Charges for Epidural If Patient Goes for LSCS

Dr. Bachan Singh revealed that some concerns had been raised at the last Perinatal Subcommittee Meeting about the non-standard method of charging by various anaesthetists in the above situation.

To resolve the issue and also to avoid the problem whereby our charges are reduced to a C major consultation, Dr. Chan suggested, and the group agreed, that whenever a patient with an epidural performed for labour analgesia subsequently undergoes a Caesarean section, the anaesthetic charge for the performance of the epidural shall be changed to a 748 C (Initial Major Regional) charge.

Dr. Charlie Chan also reminded members that after discussion with Dr. Haris, it had been previously agreed that for epidurals performed at unsociable hours, the anaesthetists were free to include an additional charge of a major visit if they so desired.

Anaesthetic Leave Coverage

Dr. Chan pointed out that there was generally at least 2 anaesthetists without any lists at any one time. Therefore, he felt that should 1 anaesthetist were to go on leave, there should be no problem in covering the sessions so vacated. There was general agreement.

However, Dr. Anne Wong stressed that this could only be done with the cooperation of everyone. There should not be any complaints about the loss of the occasional free half-day and we must also chip in to help cover the extra calls if necessary. She also asked Dr. Bachan Singh to give adequate notice of at least 48 h whenever he needed anyone to cover his lists. Only if we could not cover in-house should be get a locum to cover us.

Emergency Cover Just Before 18:00 h

Dr. Robert Liew inquired whether a case scheduled for 17:45 should be done by the afternoon emergency anaesthetist or the on-call anaesthetist. He felt that long cases should preferably be done by the oncall anaesthetist.

As it would be difficult to make an all-encompassing definition as to what constitutes a long case, it was decided that the current practice would be continued.

1. All cases booked to be done before 18:00 h will be done by the afternoon emergency anaesthetist.

2. Cases booked for 18:00 h and later will be done by the oncall anaesthetist.

3. If a case booked for before 18:00 h is delayed, e.g. anaesthetist is ready but surgeon is late or doctors are all present but patient is delayed, the case should still be done by the afternoon emergency anaesthetist.

4. If a case initially booked for before 18:00 h is rescheduled for 18:00 h or later, the oncall anaesthetist will do the case.

5. The expected length or duration of the case will have no bearing on the anaesthetist who should be doing the case.

6. However, the afternoon emergency anaesthetist is free to ask the oncall anaesthetist to do a case for him if he so desires. Any such arrangement will be by mutual agreement of the parties involved.

Allocation of Released Lists

Dr. Anne Wong reiterated the plans for various anaesthetists. Dr. Tan Poh Hwa had planned to reduce his lists once Dr. Robert Liew was back to his full capacity while Dr. Bachan Singh had planned to give up more lists after the Chinese Seventh Month.

So far, Dr. Tan had given his alternate Wednesday morning emergency session to Dr. Alan Wong while Dr. Anne Wong had given her whole Wednesday afternoon emergency session to Dr. Alan Wong. Dr. Bachan Singh however retracted on his plans to give up his Friday lists.

Based on the decision we made at our meeting held on 28 April 1997 that "3. .... lists will be offered to the anaesthetists starting from the most senior member and then in order of seniority (based on their duration of service with the centre as active consultants) down to the most junior member", Dr. Robert Liew asked that the Wednesday afternoon emergency session be given to him as otherwise, he would have only 8.5 sessions. Dr. Anne Wong suggested that the list be split between Dr. Alan Wong and Dr. Robert Liew but Dato' Dr. Radha felt that the whole list should be given to Dr. Liew.

Dr. Tan suggested that he would also be probably giving up his alternate Monday morning Open list and his alternate Tuesday morning Thambyrajah/Ong C. S. list. He will be confirming this next week.

It was then decided that from October, Dr. Liew will be doing all the Wednesday afternoon emergency sessions and when Dr. Tan gave up his Monday morning and Tuesday morning sessions, Dr. Liew will take up what he could and then pass on half or all of the Wednesday afternoon emergency sessions to Dr. Alan Wong.