Med students not all alike
In his article, "Bucking the system"
(April 14, p. 12), Michael Romano claims that "America's medical students, rocking the boat in youthful rebellion, have announced their collective opposition to caps on noneconomic damages in medical malpractice lawsuits, a stance that directly contradicts the position of most other U.S. medical groups." As a medical student I take offense at this view of the situation.
There are several flaws in this assertion.
First, this "collective" announcement stems from one medical student organization, the American Medical Student Association, which is smaller than another group listed in the same article (student members of the American Medical Association). No single organization speaks for all medical students, so this announcement is far from collective.
Second, organizations rarely speak for all of their members. I do not belong to the AMSA, but a quick poll of several of my colleagues who do revealed no knowledge of the AMSA's recent denouncement of noneconomic caps. Furthermore, upon hearing of the stand the group took, these members announced plans to drop their affiliation with the AMSA.
Third, the AMSA (and other organizations for medical students) provides incentives for medical students to join. After taking the incentive and filling out a form or two, many medical students never hear from these organizations again. It is not surprising that many of the AMSA members are unaware of the positions the organization takes, so even the organization's numerical membership is an inaccurate measure of the strength of this recent stance on medical liability reform.
Fourth, although I have no hard data to support this assertion and base it only on the atmosphere I perceive at my medical school, I believe that most students, in fact, support caps on noneconomic damages.
Finally, I am insulted by your reporter's characterization of the decisions of America's medical students as "rocking the boat in youthful rebellion." This implies that decisions made by medical students are not thoroughly contemplated but simply arrived at based on their rebellious effect.
University of Kansas School of Medicine
CON is anticompetitive ...
The article "Pros and cons of certificates" (April 21, p. 4) focuses on one narrow aspect of the certificate-of-need debate. It is true that nearly all projects are approved, but the article does not point out why healthcare providers in many states fight attempts to keep CON laws from expiring. It is also why many healthcare providers in states that no longer have such laws wish they still existed.
Simply put, the CON process allows healthcare providers to form an economic cartel under government approval that allows them to restrict services, charge higher prices and limit market innovation in the delivery of healthcare services. Under CON, when a healthcare provider files an application to provide expanded health services, providers that are threatened by this marketplace action can legally oppose the CON by banding together with similar providers or take individual action to delay a CON. In any other industry, such an act would be considered collusion, restraint of trade, anticompetitive and manipulation of the marketplace. But under CON this type of commonplace behavior is acceptable and exempt from federal or state antitrust action.
I believe that CON should be eliminated in all states. That would force providers to provide higher-quality care and become more consumer friendly, innovative and price-conscious-hallmarks of market-driven industries. An informed and demanding health consumer deserves no less.
Independent marketing consultant
... but that misses the point ...
Many of those against the CON process say it prevents competition that would help control healthcare costs. On the surface and in a true market industry, this position would be credible. However, in healthcare and specifically rural healthcare, this is not a true market industry.
Without CON, hospitals are subject to venture capitalists whose main purpose is to take away any profitable business that still exists at a hospital. It is not true market competition because the hospital is left to serve the indigent and those patients who are covered by government-based payment programs. Because those patients generally pay less than the actual cost of services, hospitals are forced to raise rates to any commercial customers left. This practice will generally drive away even more patients. Eventually, as more and more business is taken out of the hospitals because of a lack of a CON process, hospitals will be forced to change their mission (convert to for-profit status) to better compete with the specialty hospitals and for-profits or close their doors.
Closing a hospital is not necessarily a bad long-term strategy, unless the not-for-profit hospital is a sole community provider in one of many rural states throughout our great nation.
For these reasons, I believe in the CON process. Many of the failures of CON are the fault of those empowered to administer the process. Many are well-intended but lack the training to properly evaluate very complex issues with very complex financial implications.
Vice president of finance
United Hospital Center
... and CON prevents bad projects
In your article, the fact that most CON applications are approved is exhibited as proof that the program has little or no effect. If the number of projects denied is the benchmark for showing how well CON is working, then the more projects denied the better the program is working and the best programs would deny 100% of the applications. This is not true.
Over time, healthcare providers gain expertise in submitting CON applications and avoid the time and expense of applying for projects that are unlikely to be approved. The issuance of review criteria and state health system plans prevent many poorly conceived projects before they even get to a CON application. In regulation of healthcare as in promotion of health, prevention is by far the most effective strategy.
Projects that are denied may be few and far between, but the ongoing cost of one poorly planned project will last for many years. As someone once said, build it and they will come. Over the 27-year life of one CON program in a sparsely populated state, projects calling for a combined 573 long-term-care beds, 468 acute-care beds, nine ambulatory surgery center suites, 144 substance-abuse beds, 60 psychiatric beds and 30 rehabilitation beds were denied. This resulted in the avoidance of nearly $200 million in construction costs and an additional $240 million in annual operating costs. The program also has resulted in improved planning for many projects as a result of going through the process.
