Should Lawyers Invest in Their Clients?
Re: "Inside a Prominent Lawyer's Practice of Investing in His ASC Clients" (April, page 12). Having worked in the ASC industry for more than 15 years, I have to commend Outpatient Surgery Magazine for taking on a sensitive issue that needed to be addressed.

I have known Scott Becker from my early days in the business and I both respect and admire much of what he has done. He is a strong proponent of the ASC industry and has done an awful lot of good things. However, when it comes to self-promotion and working both sides of the fence, there comes a point when someone has to stand up and bring into question his relationships with the surgery center companies that he represents.

It is well known among many in the industry that he has profited by placing himself in the precarious position of orchestrator, advisor, client and partner to many of the companies that he promotes and represents. Whether it is 1/10th of 1 percent or 10 percent, it does not matter how much he owns in a company — the fact of the matter is, it is inappropriate to own a piece of a company that you represent, promote and are paid by.

Many people in the industry feel the same way and refuse to do business with him for just this reason. Many more feel it is essential to their success to be involved with him. His publication is for the most part self-promotional and points to, almost exclusively, people that he does business with. All of us in the industry who feel this way know that we cannot sign our names, for it would significantly impact our relationships and the business that we do in the industry, but Outpatient Surgery Magazine should be commended for doing the right thing.

Name withheld upon request

I have worked with Scott for almost 10 years and he does not own shares in our center. He gives excellent legal and business advice. I believe if you know him, you would find it hard to question his ethics on this or any issue.

Mike Pankey, RN, MBA
Administrator
Ambulatory Surgery Center
of Spartanburg
Spartanburg, S.C.
[email protected]

Not Fit for Print
Re: "Cutting Wit" (April, page 88). I have worked in the operating room for 35 years and I must say that I think this column is unfit for printing, and is extremely inappropriate. We all know what things are said in OR settings, but I think you are unprofessional, immature and really desperate for information to publish this.

Dale Alonzi, RN
Charge Nurse/Director of Nursing
The Urology Center of Colorado
Denver, Colo.
[email protected]

Wash, Wear Your Own Scrubs
Re: "Our Readers Come Clean on Home-laundered Scrubs" (March, page 36). Based on no real evidence of increased infections with self-laundering, we decided our staff would purchase their own scrubs. We set a color standard (seal blue and navy blue) and pattern. Two rules: No cartoon characters and staff must change into the scrubs they bring from home here at our facility. Our staff loves the ability to express their individuality. We provide scrubs for our physicians, but some of them have been wearing their scrubs from home or from another facility.

Tanya Mueller, RN, BSN, MHA
Clinical Director
Sentara Obici Ambulatory Surgery
Suffolk, Va.
[email protected]

CRNAs Represent a Cost-effective Alternative
Re: "Anesthesia and the New Economics of GI" (October 2007, page 45). Although some GI clinics do have anesthesiologist involvement, it's necessary to point out that there is no mention of the role of the certified registered nurse anesthetist in providing the same level of anesthesia care in GI clinics as anesthesiologists. Regrettably, your article makes no mention of what a CRNA even is. (Please go to www.aana.com for more information on CRNAs).

The real economics of using CRNAs instead of anesthesiologists is the fact that a CRNA's salary is nearly half that of an anesthesiologist's. That savings is passed on to the patient in the form of lower costs to provide anesthesia. While very ill individuals do need specialized care because of their co-morbid conditions, CRNAs have been providing that level of care since World War II. It is amazing that some anesthesiologists still believe that they are the end-all and be-all of anesthesia care. Unfortunately, those few have misinformed some of their surgical colleagues that their presence is a medical requirement when it is not. That way of thinking is not serving the public interest in terms of safety nor in providing patient access to care. It really is time for journals such as Outpatient Surgery to look at the whole economic picture and see the advantages of using CRNAs, especially when the purpose of the article was "economics."

Mark Green, CRNA, MSN
[email protected]

Climbing the Corporate Ladder
Re: "Are You Management Material?" (April, page 22 ). Just a quick note of thanks for this helpful article. As an administrator, I have a goal to be a part of the VPs of management at some point in my career and I possess the willingness to do whatever it takes to learn all the clinical areas that I'm not familiar with. A road map is greatly appreciated.

Beverly Baker
Administrator
Timberlake Surgery Center
Chesterfield, Mo.
[email protected]