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'Cost-Saving' Moves at Expense of Elderly

May 18, 1985

I think the public should be informed about "cost-saving" measures taken by the federal government at the expense of elderly patients. Recently I examined a 77-year-old man who had a large painful hernia that requires surgical repair. The patient had a coronary bypass five years ago for severe heart disease. Thankfully, he is not suffering from symptoms of heart disease at this time.

The California Medical Review Organization has determined that this patient cannot be hospitalized for his indicated hernia repair. He must come to the hospital on the morning of surgery, have his operation, and then go home three hours later with a painful surgical incision. He is expected to get by on oral pain medication and take care of his personal care needs. Of course, if he has complications develop postoperatively, then he will be allowed to be hospitalized.

I am extremely cost-conscious in the practice of surgery and have successfully changed my practice to make many surgical procedures on an ambulatory, same-day basis, which formerly would have required overnight hospitalization. Nevertheless, I feel that the elderly and infirm are being asked to subsidize the Medicare system with discomfort and increased risk and possibly their lives.

I wonder if the medical review organization, which profits directly from the government by denying hospitalization, is composed of people who have parents.

DAVID B. SIEVERS MD

Tarzana

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