Fatal Flu

Putting People First

A global influenza pandemic is one of the greatest and most likely threats to human health. We commend Seattle Weekly and Roger Downey for bringing this issue to the fore ["Fatal Flu," July 27]. Downey's article will surely help the public make sense of bird flu in Southeast Asia and understand the risk of a global outbreak. We also appreciate his recognition that local preparations are important, and that we need resources to meet the challenge of a potential pandemic flu.

The article raises some public-health-related issues that warrant clarification to best serve the public.

Public Health Puts People First: Public Health and the broader health care community are taking steps to prepare for a pandemic that focus on limiting its spread and providing the best possible care for those who become ill. It's clear that we cannot guard against all contingencies and that a severe outbreak would test our capacity in ways unknown for half a century. The article seems to imply that institutions are being prioritized over people when in fact we are working to save lives and reduce illness by strengthening the institutions the public will turn to in a pandemic.

The Public Can Help: Downey pokes friendly fun at the basic steps people can take to protect themselves and others during a pandemic, such as frequent hand washing, covering your cough, and staying home when you are ill. In fact, these simple actions are quite effective and can help reduce the spread of the disease.

In partnership with our community, state, and federal colleagues, Public Health–Seattle & King County will continue to prepare for a pandemic flu outbreak. Our goal will always be to do as much as humanly possible to protect the public's health.

Greg Kipp

Chief Administrative Officer, Public Health–Seattle & King County

Masking the Problem

Roger Downey's important article "Fatal Flu" [July 27], about the crucial need for local planning in advance of what may be an imminent avian influenza pandemic, makes one point with which I routinely quibble: the notion that "cheap paper masks are totally useless."

In some ways, Downey is right. Such masks are permeable to virus particles. They will not entirely contain droplets sneezed or coughed by Cheap Mask Wearer No. 1. They may not entirely protect Cheap Mask Wearer No. 2 from sneezed or coughed droplets from others. But picture Cheap Mask Wearer No. 3, who is trying hard to follow CDC directives to wash your hands often and avoid touching your face when in public places, where surfaces (picture it: subway poles!) are germ-infested. Cheap Mask Wearer No. 3 is in a crowded subway, with his nose itching like crazy. He lets go of the subway pole to scratch—and encounters the mask, reminding him not to touch his face until after he's had a good wash.

The recommendations to "cover your mouth when you cough and sneeze," "wash your hands often," and "avoid touching your face with dirty hands" are, in effect, arguments for the relative utility of wearing a mask—any mask—as a reminder about these hygiene habits which are so hard to follow in public.

Downey's excellent article also calls attention to the dilemmas that officials face, including the risk of being accused of overreacting versus underreacting to a disaster that may or may not happen, and the impossibility of ever being totally prepared. Seattle/King County, during the long tenure of former Public Health Director Alonzo Plough, became known in disaster planning circles as one of the most actively preparing regions in the country. Office of Emergency Management Director Eric Holdeman hosts a highly respected preparedness Web site, Eric's Corner, which is consulted by emergency response officials from all over the world. Nevertheless, local officials Jeff Duchin and Michael Loehr candidly acknowledge the county's present unreadiness to cope with an almost unimaginable public-health catastrophe like a severe flu pandemic. They trust that the Seattle-area public is mature enough to cope with this scary reality. The public is likely to trust them in return, both now and when the pandemic actually begins.

Jody Lanard, M.D.

Princeton, NJ

Whistle-Blower Speaks

As the whistle-blower in the University of Washington billing fraud case, I applaud Rick Anderson and Seattle Weekly for your coverage of this scandal ["Unimpressed Whistle-Blowers," July 27]. Regarding the UW's "independent" review of said scandal, I believe that the review board did a fair job of looking into the particulars of the UW Medical Center's role in the scandal and how to try to bring them into compliance. However, the report was lacking in certain areas of their analysis of the private billing/administrative companies that are UW Physicians (UWP) and Children's University Medical Group (CUMG). I was never an employee of the UW Medical Center or the state of Washington. It was the private companies that I worked for and against whom I filed my lawsuit. Whether the review committee was unwilling or unable to look at the billing companies in depth is open to debate. UWP and CUMG handle the clinical billing and certain administrative functions of the physicians who teach at the University of Washington Medical School, and it is through UWP and CUMG that these physicians are able to augment their state salaries. The fact is that these companies, as privates, are not required to open their books to the state auditor. They are allowed to operate without regard to certain rules and regulations that state-controlled entities must follow. Indeed, a recent UW Faculty Council on Faculty Affairs report noted that UW School of Medicine and Dean of Medicine reserves "held by UWP and CUMG" totaled $81 million. Why are these monies being held by private companies? Shouldn't they be held directly in a state of Washington or School of Medicine reserve account? Regardless, UWP and CUMG should be subject to much greater transparency, but until their bylaws are changed, the oversight that the review committee has recommended for the rest of UW Medicine will continue to cast a blind eye

to the inner workings of UWP/CUMG. I wish only the best for UW Medicine, but tremendous liabilities remain and must be dealt with if they are to truly "move forward."

Mark Erickson

Seattle

Malpractice Fine Print

I enjoyed Nina Shapiro's article ["Distort Reform," July 27], and it was very balanced. But one thing needs to be clear. The amount of the cap in Initiative 330 is $350,000, and the "exception" will never occur. The medical malpractice insurers want people to think the cap is $350,000 with exceptions that can bring it to about $1 million. But the exception is so theoretical that it is often referred to as the "flying saucer exception." For it to apply, there must be a unique set of circumstances combining medical negligence and nonmedical negligence in a very specific setting. Frankly, in 25 years of handling medical malpractice cases (20 for the defense and the past five for plaintiffs), I have never seen or heard of a case where this would apply. People should be aware that for more than 99 percent of all cases, the cap is $350,000. To claim otherwise is inaccurate.

Also, a cap would punish the meritorious case where the jury, judge, and Court of Appeals were all convinced that the defendant committed malpractice that seriously injured a patient. The cap does not affect "frivolous" cases. It means the negligent doctor or hospital does not have to pay for the injury they caused. So the insurance company saves money.

And nothing in I-330 will reduce premiums. The largest insurer of doctors in the state has twice been forced to return premiums this year for gouging its insureds, the doctors.

Reed Schifferman

Seattle

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