Emergency Medical Aid

* Re “ER Patients Lose in Specialists’ Rebellion,” June 1:

How ironic that even with health insurance the parents of Jacob Saitman had to offer $2,000 cash to persuade a plastic surgeon to show up and assist them--for a procedure that The Times reports costs a “few hundred dollars.” How infuriating the doctor required the Saitmans to sign a promissory note for the money.

So, because these physicians are lashing out at the managed-care industry, children and adults in need of a specialist languish in emergency rooms should they have the misfortune of becoming ill after 5 p.m. or on a weekend.

DENISE ST. CLAIR-ESTRADA

Northridge

* I take strong offense to your article. I was made the villain for being the only physician willing to assume care of the child in question. I was not on call on that date. This was clearly the HMO’s responsibility to have physicians available to take care of their patients.

The medical director of the HMO in question was informed by me several weeks before this occurrence that I would see no new patients for them until my previous overdue claims were paid. This HMO still owes me a sizable sum on claims dating back as far as 1996.

None of the physicians in question would allow a patient to lose life or limb. Taking care of facial lacerations is an elective cosmetic repair, in most circumstances, and time is only of the essence for patient and family convenience.

How often does a lawyer take on a case without a retainer, unless it’s a personal injury case with a chance of a jackpot reward? Does the plumber leave a home where he/she has done work without expectation of being paid? How long would The Times continue to deliver after no payments are received?

JEROME D. VENER MD

West Hills

* The cases you described appear to be violations of EMTALA, a federal law. Under this law, hospitals are required to have a call schedule for all specialists represented on their staff (with a few exceptions) and those specialists are obligated to attend emergency department patients when called. Hospitals are required to report violations to the federal government. Failure to report a violation is itself a violation and subject to the same stiff fines. This should be a potent tool in fighting the abuses you depicted.

Of course, the underlying problem of managed care is serious, but this is not the right response.

KEN ZAFREN MD

Past President

Alaska Chapter of the American

College of Emergency Physicians

Anchorage