Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
A Harrowing Tale of Racism
I liked the article “The Making of Reluctant Activists: A Police Shooting in a Hospital Forces One Family to Rethink American Justice” (May 10). As a physician in Texas, I reached out to the senior Dr. Pean the day after the shooting. I encouraged the Harris County Medical Society to advocate for this family and got nowhere. I wrote several times to the then-current president of the medical society and got nowhere. Medicare threatened to shut down the hospital because of this incident and then the president of the medical society protested the shutdown but not the shooting. Although the president of the medical society was Latino, he showed no concern for the doctor’s part-Latino son getting shot. I have stayed in touch with the family and have been pleased with their successes.
— Dr. Robert Jackson, Houston
— S.E. Smith, Fort Bragg, Colorado
The article about the Pean family is informative about this pernicious, persistent type of American racism. As a 70-year-old African American woman, I know it well. My question is, What is the health industry doing to alleviate the scourge that destroys the minds and bodies of people of color? Publishing a meaningful article on the Pean family is not enough.
— Evonnie Gbadebo, Windsor, Connecticut
Care Inequities Extend Beyond Race
I’m tired of hearing about racial disparities (“Stark Racial Disparities Persist in Vaccinations, State-Level CDC Data Shows,” May 20). How about some comments about people with disabilities who live independently and don’t have caretakers to do everything for them?
I had a negative experience at a local pharmacy getting my covid shots. The first shot, I bore with it but complained loudly about lack of accessibility. The second shot, nothing had changed so I made a bigger scene about it.
I hope they finally got their act together, but I can’t go to every single pharmacy in the country and tell them we need signage to tell us where to go for accessible service. (In this case, the pharmacy counter might have worked.) Also, they need to have their questions in writing, in advance.
I’m not surprised that the Centers for Disease Control and Prevention data is incomplete. I haven’t seen any stories about outreach to deaf or hard-of-hearing people either, and given that everyone is wearing masks, I found getting a shot unpleasant for lack of communication during the process. The waiting line was wholly audist-oriented with no hand signals, the questions were incomprehensibly spoken, and the drugstore had no signage to help anyone with disabilities.
— Therese Shellabarger, North Hollywood, California
— Dr. Céline Gounder, New York City
The Push-Pull of Dentistry
Here’s another questionable dental revenue-generating tactic: When many dentists say, “We take all PPOs,” it really means: “Even though we are out-of-network, we will bill your PPO instead of you having to submit an out-of-network claim.”
It’s a common business practice in dentistry (“Why Your Dentist Might Seem Pushy,” May 19). People get hit with surprise balance bills and think it’s their “bad” insurance coverage instead of the intentionally misleading (and usually nonexistent) explanation of their dentist’s out-of-network relationship with their insurance carrier. The front desk does this, the dentists themselves do this, and their webpages about insurance do it.
And again, it all boils down to dentists generating more revenue than they otherwise would, either because they’d have to accept the lower contract rate if they were in-network or they’d outright lose the patient when they find out they are actually out-of-network.
Making matters worse, some people “love” their dentist and don’t take the time to research in-network dentists who they might also love if they went to them, so they pay the extra to stay with their dentist and figure it’s “worth it.” The widespread fear of dentistry plays into this, too — the dentists act nice, the patient likes them and believes they are therefore a good dentist because they are nice and the patient didn’t have a bad dentistry experience, in the end creating loyalty that is then exploited with the PPO scam. Hashtag caveat emptor.
— Jonathan Greer, Rockridge Health Insurance, Oakland, California
— Harry Sit, Reno, Nevada
Dental Care Is Essential
I write in response to your article “Why Your Dentist Might Seem Pushy” (May 19). The piece’s lack of empirical or systemic data is troubling and dangerously downplays the important work done by dental professionals every day.
There are often allegations of fraud and abuse in all industries, unfortunately including health care. However, the percentage of complaints has been consistently low in the dental industry. According to the National Health Care Anti-Fraud Association, each year roughly 5% of the $250 billion spent on dental care procedures are associated with alleged fraud or abuse, compared with up to 10% in other health care fields, as noted in the article. Suggesting that dentists regularly push unnecessary procedures to drive up profits is false and damaging to the dental profession and patients’ perception of dentistry. Dentists provide essential care that keeps patients healthy.
At the core of improving oral health is the dentists and their entire team who play a crucial role in providing safe and accessible health care for communities across the country, especially in underserved areas. Many studies have shown that that dental care is critical for early detection and prevention of diseases, including heart disease, stroke and diabetes. Additionally, more recent studies have shown that increased dental hygiene also greatly increases a patient’s chances of surviving covid-19.
