Mug shots unfair ...
I thought your story on the arrests of a physician and nurses at Memorial Medical Center in New Orleans was thoughtful and complete, but I object to one aspect of your coverage: The use of the mug shots on the cover was unfair to these individuals ("Life-altering decisions," July 24, p. 6).
These women were arrested late at night, even though Louisiana Attorney General Charles Foti had been investigating the case for more than 10 months and knew they would voluntarily appear whenever he asked.
The resulting photos were unflattering to say the least. I wonder how any of us would look in a mug shot after being dragged out of bed after 10 p.m.
In the PR game of perception, however, the photos scream "Guilty!" even though the state attorney general has no ability to charge them with a crime and there is some question that the district attorney in New Orleans will do so.
I am surprised that so many in the media bought into this strategy by publishing these photos.
I am not diminishing the seriousness of the allegations. Tenet Healthcare Corp.'s official statement makes clear that we will never condone euthanasia, but we also believe that these three people are entitled to the presumption of innocence until proven guilty -- something Foti certainly did not give them.
Senior vice president of
Tenet Healthcare Corp.
... sensationalistic ...
Your use of black-and-white, convict-looking photos supplied to you by the Louisiana attorney general's office is sensationalistic, disgusting, judgmental journalism.
Your magazine used to have some class. Now you seem to want to be a combination of People and the National Enquirer. You ought to be ashamed of yourselves.
President and CEO
Decatur (Ill.) Memorial Hospital
... even Scrushy treated better ...
You should be ashamed of the cover photos and the not-so-subtle suggestion that these people are guilty as charged. Why didn't you just airbrush on orange jumpsuits with numbers on the front? Oh, but that would be going too far. Instead, you maintained your integrity by merely making the cover the darkest, most ominous and least colorful in recent memory.
Where was this moral fortitude and courage when it came to covering Richard Scrushy? I do not recall seeing his picture smeared on the cover in such a manner.
Director of materials management
Memorial Health System
Colorado Springs, Colo.
... wrong to accuse providers
I am dismayed that a physician and two nurses have been accused of second-degree murder when they, in fact, should be praised for remaining behind to care for patients. If anyone should be accused of a crime, it should be Federal Emergency Management Agency officials for not planning ahead properly, not putting any workable plan into action and leaving people stranded and without any type of aid for much too long after Katrina hit the Gulf Coast.
The indictment of these healthcare officials will only cause clinicians to stop and think "Is it worth it?" when another crisis occurs. I'm sure that if they did do what they are accused of, they felt they were saving these four people from untold misery by providing them with a less painful demise.
The government is so very, very wrong in prosecuting these healthcare workers. It makes me angry and further disillusions me that we can't count on our government to do what is needed, what is right and what is just.
A missed opportunity
I am very disappointed that you failed to use your opportunity to ask Federal Trade Commissioner Deborah Platt Majoras the questions the physicians who can't make payroll would like to ask ("Antitrust watchdog," June 26, p. 28).
The two main questions that physicians are perplexed over are: How come primary-care doctors haven't received an increase from most of the commercial carriers in seven years even though insurance rates have gone up almost 100% over that period? And why have you allowed carriers to merge and control large swaths of the market, yet when physicians ask for an increase we are told insurers will not negotiate as long as one physician will accept their rates?
Many physicians band together so they can remain in business, otherwise they see no hope. I am in pediatrics and I see the devastation happening all around me. There is not one group in my community that hasn't used up its line of credit so it can meet payroll.
As new and very expensive vaccines come to market, pediatric groups are unable to afford to purchase them because of a lack of profits.
Unfortunately, most family physicians see the FTC as another weapon paid for by our taxes to help big business increase its profits, not to control health costs.
Risks and rewards
Your discussion of hospital preparedness for a pandemic highlighted a gap in our efforts that could be adequately addressed with sufficient national political will ("Arming for an emergency," July 17, p. 6).
In the article, Richard Duma, director of infectious diseases at Halifax Medical Center in Daytona Beach, Fla., notes the likelihood of hospitals engaging in turf battles to maintain their competitive edge in the event of a pandemic, to the detriment of the public's health. Such competition is inevitable with a healthcare finance system that depends on hospitals shifting the costs of care of the uninsured and beneficiaries of inadequately funded public health programs, such as Medicare and Medicaid, to patients with commercial insurance.
