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Local lawmakers sponsor mastectomy legislation

January 30, 1997

By GUY FLETCHER

Staff Writer

ANNAPOLIS - Dealing with the trauma of being diagnosed with breast cancer last October was difficult enough for Del. Louise V. Snodgrass.

But when she underwent a lumpectomy last November, she was in for another jolt when hospital medical staff in the recovery room at Frederick Memorial Hospital asked if she was ready to go home.

"I could barely sit up, I was so drugged ... I thought to myself, `You've got to be kidding me,'" Snodgrass, a Frederick County, Md., Republican, said during emotional testimony to the Senate Finance Committee Thursday.

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Snodgrass was speaking in support of proposed legislation that would give mastectomy patients a choice about being released from hospitals the same day as the surgery.

"It's just too soon for women to go home," said Joan Fell, executive director of Y-Me of the Cumberland Valley, a breast cancer support group.

Dr. Frederic Kass, a Hagerstown oncologist, said he's concerned that health insurers and health maintenance organizations (HMOs) are pushing for the so-called same-day mastectomies - sometimes referred to as "drive-by mastectomies" - as a means of cutting costs, while ignoring the health risks to the patients.

"I think it's a situation of significant concern," Kass said.

Two local lawmakers are sponsoring mastectomy legislation.

One bill, by Del. John P. Donoghue, D-Washington, would require insurers and HMOs to provide coverage for hospitalization for patients undergoing mastectomies deemed necessary by their doctors.

"It puts the decision in the hands of the physician, in consultation with the patient," Donoghue said.

"You're talking about major surgery that, in my view, shouldn't be left in the hands of the HMOs and insurers just for the sake of cutting costs," he said.

The second bill, co-sponsored by Sen. Donald F. Munson, R-Washington, would require insurers to pay for a minimum of 48 hours of inpatient hospitalization following a mastectomy.

Snodgrass, who is now cancer-free, testified on behalf of the Munson bill. She said her operation wasn't as severe as a mastectomy and showed her the importance of inpatient care.

"If I could barely manage with the operation I had ... what happens to the rest of the women (undergoing mastectomies)?" she said.

The Maryland Association of Health Maintenance Organizations said it prefers that decisions about a hospital stay be made by the physician, in consultation with the patient.

"MAHMO health plans do not and should not require outpatient care for removal of a breast," said Sharon Pavlos, the organization's president.

Kass said there is an experimental program at Johns Hopkins Hospital involving same-day mastectomies, but that doesn't mean community hospitals like Washington County Hospital have the means to provide the type of intensive follow-up, at-home care such a program requires.

Kass said going home the same day as a mastectomy might be fine for some patients, especially those who are in good physical and mental condition. "But for the vast number of people, it's not good care," he said.

Fell said same-day mastectomies are not being performed in Washington County Hospital, but the legislation is needed to eliminate the possibility.

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