by Ken Quintanilla

Guam - Local gynecologist Dr. Thomas Shieh thinks it's unconscionable that women who are in labor are subjected to tremendous pain without the option of getting an epidural. In a letter to elected leaders and hospital management, Shieh says the Guam Memorial Hospital is failing expectant mothers and families.

More than 2,000 babies are born on Guam every year, of which Shieh delivers about 300 annually and says he's fed up that the accredited GMH isn't doing more to ease the pain of suffering expectant mothers. "Epidurals have got to be part of the services at GMH, there's no excuses for them not being able to offer those services," he said.

Dr. Shieh says in the 21st Century, it's unconscionable and inhumane for GMH not to provide epidurals to women who are in need of pain relief during labor. "It has to be an option for them. If you hear them screaming in pain for us to just sit there and to say, 'Sorry, we can just give you this to ease the pain', but when we know, that one of the most effective pain relief that there is today available to almost all the hospitals in the country, even rural hospitals in Hawaii."

Shieh says epidurals are the most common procedure done in obstetrics today and most hospitals in the United States use the procedure to generate revenue, noting, "Why is GMH not providing them when we have seven full-time anesthesiologists and they are paid for good over $300,000 a year. What we really need to do is shakedown GMH and make sure that they don't make women continue to suffer."

GMH medical director Dr. Larry Lizama says the hospital can provide epidurals but on a case by case basis when anesthesiologists are available. Officials are in the process of trying to find the most efficient way of providing the procedure with the resources they have. "The issue is what processes can we create so when we provide it on a case by case it is not disruptive to the rest of the hospital's mission and obligations to provide care to the other specialties that depend on for instance, other anesthesia service," he said.

GMH currently has seven full-time anesthesiologists who provide services for the Surgery Department, trauma cases, the emergency room, and obstetrics. "Our anesthesia services at this point is not a dedicated obstetrical service but if we did have that it would basically allow for an epidural service to be available anytime 24/7," he said.

Lizama says the hospital has acquired infusion pumps that would ensure the safe delivery of an epidural but the staff still need to be trained on the equipment which is being coordinated with the vendor.

The bottom line though - he says it all boils down to not having enough anesthesiologists. "Is seven anesthesiologists adequate for this population of patients to have a dedicated obstetrics service? I don't know the answer to that but I would suspect that it's not because of all the responsibility of serving the community of patients that come in for non-obstetrical care, seven is not going to do it," he said.

Lizama says another anesthesiologist will be leaving in the next couple of months leaving the hospital even more short staffed. Shieh meanwhile contends that the lack of resources is hardly a good excuse for not easing pain.

That the hospital was performing intrathecal procedures before to administer pain medication for women in labor but they have since stopped because of various complications.