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Patient Wasn't Willing to Play by Kaiser Rules

October 30, 2000

Regarding your Oct. 23 article "He Knew What He Wanted, but His HMO Disagreed," it is clear that The Times chose to create a story where none existed. If, in fact, Don Pugh is a "consumer's consumer" as stated in your piece, then he surely knows that "for 30 years" he had a contractual agreement with a "closed health-care system"--namely, Kaiser Permanente of Northern California.

Kaiser is and always has been a self-contained system. A system from which the Pughs and their family received "top-notch care for 30 years. His wife, Sandie, delivered both of their children at Kaiser. . . . Pugh is convinced that Kaiser spared no expense along the way." Kaiser doctors were "very thorough, very clear in their diagnoses." Then, one day, Pugh chose to rewrite the contract! Pugh expects Kaiser to cease being his HMO and become a traditional insurance company. Clearly, Kaiser could never survive if it granted all such demands.

--FRANK L. JAMESON Jr.

Pasadena

*

I began reading expecting a nice, juicy case of an HMO gone bad. Instead, I see glowing reports by the patient and an HMO that reconsidered their stance without any proof that they would have been forced to had the decision actually gone through the appeal process. Much is made of the absence of specific statistics on the success rate (of surgical procedures). However the absence of evidence is not the evidence of absence. These are, I presume, board-certified physicians with training in the procedure described.

As you may guess, I am an "HMO doctor." But I also am a consumer and read with interest any reports of malfeasance by "big business," especially when it has to do with health issues. But I would prefer the editorializing in the title not be contradicted by the bulk of the report. This report may well have been titled "Good Consumerism Equals Good Health Care" or "An HMO Sees the Light!" It's a shame that you examine the question of why board-certified physicians trained in a procedure are not "good enough," instead of why it should cost $30,000 to obtain this procedure "on the outside."

--NICOLAS WIEDER

Los Angeles

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Your article on Don Pugh did a disservice by worrying people who need HMOs--people who, unlike Silicon Valley-enriched Don Pugh, could not even dream of raising $30,000 for optimum care. HMOs are for-profit businesses that fill a niche for those needing economical health care. However good, HMO doctors are not the absolute top of their profession. Those are found where Pugh found Dr. (James) Brooks--at a teaching hospital. And they cost plenty, more than any HMO could lay out for each patient in exchange for the premium they collect. Only in health care do people like Pugh expect the best on the cheap. Pugh was not entitled to what Kaiser was bullied into providing. Obviously, they gave in because the stink he was raising could cost them more than $30,000 in public relations.

--BERNARD S. KRAUSE

Camarillo

*

If it were my prostate, my potency, my continence and possibly my life, I'd find out the name of the head prostate surgeon in the known universe, beg, borrow or steal the money, and go have my operation, my HMO be damned!

--JOHN ELFMONT, MD

Torrance

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