We are physicians practicing at Shady Grove Adventist Hospital, and we and our colleagues take issue with Avram Goldstein's Oct. 17 and Oct. 19 articles about the hospital [Metro]. Some of our colleagues revealed not only the confidential proceedings of the Medical Executive Committee but also clinical details about patients whose cases were being handled through our peer-review mechanisms. Medical staff as well as the hospital administrators are barred from discussing the details of these cases by state and federal regulations, and therefore Mr. Goldstein's reporting appeared to stand unchallenged by the hospital's leaders.

In the context of the nearly 140,000 patient encounters that take place at Shady Grove Adventist Hospital each year, the four incidents cited hardy constitute "rampant errors." The unbalanced nature of Mr. Goldstein's article damaged the reputation of a fine hospital. That the Medical Executive Committee proceedings were leaked to the press within hours also left no chance for the administrators or governing board members to deal with the physicians' concerns expressed at that meeting.

Medical-surgical nursing units traditionally have a high turnover as nurses seek reassignments in specialty units or less stressful positions. Prior to the press reports the hospital had instituted a program of mentoring, lectures and specialized training to ensure quality of care. There has been a shortage of nurses on a national level for many years, and Shady Grove Hospital has had a program in place to recruit new graduates.

The financial pressures that led to staff cuts are the result not only of pressures in the health care industry to reduce costs but also of the announcement earlier this year by the Maryland Health Services Cost Review Commission that every hospital in the state would need to reduce costs by 10 percent during the next three years.

The public expects continued high-quality care, and the necessary changes can only be made by close consultation with physicians, nurses and others involved in patient care. This was the real message of our Medical Executive Committee, a message with which we agree.

MARSHALL ACKERMAN

CARL SCHOENBERGER

Rockville