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OCCUPATIONAL SAFETY

Dear Editor:

The first item I would like to address is that should a fisherman be employed on a U.S. fishing vessel he or she would be covered under the Jones Act, a U.S. Government law which covers seamen. This act is somewhat like workers' compensation in that the employer is required to pay medical bills, wages and transportation. But unlike state workers' comp laws where benefits are the only remedy, accident victims can sue their employer or the vessel's owner as a tort action. This law is one reason why many fishing vessels are uninsured as the rates are enormous.

Also, the Maine lobsters are coldwater lobsters with large claws. They are always caught, as far as I know, commercially using traps. The lobsters caught in the Gulf of Mexico and other southern seas are spiny lobsters which do not have large claws. The tails are frozen for shipment as they do not have to be kept alive.

At present many boats in Central America use traps. The use of divers is very high risk as you point out, as many are not well trained and some operations have less-than-desirable equipment.

I do not know the breakdown between trap-caught spiny lobster and diver-caught lobsters but I understand that many of the deeper-caught ones are now caught with traps.

HAL LUCAS

Risk Manager

Tampa, Fla.

HEALTH CARE FOR THE RICH

Dear Editor:

It seems that you have failed to digest the difference between what we in Washington call "access-fee practices" and "retainer-fee practices." (Risk & Insurance, March 2005, page 20.)

Access-fee practices charge for special access rights for patients who wish for services beyond what their insurance would guarantee by their contract. But every service covered on the insurance is still charged to the patients' insurance plan or they pay out of pocket per service.

Since the parent clinic group has other insurance-based practices which do not charge an access fee or provide these special services, it is true that the patients are stratified by their ability or willingness to pay the extra fees. (Oh, surprise! The patients driving a Lexus want to be able to buy more personalized health care than those driving a Volkswagen.) Our practice, on the other hand, has been designated by the Washington State OIC as a "retainer practice" because we charge only the monthly fee. Our fee is lower than the "access fee" charged by similar programs.

Our patients pay by age group, from $35 a month for kids to $75 a month for seniors, and it covers their access and their care. We have no contracts with insurance companies, although many of our patients have insurance, Medicare, even welfare, and choose to pay our modest fee out of pocket for our services.

Now I think you have to admit that our fees are hardly high enough to be accused of catering only to the rich!

In fact, we find that it appeals to many who cannot begin to afford insurance on their own. If they choose to pay each month a flat fee which is less than they are spending on lattes, and happen to get quality personalized care that they could not afford to pay cash for at a traditional practice, we feel we are accomplishing our mission.

NANCY J. MORGAN

Medical Doctor

Mill Creek, Wash.

July 1, 2005

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