Board Calls for VBAC Doc's Suspension
One of Florida’s most experienced OB-GYNs was “grossly negligent” in attempting a vaginal delivery in a risky case that ended in a stillbirth, the Florida Board of Medicine said Friday.
Meeting in Palm Beach Gardens, the board told Dr. SimionTsinker of Hallandale Beach that he should not have attempted a vaginal delivery in a breech case when the mother had another risk: She had previously had a cesarean section.
The board rejected the state Department of Health’s proposed settlement, which would not have interfered with Tsinker’s practice. Instead members voted unanimously to seek suspension of Tsinker’s license pending evaluation of his practice by safety specialists.
If Tsinker rejects the board’s offer, as expected, he would have to defend himself at a formal administrative hearing – a lengthy and expensive process akin to a trial. He will have seven days to notify the state of his decision after he receives formal notice in the mail.
Tsinker, 67, said the board’s vote will force him from practice after delivery of 12,000 babies.
“Who are we kidding?” he said. “That means my retirement.”
If that’s so, South Florida will lose one of the few OBs who perform vaginal birth after a previous cesarean section, or VBAC. It may be left with no OBs who deliver breech babies via the birth canal, which Tsinker says he has done in 350 cases.
Authorities in the field of obstetrics say it is permissible, although not recommended, to perform vaginal birth for “frank breech” presentation, in which the infant has entered the birth canal buttocks-first instead of head-first. It is not considered safe to attempt vaginal birth for “footling” breeches, in which the presentation is foot-first.
There are few OBs who allow patients to attempt vaginal delivery after a previous cesarean, or VBAC, because of rare, life-threatening complications. It’s even more difficult to find a physician willing to perform a vaginal delivery for a breech.
Thus Tsinker’s name has been shared along the natural-birth grapevine. One woman who wrote on Vitals.com said Tsinker was the only doctor in all of South Florida who would give her a natural delivery for her son, a breech. She called him “a hero.”
But Dr. James Orr of Fort Myers, an OB-GYN and current chairman of the Florida Board of Medicine, said it was reckless for Tsinker to attempt vaginal delivery in a case that presented both breech and VBAC risks.
“It was grossly negligent,” Orr said. “I’m also appalled that this physician is trying to blame the patient.”
Tsinker said the patient, identified in the record only by her initials DG, did not push when he told her to do so. Instead, he said, she disconnected the fetal monitor and went to the bathroom for half an hour. He went to the doctors’ call room and by the time the nurse called him back in, the baby boy was probably already dead, Tsinker said.
Orr said that was beside the point, since Tsinker should have done a C-section as soon as the patient arrived at Broward General Hospital.
Dr. Steven Rosenberg of West Palm Beach, the board vice chairman, said Tsinker made so many mistakes with patient DG that he should be restricted from delivering babies until he can be evaluated.
The board contracts with a University of Florida program called “CARES” -- Florida Comprehensive Assessment and Remedial Education Services Program -- to assess a physician’s ability to practice with skill and safety.
The Department of Health and Tsinker had proposed to settle the case with a “letter of concern,” a fine of $10,000 and courses in record-keeping and breech births. After rejecting that as inadequate, the medical board counter-offered a suspension pending evaluation, a reprimand, and courses in ethics and empathy.
That counter-offer will be mailed to Tsinker, at which point he may accept or reject it.
Tsinker appeared before the board without an attorney, a rare occurrence. Earlier this week, Tsinker told Health News Florida he didn’t hire a lawyer because he wasn’t worried about the outcome.
“I’m the number one expert in the state of Florida as far as delivery of breech or twin babies vaginally (is) concerned,” Tsinker said. “Nobody denies that.”
On Friday, he told the board his that his low C-section rate, is unlike the majority of OBs in Florida. South Florida has the highest rate in the country, which Tsinker called “an abomination.”
Board members told Tsinker his experience was impressive and that he’s right about the C-section rate in Florida. But their mission is to safeguard the public, they said, and since he demonstrated poor judgment in this case he needs evaluation.
“The bottom line is that under your care, you delivered a dead baby,” said board member Merle Stringer of Panama City.