Medical Decisions

WHEN IS LIFE no longer worth living? That ancient question has long received a standard response: That is not for men and women to decide.What about the 94-year-old woman who is "ready to go" but finds a new lease on life after a cataract is removed? Or the cancer patient who says he "can't take it anymore" -- until he gets proper pain medication? And what about the uninsured father who faces the agonizing choice of using his meager savings for treatment or finding a way to "go quickly" and leave something for his family to live on?

YOUR MARCH 20 editorial, "Curbing the power of HMOs," contained a number of factual errors. The most blatant one was your assertion that "medical decisions are made not by physicians . . . but by bean-counters. . . ."I have been a sole practitioner for 25 years in Columbia. My specialty is family practice and I belong to several HMOs (over two-thirds of my patients are members of HMOs).I have never been told how to practice medicine by any HMO.I have been given practice guidelines on selected diseases (like asthma and heart failure)

HMO regulations raise many more questionsIn a March 12 letter, "HMOs seen in need of more regulations," Steve Shearer supports legislation making physician administrators in health maintenance organizations accountable for their medical policy decisions.He references a March 5 article, "Stronger oversight of HMOs sought," that detailed current legislative efforts to micromanage health care in this state. I say such efforts are Band-Aids. We need a tourniquet.State and federal legislation created the problem.

A BILL that would require health insurers to give patients the right to appeal unfavorable decisions on coverage would not entirely correct the imbalance of power that characterizes many of these situations. But it would be an important step in the right direction, and we urge its passage -- provided that insurers bear some of the costs.Health insurers, especially health maintenance organizations and other managed care groups, have profited handsomely on their ability to control spiraling costs for medical care.

Emissions test crucial to environmentAs people who have had cars tested on the new dynomometer and who would like Maryland's children to be able to breathe clean air, we were dismayed by recent legislative actions to delay the important Vehicle Emissions Inspection Program.We have pushed utilities, industries and auto manufacturers to clean up the air pollution that their companies create; we will continue to do so. But we must also make sure car owners are doing their part to maintain their cars properly.

'TC She is a 92-year-old woman -- anybody's mother, anybody's patient.Because of bad circulation, she developed a foot ulcer, for which surgeons offered two choices: Amputating the foot in a fairly simple surgical procedure, or a more complicated bypass operation to save her foot by grafting other blood vessels onto the decayed area.Her chances of walking were limited either way because of her severe arthritis. But her family wanted to save her foot. So she chose the bypass, and at first things went well.

A former chief of Howard County General Hospital's medical staff is suing the hospital and three doctors for at least $80 million, alleging that "bad blood" and racism -- rather than questionable medical decisions -- led to the suspension last year of his privileges at the facility.In a federal lawsuit filed Monday, Dr. Kline A. Price Jr. -- a black gynecologist who claims to be Columbia's first private doctor and is the brother of National Urban League President Hugh B. Price -- lists a host of alleged medical miscues performed at the Columbia hospital by white physicians that were not punished.

A former chief of Howard County General Hospital's medical staff is suing the hospital and three doctors for at least $80 million, alleging that "bad blood" and racism -- rather than questionable medical decisions -- led to the suspension last year of his privileges at the facility.In a federal lawsuit filed Monday, Dr. Kline A. Price Jr. -- a black gynecologist who claims to be Columbia's first private doctor and is the brother of National Urban League President Hugh B. Price -- lists a host of alleged medical miscues performed at the Columbia hospital by white physicians that were not punished.

A former chief of Howard County General Hospital's medical staff is suing the hospital and three doctors for at least $80 million, alleging that "bad blood" and racism -- rather than questionable medical decisions -- led to the suspension last year of his privileges at the facility.In a federal lawsuit filed Monday, Dr. Kline A. Price Jr. -- a black gynecologist who claims to be Columbia's first private doctor and is the brother of National Urban League President Hugh B. Price -- lists a host of alleged medical miscues performed at the Columbia hospital by white physicians that were not punished.

You've been in an accident and you're unconscious, attached to a life-preserving respirator. You're being kept alive artificially; doctors give you virtually no chance of recovery.Would you want to be kept alive while trying to beat the odds? Or would you want the life-support system withdrawn? Because you can't communicate your decision now, how does anyone know what you want? Should someone choose for you?Baltimore Circuit Judge John Carroll Byrnes says a bill he helped write for consideration in the 1993 General Assembly would allow Marylanders to choose surrogates who would be able to decide whether they should be kept alive on life-support systems.

