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The letter by Pugno et al highlights the value of multiple perspectives in evaluating policy changes. While they did not perceive a change in the availability of health care services in Shasta County after the public hospital closed, the patients who used that hospital provided a very different opinion. Physicians' and administrators' opinions do not substitute for the patients' point of view.Pugno et al assert that we did not communicate with them in performing our evaluation. In fact, we consulted with many of Shasta County's health care providers and community leaders and the chief executive officers of Mercy Medical Center and Redding Medical Center, and the county health officer and the state assemblyman from Shasta wrote letters to support our proposal to funding agencies.We were aware of the transition of the Family Practice Residency from Shasta General Hospital to Mercy Medical Center and hoped that this
Bindman AB, Keane D, Lurie N. The Closing of Shasta General Hospital-Reply. JAMA. 1991;265(14):1827-1828. doi:10.1001/jama.1991.03460140055021