- The Washington Times - Saturday, February 12, 2005

Don’t kill specialty hospitals

In his Op-Ed column “A health-care loophole” (Feb. 3), Charles N. Kahn III writes that the growth of specialty hospitals is not fair and that such hospitals provide their physician-owners with self-serving incentives to refer patients to facilities where they have ownership interests.

Conveniently, Mr. Kahn omits the many benefits specialty hospitals bring to patients.

I am a retired ophthalmologist whose experience can shed light on those benefits. In 1980, when I was unable to persuade local hospitals to purchase the equipment I needed, I resorted to using personal credit to buy $180,000 worth of equipment to perform invasive eye surgery. That doesn’t happen in specialty hospitals — especially in ones owned by physicians — where the latest and best surgical equipment can be purchased easily.

In specialty hospitals, the surgical environment is better controlled, and nosocomial infections are far less frequent. Having finished surgery late one day, I was about to exit the operation room when a patient was brought in from the emergency room with a ruptured aortic aneurysm. I helped a young surgeon save this man’s life. The man was later found to be HIV positive. This was no place for an ophthalmologist. Such situations don’t occur in specialty hospitals.

Specialty hospitals have more experienced help, too. In one case, six hours of “routine” eye surgery turned into nine hours when my privately trained surgical registered nurse developed an impacted wisdom tooth and I suffered the inexperience of a substitute floater.

The Texas Heart Institute, New York Hospital’s Bone and Joint Surgery, Bascom Palmer Eye Institute, Moffit Cancer Institute — all these are specialty hospitals that provide the highest level of patient care.

That is really the only important story.

Is there a conflict of interest? Not when the referring physician seeks only the best outcome for a patient. Mr. Kahn’s criticism is analogous to saying I shouldn’t buy or sell Exxon gas because I own shares in Exxon.

General hospitals will survive — as will emergency rooms, high-liability malpractice exposure, pharmacies and insufficient bureaucracies. Just don’t kill the efficient, competitive specialty hospital.

DR. JOHN STEWART

University Place, Wash.

Droopy drawers, cowering parents

I remember my teen years in the District in the ‘60s. Our “Chucks” were clean, Afros usually well-coifed, khaki pants pressed to a razor-sharp edge, and our gabardine (“gabs”) slacks rested correctly on our hips. Ample use of soap and water also was de rigueur. Any “hoochie”-lookingfemale wouldn’t have made it out of her room, let alone the house. Don’t worry about fining Generation X (” ‘Droopy drawers’ bill seeks end to overexposure of underwear” Page 1, Wednesday).

The countenance Xers are embracing is a result of apathetic (in other words, cowering) parents, peer pressure and the belief that it is cool to look like an unmade bed or worse. Of course, adult earning power is not tied just to education, sorority/fraternity networking and luck. A modicum of conformity toward societal norms early on can be a barometer of success — or lack thereof — to come.

RICK DU BOSE

Washington

A right to obscenity?

In their Op-Ed column ” ‘Extreme’ judicial activism” (Thursday) Sens. Orrin Hatch and Sam Brownback take umbrage at Judge Gary Lancaster’s exceptionally well-reasoned opinion in United States v. Extreme Associates and, because they can’t find flaws in its precedential basis, deliver sermons to the birds about its “judicial activism.”

The following facts are uncontroverted: The Supreme Court’s 1969 decision in Stanley v. Georgia recognizes American citizens’ unfettered right to own non-child pornographic obscenity in the privacy of their own homes.

A few years earlier, in 1965, the high court ruled in Griswold vs. Connecticut that in-state doctors could not be prohibitedfromprescribing birth-control devices to Connecticut residents. That also must have meant that those residents couldbuycondoms,diaphragms and birth-control pills. Few people manufacture such devices in their own homes.

It doesn’t take a genius to understand that if it’s legal for Americans to buy prescribed birth-control devices, it’s a pretty straight line to the idea that they should be able to buy the obscenity they already have the right to own. For the most part, people don’t manufacture obscenity in their own homes.

The Supreme Court, however, suffered from a defect in that logic, later ruling that buying obscenity was not a right becausedoingsoallegedly harmed the morality of the community. That excuse was taken away with Lawrence v. Texas.

Associate Justice Antonin Scalia, the court’s most conservative member, claimed that in the Lawrence decision, “state laws against bigamy, same-sex marriage, adult incest, prostitution, masturbation, adultery, fornication, bestiality, and obscenity are … called into question by today’s decision.”

Admittedly, Justice Scalia’s comment was part of the dissent in that decision, and it remains to be seen whether a majority on the court accepts his assessment of the ultimate meaning of Lawrence. But since a majority of the court has not made its views known on that subject, Judge Lancaster was following proper judicial procedure in considering Stanley, Griswold, Lawrence and the majority opinion in City of Los Angeles v. Alameda Books and deducing that, taken together, the government has no power to prevent consenting adults from buying even obscene material from each other, as long as children and non-consenting adults aren’t involved in the transaction.

What’s sad is that two veteran senators don’t understand that many perfectly sound judicial opinions are the result of “tak[ing] a little piece of this, toss[ing] in a chunk of that, and smear[ing] a layer of the other on top” in order to come to a completely reasonable assessment of the law.

MARK KERNES

Senior editor

Adult Video News

Chatsworth, Calif.

CARE in Afghanistan

I was taken aback by the article, “Aid group gets OK to set up Kabul hospital” (World, Feb. 5), especially the inaccurate assertion that the only international humanitarian organization working in Afghanistan is CURE International. Hundreds of international humanitarian and development organizations work in Afghanistan, including CARE, which started operating here in 1961. CARE has more than 850 staff in Afghanistan, including seven international staff working in 11 provinces with programs in education, rural assistance, water and sanitation, shelter, and micro-finance.

By quoting only Dr. Scott Harrison from CURE, the article also gave a distorted view of how aid agencies operate. Though he is correct that we value our neutrality and impartiality, they are not obstacles to assisting communities in need. In fact, it is exactly these qualities that allowed us to work with communitiesacross Afghanistan throughout the conflict in the 1980s and 1990s. These same qualities allow us to operate here today.

The inference that our principles keep us from aiding those in need displays a fundamental misunderstanding of how agencies such as CARE operate. By publishing such inaccuracies, your paper can flame animosities and hamper the work of legitimate aid organizations.

PAUL BARKER

Country director

CARE

Kabul, Afghanistan


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