If dependent on such a system, hospitals will inevitably attempt to avoid being designated as quarantine or treatment centers for pandemic victims perceived as nonlucrative, especially if it prevents the hospitals from offsetting the costs of treating these patients with more lucrative, commercially insured patients undergoing elective procedures.
The ultimate outcome of such competition is likely to result in a less-than-adequate response to a public health crisis, and the demise of important safety net hospital providers after a pandemic, due to their inability to cost-shift during a pandemic and the large revenue losses that will ensue from this inability.
The federal government has communicated to the American public that it views pandemic preparedness and response as a local or regional function. The American public has communicated to the federal government that it does not have the political will to engage in a wholesale shifting of our system of healthcare financing from a mostly private to a primarily public model. Nevertheless, we should consider implementing a national program that would ensure that hospitals and other healthcare providers will not put their continued viability at risk when they act in the interests of the public's health during a pandemic.
I suggest a program modeled after the public-private terrorism risk insurance program (the Terrorism Risk Insurance Act of 2002) that was enacted after the events of Sept. 11, 2001. Such a program would create a private insurance market for business-interruption insurance that would cover hospital losses in the event of a pandemic. The federal government would act as an ultimate re-insurer, picking up the tab for losses over a certain amount. This allows the private insurance industry to estimate actuarial risk and set rates for such insurance accordingly.
The federal government apparently believes that there is a need to ensure that the insurance industry -- which has billions of dollars in reserves -- would not go bankrupt in the event of another terrorist attack. Surely it should understand the need to ensure that American hospitals operating on razor-thin margins would not go bankrupt in the event of a pandemic.
Gonzaga University School of Law
Filling the pharmacy gap
Finally the healthcare system is giving attention to pharmacy administration and pharmacy executive training and education. The commentary by Gary Filerman and Kathryn Komaridis brought back many memories ("A gap in the pharmacy," July 24, p. 24).
In addition to all the challenges faced by the director of pharmacy in most institutions, clearly there is a structural inadequacy that many CEOs have failed to recognize. In most organizations, the pharmacy director reports to a vice president, often of support services. That individual typically oversees laboratory and radiology, and, in many organizations, interventional cardiology and other physician-led parts of the organization. Competing for resources with high-powered physician-led departments frequently leaves the pharmacy director in a tenuous position.
CEOs should consider whether to invest in executive education for high-quality pharmacy directors and future pharmacy leaders; restructure the administrative team to accommodate a vice president of pharmacy services; and, most importantly, draw on the expertise and insights of one of the most highly trained and underutilized resources in healthcare, the pharmacy director and his or her staff.
The complexity of the health system, in addition to new and innovative therapeutic modalities, will require deeper and broader involvement by highly trained pharmacy executives in the future.
Director of pharmacy
Physicians Plus Insurance Corp.
The CHA's shell game
Sister Carol Keehan eloquently states the position that Medicaid "shortfalls" and "research" should be part of the charity-care mix, but I disagree ("Charitable formula," June 26, p. 18).
Medicaid is a payer just like any other; the difference between charges and reimbursement should be a deduction from revenue; it's a cost of doing business. Considering it any differently is playing a shell game with the community-benefit formula.
It would also facilitate the argument from for-profit hospitals that their real tax burden is their actual taxes paid plus their Medicaid "shortfall." Is this a can of worms that we want to open?
Additionally, research cannot be considered since most for-profit hospitals cannot conduct government research or accept foundation grants without having a fiduciary organization.
Keehan makes the inference that research is a burden when in reality overheads are attached to compensate for the use of facilities and support staff.
I think a reassessment and return to the drawing board is in order for the Catholic Health Association.
Intensive-care unit nurse
St. Mary's Health Center
In your hospital systems survey, the listing of "10 Largest Non-Catholic Religious Healthcare Systems" included Omaha, Neb.-based Alegent Health ("In good health, at least for now," June 12, p. 24).
Alegent is a joint operating agreement between Catholic Health Initiatives and Immanuel Health System, which is affiliated with the Nebraska Synod of the Evangelical Lutheran Church in America.
I recognize that Alegent thus can't be considered a Catholic health system, but I also believe that it shouldn't be included among non-Catholic religious systems.
President and chief executive officer
Catholic Health Initiatives