Consumers eventually pay for overbuilding in one way or another, through increased insurance premiums, higher deductibles or increased taxes. Given the recent management problems of some major healthcare providers and cutbacks in Medicaid, states need some sort of process to control healthcare development and say no to projects that do not seem needed. In some cases, CON is the only process that a state may have to say no to increased growth that they will have to pay for.
Regarding the effectiveness of CON programs, effectiveness is likely to vary by state and by type of service. Remember that CON is only a tool and is not a cure-all. The effectiveness of a CON program depends upon how well the planning process works in the individual states and how unpoliticized the process is.
Given the high cost of healthcare and potential economic crises in many states, it seems likely that there will again be a move to find a way to limit the cost of healthcare, whether it is through CON or some other means.
State of Alaska
Develop U.S. nurses
Regarding your story "Importing controversy" (March 31, p. 20): The higher education system in the U.S. has been a dismal failure by turning away would-be professional nurses and physicians.
When I graduated from college in 1956, the speaker expounded that our educational system is so superior that within 50 years, graduating students would be going to all parts of the world spreading our professional knowledge.
Never did I think I would be recruiting nurses from the Philippines and doctors from Pakistan.
Uvalde (Texas) Memorial Hospital
Better uses for the money
Regarding Robert Sade's commentary, "Why illegal aliens get a place in line" (March 31, p. 16): Of course he is an apologist for organ transplantation. He makes a very good living at it. On the other hand, how much prenatal care, how many childhood immunizations, how much family planning assistance, smoking prevention/cessation, and how many defensive driving classes-things that actually improve public health-could we have purchased for illegal aliens with the money spent on transplants for people such as Jesica Santillan?
Thousand Oaks, Calif.
Your recent coverage of the events at Nassau Health Care Corp. ("To take or not to take," May 5, p. 18) failed to be as balanced as your typical reporting.
Wasn't this the same public hospital that was clearly headed into bankruptcy before Richard Turan and Christine Forman stepped in and turned it around? If you could afford 629 words on how the two were accused of accepting gifts totaling $10,272.93 over a period of almost three years, I would expect at least a sentence or two about how the union bosses previously had squandered the better part of $50 million on inflated payrolls and political patronage. In that way, you would allow your readers to make their own informed opinion about who the real criminals are.
Exec searches need teamwork
At the risk of continuing a debate currently being waged on your letters to the editor page (Feb. 10, p. 32; Feb. 17, p. 22; Feb. 24, p. 23; March 10, p. 24) I wish to add a different perspective regarding the responsibility an executive search firm has to its client.
As the founder of an executive search firm and a recruiter for 20 years, I have observed terrible hiring mistakes made by numerous organizations. Some have suggested that the executive search firm that recruited Bruce Perry to Mount Sinai Medical Center, Miami Beach, Fla., did not have "ownership" in the outcome. A colleague has suggested that search firms need to guarantee a placement for a minimum of two years in order to have enough investment in the process to do it right.
The ownership of hiring a leader is about more than guarantees. It is about working with the client to truly understand the needs and culture of the organization and offering ideas and suggestions to improve the outcome and creating a true partnership with the client. Unless a client and a search firm truly partner in the process, a two-year guarantee has no value.
When it comes to hiring, I sometimes find myself at odds with the client when I withdraw my support for a candidate that I introduced to the process. Some clients would rather just hire the candidate and hope for the best. I can think of several executives with fairly well-known problem pasts who keep getting hired because no one asked the right questions. This is not about who is right or wrong but rather speaks to the need for the search firm and client to work together to ensure a successful outcome.
Although I am sometimes very hurried and think I should just ignore your Daily Dose e-newsletter, I have found that if I open it I will invariably find at least one item that is right on point with my daily assignments.
Your summaries of the news always seem to include market developments, federal regulatory enforcement and other topics I have dealt with in a phone call or meeting earlier in the day.
Keep up the good work.
Law and patents department
Bayer Pharmaceuticals Corp.
West Haven, Conn.
I would like to find out where I can get a copy of a document mentioned by the Rev. Michael Place in his April 7 commentary, "The sunshine covenant" (p. 24). The document, revised in 2001, is entitled, Community Benefit Program: A Revised Resource for Social Accountability.
Public relations, marketing assistant
Rapid City (S.D.) Regional Hospital
Editor's note: You can order a copy through the Catholic Health Association Web site. Use this link: chausa.org/resources/searches/default.asp? Type=21&OrderBY=Title.