“GAG” CLAUSES: SHARP HEALTHCARE EMPLOYEE SPARKS DEBATE

      A passage in the Sharp HealthCare System's newly released
 employee handbook stating that "[a]ll employees have the
 responsibility to place the interests of Sharp HealthCare above
 their own and those of others" has "triggered heated debate" over
 two pending patient rights initiatives in California, JOURNAL OF
 COMMERCE reports.  The debate centers on Proposition 216, the
 Patient Protection Act, and Proposition 214, the Health Care
 Patient Protection Act, both of which will appear on the state's
 November ballot.  The two measures, supported by the California
 Nurses Association (CNA) and the Service Employees International
 Union, respectively, "prohibit employee gag rules and physician
 referral restrictions" by HMOs.  The JOURNAL OF COMMERCE reports
 that Proposition 216 co-author and consumer advocate Harvey
 Rosenfield said the Sharp HealthCare handbook excerpt "stands as
 the worst form of 'gag' order," adding that the message from the
 company to the employees "inhibits worker rights to call
 attention to inappropriate or inadequate medical treatment." 
 Rosenfield said, "These documents show that the health-care
 industry's claim that gag orders do not exist are lies" (Lent,
 7/22).
      FEAR AND LOATHING IN HMOs:  According to the CNA, co-sponsor
 of Proposition 216, the Sharp conflict of interest issue surfaced
 when an anonymous nurse gave CNA the handbook, stating, "It's
 clear that we can be terminated for any reason.  The message is
 we have to perform to [Sharp's] budgetary expectation, not the
 expectation of patients and their families ... I am being stopped
 from what I am trained to do."  CNA President Kit Costello said,
 "Provisions like this compromise the most fundamental
 relationship in the health care process -- the trust between a
 patient and their nurse or doctor" (CNA release, 7/16).
      RESPONSE:  Sharp HealthCare responded in a prepared
 statement, "The clause from the Sharp employee handbook is part
 of a lengthier and standard conflict of interest clause.  In
 intent and in practice, the conflict of interest statement
 reminds employees to place the Sharp Mission of quality care
 above self-interest, particularly personal financial gain.  The
 policy protects patients' rights to quality of care."  Sharp
 HealthCare added that "Conflict of interest statements similar to
 the Sharp statement are common in the health care industry." 
 Sharp HealthCare is an integrated regional health care delivery
 system based in San Diego that includes seven hospitals, three
 medical groups and other facilities and services.  The system
 operates 1,955 beds, has 2,700 affiliated physicians and nearly
 $650 million in assets (Sharp HealthCare release, 7/16).
      MORE DETAILS:  JOURNAL OF COMMERCE notes that about 17
 million Californians, or 75% of the state's insured residents,
 belong to managed care systems.  It adds that by the year 2000
 about 80% of the U.S. population will be covered by HMOs (7/22).