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Emergency Care

October 09, 1988

As a surgeon familiar with Paradise Valley Hospital, having worked there in the past, I wish to express my opinion why doctors are justifiably avoiding staffing the Southeast San Diego hospitals' emergency room-specialist needs ("Some Doctors Are Treating Troubled Hospitals Like the Plague," Sept. 16).

Of course it is almost impossible to get a specialist to come in, even if he were guaranteed payment and even if his malpractice insurance premiums were to be paid by the hospital. The reason is that the physician is much more likely to be the target defendant in a lawsuit at a Southeast San Diego hospital such as Paradise Valley Hospital. There is a high possibility he will not be paid, and, even if he has malpractice insurance, the hospital will pressure or encourage him to "pay off" rather than fight a lawsuit in court.

In addition, if one has very many lawsuits settled out of court, "paid off" as in a "protection racket," or successfully defended in court, they will all be counted as part of his risk profile by the insurance industry, and he may end up being uninsurable as a practicing physician.

The rhetorical question which I will answer is, "Would the hospital be willing to accept doctors that will work free but do not have any malpractice insurance to serve severely injured patients?" My answer is that the hospital would rather let a patient die in an emergency room than have him be seen by a physician known not to have malpractice insurance. It is not "care" but "money" that counts, and the reason the hospital is offering to pay the malpractice insurance for the physician is so that the physician is sure to bear his "fair share," or the entire cost of lawsuit settlements.

I do not say that the patients, the community, the hospital, or the doctors deserve this, but they have nobody to blame but themselves. The only partial answer I can think of is to send patients to the nearest competent hospital for emergency care instead of sending them to a few designated "dumping grounds" under the guise that these are trauma centers. In that way, the risk cost would be averaged over the entire San Diego County medical community at no extra cost to the public, but possibly at extra cost to the more affluent hospitals.

LESLIE PRATT SPELMAN

La Jolla

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