When Nancy Slaterbeck came out of anesthesia after her cancerous left breast was amputated at Johns Hopkins Hospital three weeks ago, all she wanted to do was sleep and get rid of the "unbearable" pain in her arm.
But the main concern for some members of the recovery room staff seemed to be getting rid of her, the 51-year-old Towson woman told a Maryland Senate committee yesterday.
"I kept being told there was no room at the inn," said Slaterbeck, who said she was repeatedly pressured to go home just hours after having a modified radical mastectomy, which involves removal of a breast. She said she was finally given a room for an overnight stay more than seven hours after she left the operating room.
Slaterbeck, a social worker, was one of several breast cancer survivors who came before the Finance Committee to testify in favor of legislation that would require health insurers to pay for up to 48 hours of inpatient care for mastectomy patients who want to recover in the hospital.
The committee heard emotionally charged testimony from Slaterbeck and two other women, including a member of the House of Delegates, who told stories of callous treatment at the hands of the medical system after breast cancer surgery.
Representatives of health maintenance organizations and hospitals turned out to oppose the legislation, saying the women's stories did not represent standard practice. They contended that insurers do pay for inpatient care if doctor and patient agree it is necessary.
Opponents of the bills also argued that mandating lengths of stay for specific medical procedures, one at a time, is a poor way to legislate. But the industry lobbyists' protests clearly did not have the heart-rending resonance for legislators of the survivors' accounts.
"This is a tough, tough issue. This is an emotional issue," said D. Robert Enten, lobbyist for the Maryland Association of Health Maintenance Organizations.
Del. Louise Snodgrass, a Frederick County Republican, said that when she went into a Frederick hospital late last year for removal of a cancerous lump in her breast, her understanding was that she would recover in the hospital a day or so. But soon after she got to the recovery room, the nurses began telling her she was ready to be discharged.
"I thought to myself, you've got to be kidding me. I could barely lift my head off the pillow," Snodgrass said. She said she was finally allowed to stay, but that before 7: 30 the next morning, she was awakened and told the doctor had signed her discharge and she had to be out in an hour.
Outpatient mastectomies -- often labeled "drive-by" mastectomies by critics -- have become increasingly common in recent years as hospitals have come under pressure to cut the length of hospital stays.
In 1991, only 1.6 percent of mastectomies were done on an outpatient basis, according to HCIA Inc. By 1995, that number had grown to an estimated 7.6 percent of the 110,000 mastectomies performed in the United States, the Baltimore research company reported.
Most of the breast cancer survivors who testified yesterday told senators that many women are prepared neither physically nor psychologically to undergo a mastectomy or less extensive lumpectomy on an outpatient basis.
"How do you know and how can you predict what the emotional impact is going to be the first time you take take that look and see your deformed chest?" Slaterbeck said. "You need that safety net. You need that time to cope."
'Surrounded by strangers'
Lisa Shockney, director of performance improvement at Hopkins, said the treatment of Slaterbeck was an aberration in a program with a 97 percent satisfaction rating from its patients.
"Hopkins did not anticipate this patient going home," she said, adding that a nurse who put pressure on Slaterbeck had been "spoken to."
Shockney, herself a breast cancer survivor, testified that the Johns Hopkins Breast Center has converted the majority of its mastectomies to outpatient procedures -- not because of pressure from insurers, but for sound medical reasons. She said the most important factor for a favorable outcome is "emotional support."
"This is best provided not in a hospital setting, where she is going to be surrounded by strangers and in a strange bed," she said.
Pub Date: 1/31/97