4The Daily Reflector, Greenville, N.C.Tuesday, January 1, 1974 .1

FeW Other Years Were Like It

We

ALL FOR HIM!

Te have come to the nd of another year and there couldnt have been many like it for the United States.

We saw the end of the Vietnam War, insofar as United States participation was concerned and the return of our prisoners of war, some of whom has spent years confined in North Vietnam.

For the first time in the history of our proud government, a vijcer^r^ident of the United States resigned in rmdterm uiraer a dark cloud.

It is difficult to recalrthat 1973 was also the year that President Nixon tookxiffice for his second term, with one of the largest mandates ever given a president by the voters. The confidence that came with that huge vote quickly disappeared, however, with the revelations of Watergate, both in the courts and in Sen. Ervins Select Committee. That, and the

Medical

Access

By BILL NOBLITT

RALEIGH-Needless use of hospital emergency room facilities just to see a doctor for something that could have been done in a doctor's office is costing Tar Heel residents upward of $6 million every years, according to a survey of North Carolina hospitals.

An additional amount equal to that loss could be attached to time lost by wage earners and professionals waiting for hours to see a doctor in his office.

In total. North Carolinians are paying out needlessly each year for medical care enough money to build a new medical school. That is the conclusion reached from a survey carried out by the Medical Manpower Study Commission of the General Assembly.

Rep. J. P. Huskins of Statesville, author of the commission report, concluded the section on needless medical expenses with this observation:

Public Wants Action

There is little doubt that the general public is ahead of the medical profession in its willingness to underwrite whatever it costs to improve access to medical care.

The commission sent questionnaires to the 125 hospitals operating in North Carolina asking three questions;

The number of patients treated last year in hospital emergency rooms;

Approximate percentage of those that could have been handled in a doctors office;

The dollar amount of service charge added to the medical bill paid by the client, for use of the hospital facilities.

A total of 106 hospitals responded to the questionnaire, a surprisingly large response sipce pollsters generally consider a 30 per cent response quite good.

Final figures were arrived at by totaling responses, averaging them out, and expanding the numbers to cover all hospitals in the state.

Actual figures showed 1,2 million p>ersons were treated in emergency rooms at 99 hospitals in the state last year.

Expanding those figures produced an estiniate of 1.5 million treated at all hospital emergency rooms. Of that total. 829.081 could have been treated in a doctors private office instead of the hospital, ancha total of $6,461,378 was paid out by patients for the use of hospital facilities which would not have been spent if they had gone to the

Care

Costly

office instead.

Admit Patients

The report also noted that at least one doctor admitted that due to his heavy load he often admitted patients to a hospital in order to see more patients in the limited time available to him.

The patient, of course, pays a hefty hospital bill in addition to the doctor bill. There is reason to believe this practice is more widespread than the medical profession is willing to admit, the report said.

The commission report said general agreemeijt was found at public hearings that the statewide shortage of general practitioners is overloading the emergency rooms at the community hospitals. People who cannot get a doctor call an ambulance and end up in the emergency room, thus adding service charges to their medical bill.

Hospital administrators and medical staff members complained gf this problem at almost every hearing, the report said.

Dr. Thomas D. Kinney, dean of the Duke University medical school, describes the situation thus: Emergency rooms have become a major source of primary medical care.

The Medical Manpower Commission survey and report did not point out that physicians themselves are often responsible for. this growing use of hospital emergency room facilities for general doctor visits.

Doctors Require It

Knowledgeable people report there is a growing tendency among physicians to require patients to report to hospital emergency rooms to see them, generally during off-duty hours when their offices are not open, and especially during times when the doctor is already at the hospital making his rounds of patient visits and can simply work the caller into his schedule at that point easily.

This practice, as well as the practice of admitting patients to the hospital for illnesses not normally requiring hospitalization, is sometimes used as a technique for collecting medical-health insurance, as well, sinde many insurance policies will cover any expense related to a hospital visit or stay, but will not cover a visit to a doctors office, sources report.

It appears that the doctors themselves are sometimes encouraging the over-use of hospital facilities, some critics say.

The Daily Reflector

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Agnew resignation brought confidence in the administration to an incredibly low ebb.

The year 1973 was one ol inflation and worries about the economy. It was the year that Middle East war broke out again. It all tied together with the flow of Middle East oil was reduced, bringing near economic chaos in Europe and Japan and oil shortages in the United States.

Life went on, however. We saw shortages of everything during the year from beef to paper and when things are short it is a sure indication that people still have money to spend.

