Rebutting Hospital Article

I would like to offer the following rebuttals to information contained in your July 8 article, "Doctors Vie for Roles at Hospital."

As chief of the Loudoun Hospital medical staff and ex officio member of the board of directors in 1996 and 1997, I have direct knowledge of these issues. My practice integrated with the hospital in May 1997.

1) Salaried or "integrated" physicians receive preferential appointments to hospital committees.

This charge probably refers to the Care Management Committee (CMC). The CMC governs the integrated physician group and is composed only of integrated physicians and hospital representatives. The CMC negotiates, accepts and rejects contracts with managed care and other insurance companies. Independent physicians cannot legally engage in these activities because they have no recognized business associations. If independent physicians participated in the CMC, or negotiated on their own, it would invite unwinnable antitrust litigation from insurance companies.

The ability to legally and collectively bargain in the medical marketplace is the prime advantage of integration.

All other standing committees of the medical staff have indiscriminate membership of integrated and nonintegrated physicians. Because committee work is time-consuming, only the most committed physicians participate.

2) Integrated physicians are exclusively appointed to the board of directors.

I was present at the board meeting where this idea was proposed. The board gave this no consideration whatsoever. The measure could not even muster a motion.

Three of the four physician board members are indeed integrated. However, two of the three were elected to the board long before physician integration was even entertained at the hospital. They subsequently integrated. The third physician in question was elected to fill a prematurely vacated seat because of his expertise on current issues, not because of his integration status.

All board members abstain from participating in issues where there exists a conflict of interest.

3) The administration offered nominations for medical staff leadership for the 1998-1999 term.

Every department of the medical staff was solicited for nominations and endorsements for chief and vice chief of staff. A nominating committee composed of equal numbers of integrated and nonintegrated physicians submitted a slate of nominees. The business affiliations of individuals was not a criterion for their selection. The hospital administration had no input into the nomination and election of medical staff leaders.

Dr. Walter O'Brien and Dr. Russell McDow were fairly elected.

4) The hospital sets up physicians in competition to independent doctors.

The hospital has actively recruited physicians and developed practices in areas and specialties where there is obvious shortage in the community. This is an explicit part of its mission.

The hospital has been particularly successful in developing adequate numbers of primary care physician (PCP) practices.

Because managed care companies require referrals from PCPs for patients to see specialists, the specialty physicians, most of whom are independent, have benefited greatly from the hospital's recruitment efforts.

There has never been any explicit or implied pressure from the hospital for PCPs to refer to any specialist other than the one they think is most appropriate for their patients.

Most importantly, patients have easy and local access to health care.

Distrust, conflict, suspicion and jealousy between purely independent and hospital-associated physicians is nothing new. It is probably not as pervasive and severe as the current climate would have you think.

ANTHONY E. CROWLEY, MD

Leesburg and Sterling

Hold Hatrick Accountable

At its July meeting, the Loudoun County School Board voted 6 to 3 to give Superintendent Edgar Hatrick an 8 percent pay raise, increasing his pay from $120,000 to $130,000 per year ["School Board Gives Hatrick Pay Increase," July 15]. This comes on top of the 9 percent increase he received last year. During the same two-year period, Loudoun County public school teachers received annual increases of 5 percent.

On what basis did Dr. Hatrick receive these generous increases? Unfortunately, that is a question none of us can answer, since the School Board's deliberations are done behind closed doors. Who sets the goals for the superintendent's performance? What are those goals? With 67 percent of our county's budget going to the school system, it seems more than reasonable that the citizens of Loudoun County should have far more information about the performance expectations of our school chief than we are currently receiving. The one tidbit of information the public received at the meeting, however, was very enlightening. It came from Harry Holsinger, the Blue Ridge School Board member, who stated that he would like to see future increases tied to set student achievement goals.

That comment should raise a red flag for every citizen in Loudoun County. Our school superintendent received a $10,000 raise that was in no way tied to specific performance goals for county students. There is an appalling lack of accountability here. Test scores, while not the only way to measure student achievement, are certainly one objective way to view performance. And test scores on the SAT and Stanford 9 and its predecessor, the ITBS, have been flat in the last few years. While higher than in many other parts of Virginia and the nation, most Stanford 9 scores are in the 60 percent to 70 percent range, certainly more mediocre than one would expect for an affluent county like Loudoun. How did Loudoun students perform on the second round of SOL tests? This information still has not been made public, though it has been readily available for the past month. And what about the performance of minority students in Loudoun County public schools, which consistently lags behind? When will we begin to hold our top administrator accountable for failing to correct this persistent problem?

Some on the board who voted for the raise will try to make the argument that Dr. Hatrick makes less money than do some of his counterparts in the area. The argument does not wash, since Dr. Hatrick presides over a school system that is far smaller than most of our surrounding jurisdictions. Also, some of those school systems, like Fairfax's, are now directly tying their superintendents' performance objectives to student achievement and making those goals public. Furthermore, if School Board members were truly concerned about keeping up with our neighbors, then why haven't they done more to ensure that teacher salaries have kept up with the surrounding jurisdictions? Loudoun County continues to lose the very best and brightest of our experienced teachers every year to Fairfax County, whose salary scale at the mid and upper ranges far exceeds our own. Teachers are at the heart and soul of our school system, and there are few factors more closely tied to a student's performance than the quality of the teacher standing in front of the classroom. It is outrageous for the School Board in times of tight budgets to continually vote a larger pay increase to its chief administrator that to its classroom teachers. Kudos to Mr. Holsinger, Kim Price-Munoz (Sterling) and Jeffrey Maged (Leesburg) for possessing the good common sense to vote against the increase.

This is an election year. It is time to send a message to those School Board members running for reelection who have demonstrated that their priorities are clearly misplaced when they continue to provide generous raises to the superintendent at the expense of our classroom teachers. They are: Candyce Cassell (Sugarland Run), Wendall Fisher (At Large), Susan Hembach (Broad Run) and Joseph Vogric (Dulles).

MICHELE ZUCKERMAN

Cascades

* Editor's note: Zuckerman is a School Board candidate for the Broad Run District seat.

Flag Burning Is a Right

Rep. Frank Wolf (R-Va.) responded to my concern about his support of the flag burning amendment by asserting that "desecrating . . . goes beyond . . . free speech . . . into the realm of prohibitive conduct."

My problem is not with free speech but with the Declaration of Independence. The amendment suggests that someone who burns a flag, which has happened rarely since the people correctly rose up to end the Vietnam War, is a criminal. In fact, such an act is the highest form of patriotism, asserting that our government no longer reflects the goals and objectives of its people. It is a primary recourse of a person objecting to policies of the federal government. Putting a person in jail for doing so is not exactly what the Declaration had in mind.

Making flag burning a crime actually enhances its impact. Can you imagine putting into the gas chamber 200,000 flag burners arrested on the Ellipse in protest of some damn fool international venture? Utter nonsense.

I do not understand why the government has to have the right to arrest and punish people who object to government policies by burning some bunting but not when they object by any other means. That is exactly opposite to what a democratic society and the rest of the Constitution is all about.

You could call this problem, Metaphysics at the Flagpole. When we salute the flag, it is a symbol of the nation; when we burn the flag, it stands for our government. We fought for our right to disapprove. Burning the flag of our government, when it misbehaves, is a right that cannot be amended away.

JIM ROCKS

Leesburg

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