Plans must include emergency careThe Sun's Jan. 31...


February 21, 1996

Plans must include emergency care

The Sun's Jan. 31 article, "Doctors, HMOs call truce in Annapolis," reports on an understanding between managed care plans and the state medical society of Maryland.

We commend this cooperation, but the agreement language requires emergency physicians to obtain permission from managed care gatekeepers to treat subscribers who present non-life-threatening conditions.

Federal law mandates that emergency departments screen and stabilize all patients regardless of ability to pay, and prohibits any delay to inquire about insurance or obtain approval from third parties.

The requirement begins when the patient enters the hospital, and thus necessitates modification of the negotiated agreement.

Detection of an emergency condition in a managed care subscriber already in the ER, and who may have to pay the bill, creates a hazardous dilemma under federal law. Managed care plans may deny authorization for payment of emergency department services when the patient's condition is deemed minor, and shift responsibility for payment to the patient/enrollee.

This may cause resentment if the enrollee had understood that emergency treatment was covered, or if the enrollee visited the emergency room at the direction of the HMO or because the gate-keeper failed to respond.

The denied patient who foregoes treatment to avoid a bill may or may not relieve the hospital of its federal duty, but the patient might suffer harm.

The governor and the secretary of health have directed the emergency physicians to address these issues directly with the HMOs. We have requested meetings with all regional HMOs and welcome the dialogue.

We look to legislators and health regulators to encourage managed care plans to fulfill their contractual obligations to enrollees, and we offer our advice and experience toward more sensible health care systems.

Daniel Kohn, M.D.


The writer is president of the Maryland Chapter, American College of Emergency Physicians.

Managers' layoffs raises questions

Your article Feb. 3 announcing the layoffs of nine managers in the city Department of Public Works raises questions.

Supposedly, the purpose of the layoffs was a cost-saving factor. In reality, the tone of the article indicates other reasons.

What a shame it is that George Winfield is among those managers. He has served the city well for 25 years as an engineer, a bureau head, and as deputy director. He is a loyal, intelligent and ethical executive, as was Kenneth Strong who met the same fate several months ago.

In view of the many problems in city government as disclosed by The Sun this past year, it seems that men of integrity are sorely needed. It is a pity that they are being dismissed.

Sarah E. Murphy


Smoking snuffs out a bright light

Like many Marylanders, I was saddened to hear of Thomas Bellavance's death of lung cancer. His vision and leadership as president of Salisbury State College made both the higher education community and the people of Maryland proud.

It is a modern-day tragedy that so many great thinkers die at a young age due to smoking-related diseases. The state Health Department says we lose at least 7,700 Marylanders each year to smoking. According to The Sun, Dr. Bellavance believed his lung cancer was due to a life-long smoking addiction. Though he tried many times to quit, he could not stop.

The tobacco industry says smoking is a choice. Dr. Bellavance, a bright, talented university professor and president, believed otherwise. Thanks to the tobacco industry, we must say goodbye to at least 21 productive Marylanders each day. Since when is addiction a choice?

Glenn E. Schneider


Name team for those who pay the bills

How about this name for the new Baltimore football team -- the Baltimore Taxpayers?

If we have to pay for them at least they should bear our name.

Ilene Kayne


Slots will keep horses running at Md. tracks

The real issue raised by the installation of slot machines at Delaware Park is the survival of the Maryland horse racing industry. No one in more rosy times could accuse the Maryland Horse Racing Association, the management of the two major tracks for thoroughbred racing, or the Maryland Racing Commission of planning for the future in a declining industry.

The leaders of the industry have hidden from the on-rushing reality of poor track attendance, consequent lower purses and escalating expenses involving the care and maintenance of thoroughbreds.

They collectively have ignored instituting innovative measures taken to strengthen the racing industry in areas such as Delaware, Florida and California.

The argument, can of course, be made, as it can with other gambling interests, that there are moral questions involving the basic premise of legalized gambling at all.

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