During the year there was the death of former President Johnson td sadden the nation. The dollar was devalued, but the U. S. balance of payments came in balance for the first time ih a long time.

It was a depressing year for those who worry about the future of the nation and the world; and yet there was much to create hope for the years ahead.

Despite the Agnew disgrace, despite Watergate, the affairs of government went on, and while the usual nibbling at our freedoms went on, the provisions of our Constitution held firm at years end.

There were strong signs that our people could adjust to using less gas and oil and electricity and the man in the street was perfectly willing to admit that all of us have,wasted too much for too many years.

Taken altogether that is no reason that this country cant face the New Year with hope and confidence. Out of Watergate we can believe a more moral government will emerge. Out of the energy crisis comes the knowledge that the public can adjust and survive. The problems of 1973 will long be remembered, but they should serve to make us a stronger nation.

Near-Fight On Pentagon's Oil

Using rates and deadflnes avattabu jk request Merobe^ .Bureau of Circulation.

By ROWLAND EVANS and ROBERT NOVAK

WASHINGTON-Behind torrid infighting last week over energy boss William E. Simons decision to tap Pentagon aviation fuel for commercial overseas carriers was Secretary of Defense James Schlesingers resentment at the ouster of retired Vice Adm. Eli T. Reich as fuel allocations chief.

Simon and Reich reached their parting of the ways early this month when Reich, feeling downgraded in Simons fast-building bureaucracy, rebelled. His departure from Simons Energy Administration immediately followed.

Reich had worked for Schlesinger in the Pentagon before he moved into the oil allocations business in the Interior Department a few months ago. Unbeknownst to Schfesinger, Pentagon sources say, Simon took pains to call Deputy Defense Secretary William Clements before Reichs ouster to make sure that Reich could return to the Pentagon; That was a humane gesture Schlesinger did not know about.

Thus, when Simons fast-moving men got the permission of Pentagon underlings for a dip into the Pentagons reserve fuel hoard, without first clearing it with Schlesinger, the secretary did a fast boil which quickly made itself felt throughout the Pentagon and was reflected in official statements.

Actually, President Nixon himself talked to Schlesinger before the final decision to tap the reserwe fuel, and Schlesinger'^sjconsiderably mollified. Then, when he learned that Simon had specifically spoken to Clements to make sure that Reich would be taken care of, he cooled off.

A footnote: When Simons new men took over the regional allocation offices from Reichs old men, they found thousands of unanswered queries from businessmen cluttering the desks. .Reich had regional staffs numbering less than half a dozen; these staffs are now beefed up to 50 to 100 people in each of the 10

Strength For Today

ON MEN AND Ml/LEjS A man in a great deal of / perplexity once went to hi/ old pastor to ask his advice on how to handle certain moral problems. The pastor turned to the Thirty-second Psalm yid read these two verses: T mitruct thee and teach thee in the way thou shalt go;

I will counsel thee with mine eye upon thee. Be ye not as the horse or as the mule, which . have not understanding; whose trappings must be bit and bridle to them in, else they wUl not come near unto thee,

At first the man adng for advice was even more per

plexed, but fiien ha began to see that his trouble was that he was behaving more like a horse or a mule than a naan. He was just not being receptive to inspiration coming from God. He could only respond to a bit in his mouth. The whole circumstance taught him that the only way God can ever really guidaa man is by mechanical instruction coming from a fellow man, vvhich is analagous to fitting a bit into his mouth, but by speaking to the inner heart which is m^pared to recdve Him.

^By EUska De|tess

By JAMES J. KILPATRICK

Big Brother's Watching

regional offices.

The Cost of Reform

Reformist decisions at the runaway national Democratic convention in Miami Beach in 1972 are costing the financially hard-pressed party at least $1.5 million, with the probability of the price tag rising still higher.

The Delegate Selection Commission and the Charter Commission, each created by the 1972 convention, cost $300,000 apiece in 1973, with another $180,000 budgeted for the Charter Commission in 1974. The convention also required the 1974 party charter conference to be held at Kansas City in December 1974in effect, a midterm national convention. Its price ' tag: at least $750,000.

That adds up to $1,530,000. Considering the disaster wrought by the reforms drafted by the old McGovern commission, everybody agrees that money spent by the Delegate Selection Commission to write new rules is money well spent. But the need for a party charter or a charter convention, adopted by the 1972 convention, is widely doubted in the party.

Worse yet, the 1972 convention required that 8 per cent of all party funds raised nationally be set aside to finance indigent delegates attending the 1976 convention. Chairman Robert Strauss has frankly informed the national committee that he simply has not been able to do this so far. But he must eventually, comply with the conventions mandate. Assuming the party raises $10 million in the next four years, Strauss would have to come up with $800,000 for needy^ delegates in 1976.

