[Congressional Record Volume 142, Number 25 (Wednesday, February 28, 1996)]
[Extensions of Remarks]
[Pages E224-E225]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 THE PATIENT RIGHT TO KNOW ACT OF 1996

                                 ______


                            HON. GREG GANSKE

                                of iowa

                    in the house of representatives

                       Tuesday, February 27, 1996

  Mr. GANSKE. Mr. Speaker, I am pleased to join with my colleague from 
Massachusetts, [Mr. Markey] and numerous original cosponsors in 
introducing legislation to ensure that doctors remain free to provide 
critical health care information to patients.
  There is nothing more central to the doctor-patient relationship than 
trust. Patients and their families rely on doctors to fully inform them 
about the course of a disease and the various ways it can be treated. 
They deserve to know the risks and benefits, the costs, and the chances 
of success of the treatments that will be inflicted on their own bodies 
or their loved ones. And they don't want information withheld because 
of an insurance company restriction.
  Unfortunately, that essential doctor-patient trust is being 
undermined by some health plans that attempt to limit the content of 
discussions between patients and providers. Physicians are increasingly 
being offered contracts by insurance companies that contain restrictive 
clauses preventing the physician from using sound medical judgment and 
undermine the essential notion of informed consent.
  Sometimes, these contracts explicitly seek to limit the information a 
doctor can provide to a patient, preventing doctors from discussing 
proposed treatments until the plan has agreed to pay for it. How can we 
expect patients to make informed decisions about their own health if 
doctors can only inform them of options that the plan is willing to pay 
for?
  Other plans achieve the same result more subtly. Some place a general 
disparagement clause in their contracts, forbidding providers from 
saying anything that might undermine patient confidence in the plan. 
The danger of this clause is very real. Patients rely on their 
physician to tell them which doctors or hospitals are better than 
others. But in plans with general disparagement clauses, a doctor could 
not tell a patient that 7 of the last 11 patients he referred to the 
plan's heart surgeon have died. That is precisely the sort of 
information doctors should give to patients and is precisely the kind 
of communication that general disparagement clauses prevent.
  Sometimes, contracts contain no explicit restrictions on 
communications between doctors and patients, but physicians can still 
find the content of their medical advice restricted. A former 
neurologist from a large HMO indicated that ``I was told it was a 
mistake to tell the patient about a procedure before checking to see 
whether it was covered.'' Whether explicit in a contract or 
communicated to doctors orally, such restrictions on communication deny 
patients access to critical information and make a farce out of the 
notion of informed consent.
  Today, because of market concentration, for a physician to buck a 
``gag clause'' and be terminated from one of two dominant HMO's in a 
community, may mean whether that physician stays in practice. There is 
genuine fear among providers that if they act too often or too 
vigorously as a patient advocate, their contract won't be renewed. 
Under these circumstances, it takes a hero to be a patient advocate. 
And as we know far too well, heroes are rare.
  This legislation is a balanced approach to a growing problem. While I 
understand the importance of the free market, Congress must protect 
patients who are unaware that some doctors are no longer able to 
communicate their best judgment. These restrictions are unethical. They 
violate the Hippocratic Oath. They undermine the quality of care. And, 
as far as I'm concerned, they have no place in the health care market.
  I hope that my colleagues on both sides of the aisle will see the 
importance of this issue 

[[Page E225]]
and help us enact the Patient Right to Know Act.

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