Many of the Association of Dental Support Organizations members, in fact, provide charitable care and dentistry to thousands of patients annually. As executive director of the ADSO, I am proud of our members who always put patients and their safety first. Our members are enabling their supported dentists to focus on patients, expand access to underserved communities, and maintain high-quality standards for essential dental care and business operations.
— Andrew Smith, executive director of the Association of Dental Support Organizations, Arlington, Virginia
— David Hodges, Portland, Oregon
A Footnote on Breakthrough Covid Cases
Regarding Steven Findlay’s article “The Shock and Reality of Catching Covid After Being Vaccinated” (April 16). First of all, Mr. Findlay, I am sorry to hear that you got covid after your second shot. That’s a drag. But in your article, don’t you think you might have given the wrong impression about the likelihood of this happening?
You wrote: “A tiny but growing number are contending with the disturbing experience of getting covid-19 despite having had one shot — or even two.”
A “growing” number, I think, gives the wrong impression that the proportion of breakthrough cases is growing. That would be worrying. But isn’t the number only “growing” because more people are getting vaccinated?
In that case, it is entirely unremarkable that the number is growing, so why the “but”?
I’m extremely concerned about vaccine hesitancy in this country, and I’m far more worried about your article reinforcing that hesitancy than I am about myself contracting a breakthrough case.
— Jason Hodin, Friday Harbor, Washington
— Chris Collins, New Orleans
An Aha Moment on Stroke Care
Thank you. I am more educated, and quite horrified, about the condition of the state of our state‘s and nation’s health care predicament (“In Appalachia and the Mississippi Delta, Millions Face Long Drives to Stroke Care,” May 4). Your insightful investigative reporting should be a catalyst for communities to seek funding for our loved ones. I plan to share with my county commissioners and state legislators. Again, many thanks.
— Judge Tammy Jackson Montgomery, Coatopa, Alabama
— Jessica Gottlieb, Los Angeles
My Primary Care Physician Virtually Aced It
Really excellent and insightful cautionary commentary on the “virtual medicine” phenomenon (“Telemedicine Is a Tool — Not a Replacement for Your Doctor’s Touch,” May 6). It is true that most of one’s interactions with one’s doctor are informational (assuming that one does not suffer from a dread disease). But communication via email is optimal only when one has an established relationship with the physician over time, and when the physician has access to the patient’s rich electronic medical record (EMR). The best expression of the role of “virtual medicine” is the use of multi-modality communication between patient and primary care physician in the Kaiser Permanente model.
I’ve been a KP Medicare Advantage member for over eight years, and my health status is managed as a collaboration with my KP primary care physician. In our initial intake physician exam, I told him I have a boring EMR, but I’m a whiner, so he could expect to hear from me regularly. I asked him to make sure that I continued to perform well on the tennis court. He responded by saying that it is a mutual responsibility. So, over the past eight years, we have communicated almost exclusively by email. He always responds within 24 hours, and usually by the end of the day. Twice during this period, I reported symptoms that could have indicated a serious clinical issue. In each case, the response was immediate, with a referral to a specialist(s) within KP who, of course, had access to my complete EMR.
When I received a covid vaccination outside the KP network, we made sure that documentation was added to my EMR. So, within the KP model, “virtual medicine” is clinically efficient and cost-effective, because patient and physician are communicating within a very high-quality health care delivery system. Immediate access to well-informed clinicians is assured. This is very different from the many emerging for-profit ventures that promote services of dubious quality or clinical effectiveness — really, most are little more than rebranded, app-enhanced “nurse advice lines.” Thanks for a great op-ed.
— Tony Pfannkuche, Los Angeles
— Torshira Moffett, Washington, D.C.
— Steven Maviglio, Sacramento, California
The Pandemic Demanded Workarounds
This article’s implicit conclusion of wrongdoing at the expense of a public agency is quite egregious and short-sighted (“Salesforce, Google, Facebook. How Big Tech Undermines California’s Public Health System,” May 6). This unprecedented health crisis needed quick, decisive actions and policies. The current bureaucracy has consistently proven itself to be too slow in response due to its many layers of management’s accountability. The governor’s working relationship with high tech was instrumental in keeping California’s health crisis under control.
Why people complain after the fact is representative of what is wrong currently in society, creating unnecessary division. I’m not saying unbridled praise should be heaped upon Gov. Newsom, but to look for negativity or wrongdoing for the sake of an article was pretty shallow.
— Warren Young, San Francisco
— Tom Merrill, Salt Lake City
CHL link, May 18: https://californiahealthline.org/news/article/pandemic-seniors-lose-strength-conditioning-may-need-rehabilitative-services/
Bolstering Medicare Coverage to Keep Seniors Strong
As you rightly point out, after 15 months of sheltering in place, older Americans are increasingly being negatively impacted by the indirect health effects of covid-19 — including loss of strength, mobility and independence (“As Pandemic Eases, Many Seniors Have Lost Strength, May Need Rehabilitative Services,” May 21). For many seniors, this prolonged period of “physical deconditioning” has put them at serious risk of long-term disability, injuries and falls, which cause 2.8 million emergency room visits every year.
