She's right, but for other reasons.

As a practicing hospital-based physician I found myself cringing at the injudicious accusations made by Sarah McCarthy, in the March/April 2005 issue, against her health insurance company. I don't dispute the assertion that medical errors kill thousands of patients yearly, nor do I dispute that managed care insurance companies force physicians into practice patterns they are extremely uncomfortable with. But for Ms. McCarthy to extrapolate from an adverse outcome into hyperbolic statements, such as "I had almost been killed by my insurance company," it demeans the quality of the debate.

McCarthy doesn't present convincing evidence that her kidney failure was an inevitable outcome of her "premature" hospital discharge. Indeed, the reason is unknown based upon the account she gives and, therefore, lends itself only to speculation.

Physicians spend hours each day with managed care companies negotiating for care the latter deem necessary, and hospitals have had remarkable declines in reimbursements from government and private payers along with tremendous increases in cost of technology and medications. Billions of dollars are paid out yearly for the administration of health- care plans that provide no direct benefit to patients. These facts should provide enough outrage to mobilize a public outcry.

Richard McNally, M.D.

Kingston, New York