Managed Health Care

Bravo to Suzanne Gordon and Ellen D. Baer for their incisive commentary, “Managed Care, Unmanaged Pain: Keeping Quiet on the ‘Tough Choices’ ” (Jan. 24). As good nurses, their primary concern is with the ill consequences of current managed care on their patients.

As a surgeon, I am increasingly aware of the adverse effects of so-called “managed care” on nurses. Over the past few years I have seen an erosion of nurses’ morale as hospitals cut back on nurses’ salaries and force them to do unrealistic amounts of work. When hospitals, in response to managed care pressure to cut costs, reduce staffing levels to as little as one registered nurse for each eight to 12 severely ill patients, not only does patient care suffer, but the nurse is frustrated when he or she cannot provide the skilled, compassionate care they were trained to give.

Next time you hear about a friend or relative who had to wait for a bedpan, or pain medication, or about a curt nurse who didn’t have time to talk to a patient, don’t blame the nurse. Lay the blame where it belongs, on the HMO administrator whose year-end bonus came out of the money saved on nursing cutbacks.

FREDERIC W. GRANNIS JR. MD

Arcadia

* Gordon and Baer attribute “demoralization” of health care to a perceived divergence of core values between employers and employees. Employers are characterized as being uncaring and mainly focused on costs.

Actually, employers do have a vested interest in their employees’ health and well-being, in order to maintain and retain a productive and satisfied work force. They are proactively seeking to obtain health care value by emphasizing wellness, verifiable clinical outcomes and customer satisfaction, when contracting with health plans and providers, to assure that cost alone is not a predominant deciding factor in assuring appropriate clinical caring.

With regard to HMOs’ and hospitals’ interference with appropriateness-of-care issues, the authors fail to recognize the regulatory and ethical imperatives linked to licensed professionals. The responsibility and primary liability for clinical conduct (whether compensated or not) always rests with a licensed professional.

On the subject of adequate pain relief, there are multiple federal/state regulations and professional society guidelines. Again, a licensed, ethical and conscientious professional would compassionately adhere to these guidelines, from our clinical and managerial experiences in health care delivery. No plan or employer can interfere with the compassionate, competent professional.

VICTOR S. DORODNY MD, MPH

President, California Chapter

National Assn. of Managed

Care Physicians, Pasadena