Recognizing the long-term health impact of the pandemic on America’s seniors, physical therapy services will only grow in importance. That’s why it’s troubling that Medicare has chosen to push forward with significant payment cuts for physical, occupational and speech therapy services. Though Congress temporarily reduced the cuts last year, our specialty faced one of the steepest declines in Medicare spending — a whopping 34% — during the first six months of 2020. As demand for our services grows, it is critical for Medicare to protect seniors’ access to the medically necessary therapy services they need. Instead of implementing these devastating cuts in 2022 and beyond, Medicare should rethink its approach to ensure stability to the system and, ultimately, improve the health and independence of older Americans.
— Nikesh Patel, executive director, Alliance for Physical Therapy Quality and Innovation (APTQI), Washington, D.C.
— Kristin Gourlay, Oak Park, Illinois
Altering Mindsets on Addiction
Although I haven’t been personally affected by the addiction/overdose crisis, I still understand the callous politics involved with this most serious social issue (“Addiction Treatment Providers in Pa. Face Little State Scrutiny Despite Harm to Clients,” April 30). The mere mention of government funding to make proper treatment available to low- and no-income hard-drug addicts, however much it would alleviate their great suffering, generates firm opposition by the general socially and fiscally conservative electorate.
The reaction is largely due to the preconceived notion that drug addicts are but weak-willed and/or have somehow committed a moral crime. Ignored is that such intense addiction usually does not originate from a bout of boredom, where a person repeatedly consumed recreationally but became heavily hooked on an unregulated often-deadly chemical that eventually destroyed their life and even that of a loved one. The greater the drug-induced euphoria or escape one attains from its use, the more one wants to repeat the experience; and the more intolerable one finds their sober reality, the more pleasurable that escape should be perceived. By extension, the greater one’s mental pain or trauma while sober, the greater the need for escape from reality, thus the more addictive the euphoric escape-form will likely be.
Regardless, we now know pharmaceutical corporations intentionally pushed their very addictive opiate painkillers (perhaps the real moral crime), for which they got off relatively lightly, considering the resulting immense suffering and overdose death numbers.
— Frank Sterle Jr., White Rock, British Columbia
— Angela Biesecker, Philadelphia
Going to Bat for Nurse Anesthetists
As the covid-19 outlook improves, the toll on health care providers caused by the virus is unprecedented. Nurses have risked their lives as they dealt with shortages of protective equipment, medications and personnel — all while infections, hospitalizations and deaths from the disease soared.
Yet nurses have risen to the challenges, courageously caring and providing life-sustaining services to millions of patients. So, why do some question a nurse’s right to practice to the full extent of their education and training?
Nurses do most of their demanding work out of the public eye. And even less understood by the public is the number of specialties in nursing, particularly those of advanced practice registered nurses. Consider the “nurse anesthetist” or Certified Registered Nurse Anesthetist (CRNAs). Unless you have had surgery and/or delivered a baby, chances are you have never heard of the highly educated, expertly trained CRNA.
Surveys show that more than 70% of CRNAs report treating covid patients. We have seen these health care professionals travel to hot spots to provide lifesaving care. Because of a CRNA’s expertise in airway and ventilation management and other critical care skills, CRNAs have become a highly sought-after health care provider — capturing the attention of the federal government. Recognizing the need for CRNAs to be working to the top of their training, the U.S. Department of Health and Human Services waived the federal physician supervision requirements for nurse anesthetists. Because of the temporary changes to the law, CRNAs have been able to safely fill essential health care needs during the national crisis.
A new report from the National Academy of Medicine, “The Future of Nursing 2020-2030,” prioritized several opportunities in the nursing profession for eliminating health care disparities, including the permanent removal of barriers to nursing care that were enacted in response to the pandemic. It also calls for allowing nurses to practice to the full extent of their education and training as well as ensuring that they can bill for those services.
So, why snatch back a CRNA’s full practice rights, after hundreds of thousands of patients received safe, exceptional, life-sustaining care before and during the pandemic?
Some special interest groups argue that the federal physician supervision requirement is necessary, asserting that the waiver lowers the standard of care and risks patients’ lives. This kind of fearmongering lacks true evidence and attempts to confuse the public. Nurse anesthetists are highly educated practitioners whose patient safety records stand for themselves. In fact, 42 U.S. states do not require physician supervision of a CRNA in their state nurse practice act.
Now is the time to put an end to any type of pronouncement that questions the role, value and safety of CRNA-delivered care.
— Steven M. Sertich, president of the American Association of Nurse Anesthetists, Park Ridge, Illinois
