The Tip of the Iceberg?

Rumors of something wrong with the health services are familiar on almost any campus, and Harvard's University Health Service (UHS) is no exception. In fact, when UHS polled undergraduates on their impressions several years ago, they found that while 17 percent of the respondents actually were dissatisfied with the service, almost half the group thought other Harvard students were more dissatisfied than they.

But the charges that became public last week were a good deal more specific. Responding to what they called a "consistent pattern" of serious complaints about obstetric and gynecologic care, a women's group in the Medical Area last spring filed a formal complaint against the doctors involved.

Citing statistics received from an anonymous source, the Med Area's Joint Committee on the Status of Women (JCSW) charged that one of the two UHS obstetrician-gynecologists, Dr. Paul I. Winig '62, had performed too high a proportion of Ceasarian sections.

Though a hospital investigating committee reported soon after that all the Ceasarian sections in question were medically appropriate, members of the women's committee are not convinced.

They have continued to press their case, urging BWH to provide a promised year's worth of statistics on Ceasarian section operations In part, they contest the committee's interpretation saying the patient records indicating appropriateness" of the operation are insufficient evidence.

But more important they continue to aver that the particular complaint of Ceasarian sections which affects only a small proportion of the Harvard affiliated women who use the facility is only the tip of the iceberg as fat as bad gynecologic practice is concerned.

Deluge of Complaints

For example, in the week since the grievance became public members of the Joint Committee say a surprising number of women have begun to come to them with similar complaints about UHS's gynecologic services. While the committee is encouraging as many women as possible to pursue these complaints at a formal level, doing so is "an enormous burden on an individual," a source close to the Joint Committee notes.

"Statistics are the only thing that cut any ice" with UHS authorities. JCSW chairman Judith Herzfeld says. She and other members say they chose to pursue the complaint about obstetrics because other charges could too easily be dismissed as "attitudinal" conflicts or isolated difficulties.

UHS officials argue just that Nancy L. Ryan, former consumer advocate for UHS says most of the complaints she handled during her tenure stemmed from women's desire for more choice in delivery methods. Since the only option currently available is the "fairly traditional" approach of the two UHS-employed doctors. UHS has taken steps to give its patients access to the Brigham and Women's midwife program.

"System wide. I don't think there is any major complaint about our service," says Dr. Warren E C. Wacker, director of UHS Wacker says he believes the statistics in the complaint, though correct in themselves, constitute a "statistical aberration" because they refer only to a five-month period: in addition, he expresses dismay that the figures were apparently copied out of a BWH delivery log, in violation of patients' confidentiality rights.

But Dr. Kenneth J. Ryan, head of BWH's department of gynecology and obstetrics, says the hospital "has an obligation to know what is going on. "The hospital's standing committee on hospital practices will soon conclude its investigation by comparing the proportion of Ceasarian sections for Winig--the doctor in question--with the proportion performed in BWH as a whole, based on some 8000 births over the last year.