Time to Get HMOs Out of Medical Decisions

As a retired physician and a former associate medical director with an HMO, I agree with the general unhappiness with health plans as noted by Assemblyman Martin Gallego and others (“Group to Propose Managed-Care Reform,” Feb. 26). And Myra Snyder, chief executive and lobbyist for the California Assn. of HMOs, continues to evade the main issues that the public is trying to address in order to get the attention of the health-care industry.

I was a supporter of the main thrust of Propositions 214 and 216. However, I also thought they were poorly thought out, as is the “patient bill of rights” advocated by Health Access of California.

On the issue of hospitalization, why limit mandatory minimum stays for mastectomies and deliveries? Why not mandate a minimum stay for tonsillectomies also? Some insurance policies do not cover hospitalization for that unless there is a major complication. What if there is no one at home to take care of that patient? Do we need a law for each and every medical and surgical diagnosis?

What’s wrong with the “old-fashioned” notion that doctors are the ones who should determine when a patient should be discharged from the hospital? Are we to depend on an insurance clerk with a high school education to make those medical decisions?

The decision should be determined on the basis of the nature of the medical problem and its potential immediate complications, whether there is an acceptable support system at home, an extreme anxiety factor that should preclude discharge, etc. And if the physician abuses that responsibility, that can be ameliorated by an immediate peer review system; but at least the patient will not be abused.

Doctors are aware that “early discharge” is good medical care, but a “premature discharge” is bad medical care.

Dr. HARRY SHRAGG

Los Angeles