How Much Oil?

At least half the Senate is exited to sponsor a bill establishing the Bureau of Energy Information for the first time forcing oil companies to reveal their reserves.

The bill will also uncover large secondary reserves of scarce fuel held by users, such as electric utilities. Never before has the federal government been able to extract such vital national

(Continued on page 5)

The practice of medicine in the United States enters a new and ominous phase this week, as Big Brother lays his clammy hand upon

physicians across the county. Henceforth, doctors have every right to be concerned at the prospect, and their patients should be concerned as well.

^ Such concepts as

Professional standards and professional review of course are not new. Every

doctor, before he begins his practice, has to pass a board of medical examiners. If he is attached to a hospital he regularly facts the judgment and criticism of his peers. For gross mistakes, he is subject to suit for malpractice. His license to practice can be revoked. No doctor operates with untrammeled freedom.

Yet th^PSROs involve a new form of regulation and supervision that is different

Public Forum I

To the editor:

I was reading the Dec. 16, 1973 issue of the Greenville Reflector and saw on the front page a picture of the new Greenville rescue vehicle. On the front of the vehicle, I noticed the word emergency was written backwards. I wonder why. There was no mention of this fact in the article. I would appreciate any explanation you can offer as to why the word was backwards.

I would like to mention that I am employed by a press clipping bureau and my job (plus th^ee other girls) is to read afi the daily papers published in North Carolina. I have done this for the last three ifears. I admire your paper greatly. You give a

broad coverage to world news, yet dedicate ample space tdTall aspects of local news. You seem to do this without exerting any undue influence on the issues by presenting all sides. Your paper is fair and unbiased, something which I cannot say about oj^er papers.

Janet Brusko Livingston, N.J.

Editors note: The

Emergency on the front of the rescue truck is written so it can be easily read in a rearview morror of a car the truck may be approching from behind. This is done according to federal recommendations, Greenville Rescue Squad Captain D. R. Daniels said.

To the editor:

I have been reading with great interest the past few days about the revolution that has been taking place in the areas of the people concerning railroads.

In the early part of the 1800s Archiblad Murphy saw the need of an east-west system of transportation in this state. (I suggest to the leaders <)f N. D. that they get Dr. Hugh Leflers North Carolina History Book, and read hisr account of Murphys internal improvement program and benefit by some of the suggestions offered more than 170 years ago).

Beginning January 1, 1974, according to the papers, we will have a railroad going from the extreme east of N. C. to the extreme west. Since the emerging of the Southern and Norfolk and Southern, the 170-year dream has come true.

If we people in the east would support the citizens of Zebulon, Wendell and Bailey in securing commuter service into Raleigh and extend this service from Norfolk to Asheville, the railroad can haul more people on less fuel than any other means of transportation. As a by-product the railroad can also speed up the U. S. mail. NOW is the time to act and get this east-wggt^ passenger accomondations started.

WUliamC. Cobb Rt. 6. Box 245 Greenville, N.C. 27834

y

not merely in degree, but in kind. These organizations, for all practical purposes, are to be agencies of the Federal bureaucracy. To be sure, they will be composed of local physicians, drawn at the outset from local medical societies, but they will be funded by Federal funds and they will be staffed by Federal civil servants.

Until quite recently, little had been heard of the PSRO program. The review plan was authorized under a floor amendment to the Social Security Act of October 30, 1972. Few members of Congress, eager to get home for elections, paid much attention. No public hearings were held. A considerable time elapsed before doctors discovered the 15 pages of fine type creating an elaborate, nationwide system of local. State and Federal review of the professional medical decisions. Now many doctors belatedly are urging repeal of the PSRO amendment. They make a good case.

Under the law, each of the local PSROs shall apply professionally developed norms of care, diagnosis, and treatment, based upon typical patterns of practice in its regions. So long as a doctor stays within these norms, he stays out of trouble ; but if his PSRO disapproves one of his medical decisions, no funds appropriated under Medicare or Medicaid may be disbursed for payment of the particular claim.

The plan is subject to criticism at the outset merely in terms of the paper work it must entail. In a case of elective surgery, the local PSRO may approve or disapprove in advance of a patients admission to a hospital If a doctor feels his patient should be hospitalized beyond the norm, he must so certify, and his medical j|idgment will be reviewed. Agents of each PSRO may inspect a doctors offices, go over his most confidential patient records, and second-guess his every diagnosis and prescription.

