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(a) BACKGROUND On December 21, 1990, the FASB issued SFAS No 106, Employer s Accounting for Postretirement Bene ts Other Than Pensions Retiree medical bene ts are SFAS No 106 s primary focus, but life insurance and other welfare bene ts provided to employees after retirement are also included Prior to SFAS No 106, most employers had recognized the cost of postretirement bene ts other than pensions when paid Under the accounting requirements of SFAS No 106, postretirement bene ts are viewed as a form of deferred compensation that should be recognized on an accrual basis during the periods that the employees render the service needed to qualify for bene ts The speci c approach and methodology of SFAS No 106 closely parallel the pension accounting rules addressed in SFAS Nos 87 and 88 Their disclosures are similar as well The practice of providing postretirement health care bene ts took root after the Medicare program was established in 1965 Employers found that, for relatively few dollars, Medicare supplements, as they were called, bought much employee goodwill The effect of in ation on medical costs, the trend toward earlier retirement, and longer life expectancies have made these bene ts increasingly expensive During recent decades, the cost of medical care has risen at twice the average in ation rate for the same period These dramatic cost increases have prompted many companies to signi cantly reduce or even eliminate retiree medical bene ts Retiree health care bene ts are now predominantly found at larger employers, as the escalating costs have made these bene ts too costly for most midsize and smaller employers Although some employers provide bene ts only until retirees reach age 65 and become eligible for Medicare, many programs still provide lifetime bene ts Typically, bene ts for retirees are similar to those for active employees, including the ability to cover eligible dependents Many plans provide the same level of bene ts regardless of years of service, while other plans provide incremental bene ts to employees retiring with longer service periods Programs for retirees age 65 and over usually are coordinated with Medicare bene ts to help contain costs Furthermore, retirees are now often required to pay some portion of the cost of these bene ts This cost sharing is one of many methods employers have used to help contain their costs Another commonly used method is cost caps, where the company establishes a xed dollar amount above which the retiree will cover all costs.

A comprehensive discussion should be held with the patient concerning the risks and bene ts of the surgery, and clear documentation of this discussion and, in particular the risk of permanent erectile tissue damage and long-term erectile dysfunction, must be placed in the medical record, and an informed consent form signed by the patient or his guardian, preferably in the presence of a witness It is recommended that all medical records should be both dated and timed because of the emphasis on chronology of events in medico legal cases pertaining to priapism Although it is universally accepted that the longer a priapism event the more likely a man is to experience long-term erectile dysfunction, at what time this becomes inevitable is unclear There is evidence that 12 hours of priapism leads to overt histologic changes in corpus cavernosal smooth muscle, as seen by light microscopy The longer the venocclusive priapism event the greater the chance of permanent erectile dysfunction Furthermore, at what time surgical intervention is no longer warranted is unclear It is the committee s recommendation that shunting be considered for priapism events lasting 72 hours, that consideration be given to foregoing shunting in priapism events lasting > ve days, in particular where no blood can be aspirated from the corporal bodies upon presentation For priapism events lasting between three and ve days, judgement regarding the value of shunt surgery is left to the discretion of the individual clinician Some authorities suggest corporal smooth muscle biopsy be considered at the time of shunt surgery [1] If biopsy is planned this

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