Letters to the editor

Hospital monitor

Admitting physicians: In case of emergency, hope for the best

Editor, The Times:

Head of Harborview Emergency Department Dr. Michael Copass and medical director Dr. Scott Barnhart are wrong about bringing emergency physicians to Harborview ("Clash over ER training could hurt Harborview," Times page one, Feb. 11).

Clinging to an antiquated model of emergency care shortchanges the residents of the state, cheats University of Washington's trainees, and leaves the UW behind the times.

I trained in both internal and emergency medicine at the UW, and I know both Drs. Copass and Barnhart are excellent physicians. Both are role models for me. American medicine has moved on, though, and emergency medicine has become a fundamental specialty.

Supervision in the Harborview ER is nominal. The attendings are recent internal-medicine graduates — no training in orthopedics, surgery, pediatrics, obstetrics and gynecology, psychiatry or toxicology. In practice, second-year residents and a host of interns and students provide the bulk of care without expert supervision.

Departmental politics color the issue. And qualified academic emergency physicians will demand competitive salaries, certainly a concern to the Board of Trustees. However, a modern emergency department will see increased revenues — many procedures cannot be billed for at Harborview when there is no attending present who is qualified in the procedure.

Beginning with a national search for an established senior academic emergency physician, Harborview should seek the leadership role in emergency medicine that it has in virtually all other fields of medicine.

— Richard B. Ismach, M.D., M.P.H., Portland

Watch for head-swelling

I am a tenured professor of emergency medicine and alumnus of UW's internal-medicine residency. Most of what I know about emergency medicine I learned at Harborview. I am also medical director of a municipal fire department. Most of what I know about that I learned from the Seattle Fire Department and Medic One. I worked and learned in the Harborview ER as a resident and also as a junior faculty member.

The education I received there benefits my patients and my students every day. One has to check one's ego at the door to work there because Harborview is about what works for the ill and injured — not the physicians' pedigree.

No one who rotates in Harborview's ER under Dr. Michael Copass feels unsupervised, I assure you. If UW's emergency-medicine residents aren't learning what they need to know, they aren't paying attention.

I wish my students could rotate through Harborview's ER to see what's possible in an institution with that intense a commitment to emergency care. Harborview could spend a million dollars hiring people like me — it won't mean the care wasn't excellent before or any better afterward.

Harborview needs physicians who are pragmatists, not politicians, whatever their specialty.

— Terence D. Valenzuela, M.D., M.P.H., University of Arizona, Tucson

Alarm malfunction

I was a firefighter/paramedic for 34 years. I watched Harborview's emergency department become the best one I have seen. I and my fellow firefighters/paramedics were very happy when the rules were changed to allow us to take injured firefighters to Haborview. As an emergency department, it stands head and shoulders above the rest.

I can't understand why some UW doctors want to tinker with it. An old firefighter would say, "If it's not broke, don't fix it." There is also a medical axiom, "Do no harm," which may more readily apply.

— Mike Ylenni, Snoqualmie

Losing vitals

As a UW surgery resident, I was gravely concerned with "Clash over ER training." To give consideration to the emergency-medicine residents and their attendings is outrageous, especially because they have played no part in the success of Harborview's emergency department.

Instead, Dr. Michael Copass deserves endless praise for what he has accomplished. He has pioneered a system that places medicine and surgery residents in key management roles, such that every trauma or medical crisis is managed by the appropriate specialty. The result is an incredible training environment and an experienced army of residents who can manage any crisis effectively and efficiently.

More important, this is the strategy that has successfully served Harborview's patients for decades. UW ER residents were recently welcomed into this environment, but have reacted strangely with misguided accusations.

Now the UW Emergency Medicine Department seeks to overtake Dr. Copass' successful emergency department in which they played no part in developing. Whatever their reasons, they are not motivated by an attempt to improve quality. If they succeed, the medicine and surgery residents would lose a valuable part of their training and Dr. Copass would lose one of the greatest accomplishments of his career.

— John T. Droesch, M.D., Seattle

Inverted globe

Dignity stood on its head

Brava! Bravíssima! for Collin Levey's excellent commentary on the U.N.'s Human Rights Commission ("The place where tyrants lecture the U.S. on human rights," guest column, Feb. 11). That thug governments should be so placed spits in the face of dignity. Levey is totally right: Not all countries — or governments — are created equal. The U.N. should bar from such honors — even from membership — the genocidal regimes on this planet. For, if the Universal Declaration of Human Rights stands at the core of the United Nations' entente between nations, why then do violators run rampant down its corridors, much less be given such influence and power?

— Ileana Fuentes, feminist author ("Cuba sin caudillos"), human-rights and women's-rights activist, Miami, Fla.

Buster bashing

Children in the attic

Shame on national PBS leaders for caving in to pressure from reactionary Bush administration officials ("PBS caught in a cultural cross fire over programming," Arts & Entertainment, Feb. 16). It's ludicrous for PBS executive Pat Mitchell to blame the cancellation of the "SugarTime!" episode of "Postcards from Buster" on the idea that children would lack the context of discussing the purported gay subtext with their parents. In that case, keep your kids out of the classroom, summer camp, playgrounds and Sunday school, too, lest another child mention or introduce his or her gay or lesbian parents without "parental context."

If some zealots in the religious right are so afraid the values they taught their children won't hold up to life outside their homes and churches, I pity them.

I have faith that the kind of Christianity I passed on to my kids (which includes following Jesus' example of acceptance of those shunned by religious leaders) will prove much more durable.

— Niki Elenbaas, Kirkland

Modern Stone Age family values

Kudos to KCTS management and board of directors for airing "SugarTime!" ("Hey, Buster, don't be bullied," editorial, Feb. 13). We are glad to live in a community where our local PBS affiliate did not see the need to cave in to the homophobic hype and hysteria so many made of this gentle and wholly appropriate children's television program.

Funny — we don't recall that the "gay ol' time" Fred Flintstone and friends had every night when we were kids ever caused such a flap.

— Barry and Janet Lewine, Woodinville