As the Wall Street Journal

(Continued On Page 5)

Admire Traits In U.S.

By RAY MOSELEY

QSqOW (UPI) A Soviet hewsps|i)er has criticized the work habits of Soviet business executives and suggested they should follow what he calls the example of their American counterparts.

I am against the notorious American standard of living with its Philistine stani^ards, permanent fears, cruelty and social contrasts, economist Alexander Levikov wrote in the weekly Literaturnaya Gazeta.

But in the United States, he said, big business deals often are concluded verbally. Delivr eries and work are done immediately and neither side bi;eaks its word.

Despite the fact that all this has been dictated by interests of the competitive struggle, a thing absolutely alien to us, nevertheless this kind of American businesslike manner is a good thing while the American style of living is not, he said.

Levikovs chief complaint was that Soviet executives, when confronted with a problem, tend to call a conference to talk <^bout it rather than taking direct action.

Fish Story He told a story about a Japanese fishing boat captain who was asked by a Russian why he caught more fish than the Russians, even though they fished the same waters.

The Japanese replied: When you have no fish you go into conference. When I have no fish I start looking for^tbem. Levikov said a survey of 1,235 (Continued on page 5)

40 Years Ago Today

By SUSAN PRICE January 1,1934 The arrival of 1934 was greeted with little nois? in Greenville last night, and only the ringing of a single church bell and exploding firecrackers remihded the populace that the new ypar was being born. /

Usually the new y^ar is ushered in with a series pf false fire alarms, but histor^ failed to repeat itself last night, and firemen spent probably the quietest and most tranquil new year night in memory of the oldest member of the company.

Police, who are usually kept busy taking care of over-boistrous celebrants, found themselves consideration in the mayors court this morning.

Merchants in the c^y were busy, today beginning or completing their inventories and those were expected to be completed tonight or tomorrow.

Merchants said this has been one of the best fall and winter buying seasons in several years and look forward with confidence to the new year. They believe implicitly that attempts of the Federal Administration to improve conditions will continue to meet with success and are looking forward to a tremendous improvement over last year.

Business leaders said also that the tremendous amount of money paid out on the local tobacco market this season has been and will continue to be a big factor in increasing purchasing power of the general run of people.

No Audit Of Average Taxpayer

By R. GREGORY NOKES Associated Press Writer WASHINGTON (AP) -ITie average taxpayo* who fears that a simple mistake on his 1973 tax return will subject him to a troublesome and costly audit doesnt have much to worry about.

But if he is the kind <A taxpayer whose name is likely to appear bn a White House enemies list, he has greater cause for concern.

Internal Revalue Service audit guns largely nm by computer we aimed at those tax returns showing the greatest potential fcxr yielding substantial a^dit||onal tax revenue.

The IRS last year audited only about 1.8 million returns out of 78 million filed but the audits resulted in an additional $5.1 billion lax libility.

%

VThats an average of about $2,800 additional tax per audit. So $10 and $20 mistakes are not likely to bring an IRS agent to the door, even thou^ the IRS double checks all arithmetic.

About 75 per cent of all audits last year resulted in some change in tax.

IRS spokesmen explained their auditing procedure after a special congressional report show^ that a high proportion of the 700 persons named on socalled White House enemies lists were subjected to audit probes, evi though the lists themselves Were not considered by the tax agency.

The report, preparedby the Joint Committee on Internal Revenue Taxation, found that about 25 per cent of those on the list were audited com

pared with the national average of slightly more than two per cent. In addition, more than half of those on the list had their tax returns screepjed for possible Euidit.

If overall IRS averages on the percentage of audits yielding higher taxes held true, about 132 persons on the list ended up with higher tax bills.

' TTie committee said its staff found no evidence that any returns were screened as a result of White House (ressure on the IRS.

Among explanations for the higher percentage of audits, it said, were:

Persons on the list tid to be involved in a wider range of business activities than the average persons with the same income.

A large fraction of those

on the list are journalists and . writers who tend to have large deductions for business expenses, which automatically subject theqi to closer scrutiny. *

An IRS spokesman added a third reason. He said that many of those on the list were contributors to political cam-. paigns and candidates and this also tends to bring close IRS hecking.

The joint committee said 52 per cent of those named on one list had adjusted gross income of more than $50,000 and 46 per cent had incomes between $10,-000 and $50,000. The committee said that nationwide about 14 per cent of persons with over $50,000 income ar^ audited by the IRS, while 22 per cent of those on the one list were subjected to' audit. .

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