, first time commenter, because this hits close to home-- Dr. Fischbein was my backup OB for my home birth in March, and did my ultrasound. He was so supportive and encouraging, I had such peace of mind knowing that he'd be there in case of hospital transfer. It scares me to think what would happen to my ability to home birth if he couldn't provide the backup for my midwife (I believe it's a requirement for Licensed Midwives here in California?). I think he's the only doctor in the area that will cooperate with the home birth midwives. Not to mention if I ever needed VBAC or breech birth. Anyway... wow, what a shame this has to be an issue. I will definitely be supporting this cause, as it directly affects me and my friends!

  15. Hi all,

    Just weighing in here, but am so pleased to hear that there are docs out there doing VBAC and vaginal breech. Perhaps California could learn from Canada's new policies on Breech. Now it is just a matter of bringing the skills back, which we are trying to do. I will send of my donation and maybe Dr. Fischbein will be 'free' to share his experience supporting vaginal breech at the 2nd International Breech Conference in Ottawa, Ontario Canada,this October.

  16. I have worked in the Los Angeles birthing community for several years. For many women he was the only doc in the area who supported their informed decision to have vaginal birth (breech babies and VBACs). He saved many women from unwanted and unnecessary surgery and the risks and life long scars and wounds (physical and emotional) that can come with it.

    Amy, the ACOG practice bulletin (link below) clearly states as a level A recommendation (based on good and consistent scientific evidence) that most women with one prior C-section are good candidates for VBAC and should be counseled on VBAC AND OFFERED A TRIAL OF LABOR. That is exactly what Dr. Fischbein does.

    It also recommends (level A) that Epidural Anesthesia may be used with VBAC. In addition to punishing Dr. Fischbein for following through with his patients informed choices, they also have a policy punishing the women attempting VBAC by denying them an epidural.

    The level C recommendation (based on opinion only, not scientific evidence) that VBAC be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care comes together with another level C recommendation that after thorough counseling that weighs the individual benefits and risks of VBAC, THE ULTIMATE DECISION TO ATTEMPT THIS PROCEDURE OR UNDERGO REPEAT CESAREAN DELIVERY SHOULD BE MADE BY THE PATIENT AND HER PHYSICIAN.

    Again, that is exactly what Dr. Fischbein does.

    If you are going to make your decisions based on who is most likely to get sued then we should have every women who had an unnecessary c-section sue their hospital, doctor and nurse. Then insurance companies will push for more vaginal birth. At the end of the day, it isn't insurance companies who should be making these very personal decisions for women. Moreover, since I know you are a big fan of homebirth...many cities in which hospitals have ALL banned VBAC are forcing women to choose repeat cesarean or HBAC.

    Finally, your parade of personal attacks and spin make it seem like you have ulterior motive. Especially when Dr. Fischbein made it very clear that he was willing to talk directly and answer the questions that you may have.

    Here is the link to the ACOG practice bulletin on VBAC.

    Yours in Health,


  17. "We’ve all read this old article."

    Actually, when I posted the information about his court case, conviction, ADMISSION OF GUILT, and probation to other midwife blogs, most seemed surprised that they had not been informed of this.

    I think that this man is taking advantage of women who just want a good, low-intervention birth. He's not mentioning that he has had past sexual relationships with patients-- which he admitted in court-- or that he seems to enjoy exploiting the women he's pretending to empower.

    Ultimately, I think the real issue here is not that he is a supporter of natural birth-- that's good. But the issue is that he's not mentioning that he's still on probation for sexual exploitation of patients-- something that is directly contrary to being a supporter of women. You cannot be a fabulous, empowering doctor and sexually exploit your patients. You cannot.

    Do we even know for sure that this has to do with VBACs and natural birth? Maybe this is just an investigation of another sexually-based complaint by a patient.

  18. I had not read anything negative about Dr. Fischbein until Dr. Amy mentioned it. It surprised and disappointed me. I do think that character counts. However, I also know that no one is perfect. All I know of the case is the link Dr. Amy put on this page and a similar link Basiorana put on another blog's comment section. All they say is that the doctor admitted to one inappropriate doctor-patient affair. That's one too many, but it is just one -- perhaps forgivable as a "moment of weakness." Nowhere did anyone say that it was multiple women; nowhere was there even an implication that it was more than one. Is there any credible link you can give that substantiates your claims?

    Also, as the articles reported, Dr. Fischbein had to be chaperoned when around patients, which would substantially reduce or even eliminate any possibility of continued sexual misconduct with patients. As Dr. Amy says, you have to play by the hospital's rules in order to practice in the hospital -- why should we think it anything else?


