Medical Care and HMOs

I feel compelled to write this letter in response to “Death of Patient at 44 After Surgery Raises Questions,” July 27, concerning the death of Rudy Ruiz. I was the attending physician for Mr. Ruiz during his hospitalization at St. John’s Hospital. I was shocked and saddened by the death of Mr. Ruiz. My heartfelt sympathy goes out to his wife and family.

After reading the article, I was very frustrated. The article implies that Mr. Ruiz may have been discharged early in order to shorten his hospital stay, thus saving the medical group money. This is absolutely false. Mr. Ruiz was discharged in a timely and appropriate manner. I do not condone that type of practice nor have I been approached by my medical group to discharge a patient early solely for the purpose of cutting health costs. This is inappropriate and totally unacceptable.

Although the article creates some doubt and concern as to why Mr. Ruiz was discharged on March 18, I felt confident with his release from the hospital. The article also states that Dr. Swerdlin did not approve of Mr. Ruiz’s discharge because of a noted fever that day and the need for daily dialysis. It also raises the question as to why I did not contact Dr. Swerdlin prior to his discharge. Simply stated, Mr. Ruiz did not have a fever on the day of his discharge nor did he require daily dialysis. I did not contact Dr. Swerdlin because he was not the nephrologist involved in the case. Dr. Stevenson, his partner, and I managed the care of Mr. Ruiz throughout his hospital stay. Only after my evaluation and review of the case with Dr. Stevenson did I feel comfortable in discharging Mr. Ruiz. He was sent home with appropriate medication and was scheduled for outpatient dialysis.

It seems The Times has the tendency to refer to a physician who manages HMO patients as an “HMO doctor.” I am a medical doctor who serves a diverse group of patients from different economic and ethnic backgrounds. These factors have never played a role in deciding what type of treatment my patients receive. I treat them all the same, with respect, courtesy and dignity regardless of their insurance status. It angers me that this article would suggest that there is a different type of health care that denies patients with HMO insurance access to quality care. This is absurd and insulting.

ERNEST A. PILLADO, M.D.

Camarillo