It's a name only a policy wonk could love: comparative effectiveness research. But get ready to hear a lot about it; it could save your rights as a patient - and maybe even your life. If opponents have their way, it could be the bogeyman that brings down health care reform. Using false and misleading scare tactics, Conservatives for Patients Rights, a group opposed to comprehensive health care reform, announced last week a $1 million ad attacking comparative effectiveness. However, an emerging consensus of strange bedfellows - from insurance companies to the Institute of Medicine to patients rights advocates - all support making a national investment in research to compare the effectiveness of drugs, devices and diagnostic procedures, and sharing the information that results with physicians and patients.

WASHINGTON - Medical researchers and politicians are tiptoeing into an area of health care that makes some Americans uncomfortable, even angry, and it has nothing to do with such hot-button issues as cloning and stem-cell research. This time, the idea is to press doctors and patients to use particular drugs and treatments in order to save money. On the surface, it seems simple enough: Billions of dollars could be saved if everyone adopted the regimens that research showed were best and most cost-effective - which, experts say, happens far less often than most patients think.

In yet another attempt to kill legislation to give unmarried couples medical decision-making rights, Del. Donald H. Dwyer Jr. took the unusual preliminary step yesterday of trying to repeal the measure through a voter referendum. Dwyer, an Anne Arundel County Republican, said he filed petition requests with the Maryland State Board of Elections and attorney general's office. "I'm prepared to fight this every step of the way," said Dwyer of the bill, which would be effective July 1. Under Maryland election law, Dwyer would need to collect 51,195 signatures by June 30 of this year to get the question on the 2006 ballot, said Donna Duncan, director of the election management division of the Board of Elections.

MOST OF US might never have heard of Terri Schiavo if she had put her medical wishes in writing. Now she has become a household name after Congress and the president entered the legal battle to prolong her life against her husband's insistence that she would have preferred to die rather than live with severe brain damage. The emotional case in Florida has many people across the country scrambling to get documents in place to spell out their wishes on life-sustaining treatment. The documents can go a long way toward helping family members who must make hard choices on behalf of loved ones who are unable to speak for themselves.

YOUR MARCH 20 editorial, "Curbing the power of HMOs," contained a number of factual errors. The most blatant one was your assertion that "medical decisions are made not by physicians . . . but by bean-counters. . . ."I have been a sole practitioner for 25 years in Columbia. My specialty is family practice and I belong to several HMOs (over two-thirds of my patients are members of HMOs).I have never been told how to practice medicine by any HMO.I have been given practice guidelines on selected diseases (like asthma and heart failure)

Emissions test crucial to environmentAs people who have had cars tested on the new dynomometer and who would like Maryland's children to be able to breathe clean air, we were dismayed by recent legislative actions to delay the important Vehicle Emissions Inspection Program.We have pushed utilities, industries and auto manufacturers to clean up the air pollution that their companies create; we will continue to do so. But we must also make sure car owners are doing their part to maintain their cars properly.

HMO regulations raise many more questionsIn a March 12 letter, "HMOs seen in need of more regulations," Steve Shearer supports legislation making physician administrators in health maintenance organizations accountable for their medical policy decisions.He references a March 5 article, "Stronger oversight of HMOs sought," that detailed current legislative efforts to micromanage health care in this state. I say such efforts are Band-Aids. We need a tourniquet.State and federal legislation created the problem.

A BILL that would require health insurers to give patients the right to appeal unfavorable decisions on coverage would not entirely correct the imbalance of power that characterizes many of these situations. But it would be an important step in the right direction, and we urge its passage -- provided that insurers bear some of the costs.Health insurers, especially health maintenance organizations and other managed care groups, have profited handsomely on their ability to control spiraling costs for medical care.

WHEN IS LIFE no longer worth living? That ancient question has long received a standard response: That is not for men and women to decide.What about the 94-year-old woman who is "ready to go" but finds a new lease on life after a cataract is removed? Or the cancer patient who says he "can't take it anymore" -- until he gets proper pain medication? And what about the uninsured father who faces the agonizing choice of using his meager savings for treatment or finding a way to "go quickly" and leave something for his family to live on?

A former chief of Howard County General Hospital's medical staff is suing the hospital and three doctors for at least $80 million, alleging that "bad blood" and racism -- rather than questionable medical decisions -- led to the suspension last year of his privileges at the facility.In a federal lawsuit filed Monday, Dr. Kline A. Price Jr. -- a black gynecologist who claims to be Columbia's first private doctor and is the brother of National Urban League President Hugh B. Price -- lists a host of alleged medical miscues performed at the Columbia hospital by white physicians that were not punished.