  19. Honestly, I cannot fathom how homebirth advocates can support an obstetrician who has acknowledged sexually exploiting a patient. It is an egregious violation of professional conduct.

    The facts of the case are very disturbing. According to a second article in the Ventura County Star, which felt that the punishment of supervision was far too mild for the crime:

    "His patient, identified in Medical Board records as S.K., was 14 years younger than he and earning her doctorate degree in psychology. She came to Fischbein's office in Century City with her fiancee. They wanted to have a baby.

    ... He performed surgery ... to remove a mass in her uterus and called her "sweet pea" in the recovery room. He sat at her bedside for long intimate talks, testifying in a hearing he viewed her as not just a patient, but as a woman...

    S.K. said Fischbein told her he would be a better father than her fiancee. He persuaded her to leave him.

    They talked about the ethics of doctor-patient relationships. She said he told her he dated "bushels" of patients. Fischbein denied the comment or any other relationship with a patient.

    She said he advised her not to have sex for four to six weeks after surgery. Fischbein said in court he didn't remember the discussion.

    Five days after she was released from the hospital and eight days after surgery, he called and asked to visit her at her home in Los Angeles. They had sex then and again two days later at Fischbein's home.

    He testified it was consensual. She said she viewed him as a doctor who had performed a surgery that was going to enable her to have a baby. He had become a hero who seemed almost "godlike." And he was interested in her.

    "I would have done anything he would have told me to do," said the woman, who is suing Fischbein. "I look back with my hindsight and with my mind today and say, How could I have done this?'"

    Homebirth advocates have every right to forgive Dr. Fischbein for sexual exploitation. But is homebirth so important that any doctor who supports it, even one who has acknowledged sexually exploiting a patient, is worthy of the designation "Dr. Wonderful?"

  20. Politics make strange bedfellows, eh? How many liberals and Democrats remained ardent Clinton supporters even after the Lewinsky scandal broke?


  21. Hospital policies do not supercede patient rights. Such policies should be challenged and ignored at every opportunity. Politely waiting around until the hospital gets sued enough that they decide to actually abide by the law only causes more women to be taken advantage of. If a woman is informed & chooses a "procedure" the hospital doesn't want her to have, tough for them, especially if her choice involves protecting her bodily integrity & avoiding unnecessary surgery.

  22. Lisa--
    Agreed with you, 100%. Especially when "violating" a hospital policy is something that is legally protected, not to mention part of every hospital's patient's bill of rights (right to informed consent and refusal).

    Regarding the controversy about the consensual sex issue: I see it as irrelevant to the issue at hand. Dr. F's regrettable mistake in the past is being used as classic ad hominem and red herring arguments. It's a way of distracting people away from the real issue at hand (women's right to choose VBAC or vaginal breech birth, and physician's right to support them in those choices) by attacking Dr. F's character.

    In other words, no matter his indiscretions in the past, I would hate to see the Los Angeles area lose a VBAC- and breech-friendly physician. They are more and more a rarity.

    For those of you who weren't paying attention in your rhetoric class, Wikipedia comes to the rescue:

    An ad hominem argument, also known as argumentum ad hominem (Latin: "argument to the person" or "argument against the person") consists of replying to an argument or factual claim by attacking or appealing to a characteristic or belief of the person making the argument or claim, rather than by addressing the substance of the argument, the content of the discussion or producing any evidence against the claim.

    The process of proving or disproving the claim is thereby subverted, and the argumentum ad hominem works to change the subject to a personal attack.

    Red herring:
    Similar to ignoratio elenchi, a red herring is an argument, given in reply, that does not address the original issue. Critically, a red herring is a deliberate attempt to change the subject or divert the argument.

    This is known formally in the English vocabulary as a digression which is usually denoted as "red herring".

  23. yup. classic classic Amy tactics. She's mastered the art. Actually, her posts could/should be used as teaching material on the fine art of red herrings.

  24. I just want to say one thing about this debate - I think it is really sad that insurance companies are participating in setting the terms here on what women can and can't do in relation to their births.

    If insurance companies were unable to refuse to cover procedures such as VBAC or breech deliveries in hospital policies, or even unable to hike up premiums beyond reasonable levels, perhaps hospital management wouldn't be so frightened of being sued.

