​*****UPDATE: Click here to read the November 2012 ruling from the Florida Board of Medicine determination that "probable cause did not exist"*****

It's been said that lies require more lies to support them, while the truth can stand alone. But because the perception of "truth" often depends on who is telling it, "logic" is a useful tool in deciding whether a story is reasonable. Discover a few holes in the "logic," and soon the whole fabric of credibility starts to shred.

The Notice of Adverse Recommendation is a good place to start, as it contains the basis for the hospital's decision to not reinstate Dr. Dinsmore, including:

• Informed consent not being obtained for cesarean-section deliveries (even though not mentioned in any previous correspondance)
  • The Consent to Obstetrical Surgical/Diagnostic/Therapeutic Procedure form used by HEMH clearly includes the possibility of cesarean section
  • This form is a standard part of every obstetric admission as required by the Medical Staff Rules (Item G) and is required before every cesarean section(Item H)
  • This form is referenced at the very beginning of the Preprocedure Verification Process protocol required for every invasive procedure
  • The Medical Staff Rules require a surgery to be cancelled if prior consent is not documented, except in emergencies (Item A-2)
  • Is it then reasonable to believe that cesarean sections were really allowed to proceed without prior consent?
• Informed consent not being obtained for VBACs
  • Minutes from the OB/GYN committee meetings show that there was no actual VBAC consent form or criteria until after July 11, 2011 at the very earliest
  • It is well-known that Dr. Dinsmore conducts extensive counseling with any patient inquiring about a VBAC, and requires written consent that could easily be retained with the prenatal records, if the hospital wanted to
  • There are blank spaces for "other information"on the Consent to Obstetrical Surgical/Diagnostic/Therapeutic Procedure form that could be utilized for VBACs if desired until a more formal protocol was developed
  • Is it then reasonable to believe the hospital felt any real sense of urgency about VBAC consents, as is now being implied?
    
    
• "Because of this lack of (physician's) documentation, there is no insight into why... who... timing... or the involvement... of the physician in the decision-making process"
  • Nursing staff enter the vast majority of information into patient charts at specific mandated intervals, in addition to recording notable events
  • If a physician gives verbal orders to nursing staff, hospital rules require them to record who gave them the orders
  • Nursing staff are required to document each time a telephone conversation is held about a patient with a physician, or if they are unable to reach the physician
  • Other outside OB/GYN's were quite capable of following the decision-making process, utilizing exactly the same sets of records
  • Is it reasonable to believe that physician involvement can't be determined? Or that the nursing staff are really left to make major decisions about patients in labor?
• "By your own admission, your documentation was deficient and in violation of ...Rules and Regulations"
  • Dr. Dinsmore consistently reiterated in her written rebuttal of October 3, 2011 that her records "...satisfy AHCA and JHACO... requirements along with those set forth in the ...Rules and Regulations
  • Dr. Dinsmore indicates in two of the cases that additional documentation may have been helpful to others reviewing the cases, but this is hardly admission of wrongdoing
  • Other outside OB/GYN's weighed in supporting Dr. Dinsmore's assertion that she met the documentation requirements
  • No transcript was made of the hearing of October 3, 2011
  • Is it then really reasonable to believe that Dr. Dinsmore verbally recanted her written statement during that hearing?
• "While due consideration is given to Dr. Dinsmore's statements... the Credentials Committee concurs with the expert reviewers..."
  • Dr. Dinsmore provided ample references about ACOG guidelines and other recommendations that clearly refuted their outside reviewer's criticisms
  • Other outside OB/GYN's substantiated the validity of those guildelines presented by Dr. Dinsmore
  • Is it reasonable to believe that any consideration was given to her statements? Or that the hospital can really utilize anything other than current standards?
• Notice what's not in this letter - the vast majority of criticism is about documentation, not actual patient care or outcomes.
  • If any less-drastic corrective measures had ever been attempted previously, that would have been included in every correspondance with her.
  • Is it reasonable to believe that no one in authority ever looked at Dr. Dinsmore's documentation habits for any of the several hundred deliveries she attended during her entire one-year "provisionary privilege" term?
  • Is it reasonable to believe that if there had been such concerning problems, that no one advised any corrective measures at any previous time?
  • Is it then reasonable to believe that these "documentation problems" were actually as concerning as they are now being portrayed?

The "logical" answer to these questions is "No - it is not believable," and it requires no medical education to reach that conclusion. Which leads to the next question: If this one document contains so many unbelievable things, what does this say about the rest of the things being said against Dr. Dinsmore?