    Law reform is also necessary here as another commentor has already pointed out. Certain provisions exist to protect "good samaritans" from being sued if they help a person in need - why can't the same legal protection be extended to doctors who deliver babies? This can be set in motion by governments and can bind courts from the moment the law is signed.

  25. The patient exploited by Fischbein causing him to be placed on probation was not his only victim. I was a victim too. I am pretty sure there are a lot more of us out there.

  26. It has been 4 years and so far there doesn't seem to be a horde of women coming out for a lawsuit for sexual abuse by Dr. Fischbein. It is regrettable that Dr. Fischbein made a huge error in judgement by having sex with a patient in 2005. Still, as Rixa points out, you can't write off a doctor who is so important to a large group of parents who want natural birth, home birth, breech and vbac support because he made one mistake in the past.

    I would also argue that some ob-gyns who have not had any inappropriate sexual relationships with patients can also be considered abusive by belittling and bullying patients, and performing unnecessary procedures. Of course, there is little legal recourse for this kind of abuse, because it is all deemed "for the good of mother and baby".

    Dr. Tuteur, it is great that you verbally support VBAC, but in reality you don't do anything constructive about VBAC since you are not a practicing ob-gyn and don't seem to be contributing in any professional spheres related to birth advocacy issues. As far as I can see, your "professional" interests are confined to discrediting natural birth, home birth, and midwifery. You will likely find that women are more interested in hearing from and dealing with MD's who are practicing and are on the front lines for change for birth issues.

  27. Hmm, so I suppose anything is acceptable as long as it's for The Cause, for The Good of Birth. Nice to know it's so easy to throw one's principles out the window in in blind defense of someone who we'd find morally reprehensible if they weren't soapboxing for The Cause.

    I wonder if anyone of you would so quick to dismiss a really pro C Section doctor having sex with his patients.

  28. Dr Amy said "I cannot support opposition that involves the hospital, nurses and anesthesiologists in that opposition without their express consent."

    Interesting. Dr Amy cannot support opposition that inconveniences hospital personnel, but at the same time she supports hospital policies that not only inconvenience mothers and babies, but put them at higher risk of morbidity and death. Hmmmmm, what happened to Hippocratic oath and first do no harm???

    Anonymouos said, "I just want to say one thing about this debate - I think it is really sad that insurance companies are participating in setting the terms here on what women can and can't do in relation to their births."

    True dat Anonymous. If insurance companies were saying that women could not have c/secs or epidurals, you can bet the whole country would be up in arms. Remember the "drive by births" scandals of the early 90s?

  29. This is an old post, but I feel compelled to comment. I have seen women complain about this doctor on the mothering (dot) com forums repeatedly for inappropriate sexual behavior and comments. Some women do not report this, but over the years I've seen many women make similar complaints about this doctor. Each time, the moderators come in and ask people not to make any negative comments and scrub the threads; however, women have complained repeatedly in such threads. I understand the mothering website is concerned about liability if they allow those criticisms to stand, but it also allows someone who has admitted to a highly inappropriate, sexually exploitive relationship with a patient to continue to do so in a conspiracy of silence.

    In my opinion, what he did was inexcusable, and the facts that were presented in the case (including those he does not dispute) are very disturbing. I'm a natural birth supporter but I'm really an advocate of women's rights. A doctor who facilitates VBACs but is sexually inappropriate with patients is not, in my opinion, doing a net good, nor should he be allowed to continue to harm patients.

    We don't have all the facts, but clearly there is more to this situation than simple conflict over VBAC policy, and as supporters of a woman's right to make choices during the birth process and regarding her health, we should be very concerned about anyone who treats his patients with less than the utmost respect and dignity.

  30. @ Anonymous....let's start there...anonymous? This is what I hate about the internet...the anonymity allows people to say whatever they want irregardless of fact and with no consequences. I have been to these other sites and know that certain people have a vendetta against Dr. F and it is quite possible for the same person to sign in under various emails and user names and pose as several patients. Dr. F's real patients and colleagues respect him immensely. Five years ago, while going through a personal rough patch, the doctor made a terrible mistake. He is paying the price. I'd like to remind people that there is also something called forgiveness. Redemption. A doctor who has had a long, respected career and who is a phenomenal doctor who has saved many lives of women and babies over thirty plus years should not be judged by one bad decision in his personal life. As has been mentioned before, to lose him in this city would be a huge loss. There are hundreds of families that this man has helped and healed over the years. When this probation is over, everyone needs to let this go once and for all. And yes, he saved my life twice and my baby's life. He is the best doctor I have ever had in my life.


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