[Congressional Record Volume 142, Number 115 (Wednesday, July 31, 1996)]
[Senate]
[Pages S9295-S9304]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. WYDEN (for himself, Ms. Snowe, and Mrs. Boxer):

[[Page S9296]]

  S. 2004. A bill to modify certain provisions of the Health Care 
Quality Improvement Act of 1986; to the Committee on Labor and Human 
Resources.
                                 ______
                                 
      By Mr. WYDEN:
  S. 2005. A bill to prohibit the restriction of certain types of 
medical communications between a health care provider and a patient; to 
the Committee on Labor and Human Resources.


           the patient communications protection act of 1996

  Mr. WYDEN. Mr. President, I rise today to introduce two new bills 
which I believe will help more fully inform patients and consumers 
about the health care choices they face, and safeguard the most 
critical relationship between care giver and patient.
  The first bill, which I introduce with my colleagues Senator Snowe 
and Senator Boxer, is the Health Care Quality Improvements Act of 1996. 
It amends and improves the 1986 public law which created the national 
practitioner databank, an informational resource maintained by the 
Department of Health and Human Services which is a compendium of State 
disciplinary actions and civil malpractice case judgments against 
caregivers. As of this year, some 86,000 caregivers are listed in this 
taxpayer-supported databank. Currently, this informational resource is 
accessible only by hospitals, insurance plans, and State boards of 
medicine and health care licensing. The legislation introduced by 
Senator Snowe and me, today, would for the first time allow public 
access to critically important databank records. Caregivers who have 
had at least three reportable incidents in their files would have their 
entire databank records opened to the public. This legislation also 
would create an Internet site on the World Wide Web allowing easier 
access for publicly accessible information.
  The second bill, the Patient Communications Protection Act of 1996, 
would make illegal provisions in some contracts between caregivers and 
health plans which restrict communications between caregivers and their 
patients. Too often, I believe, these contract provisions limit the 
free and necessary communications of information to patients regarding 
their medical condition and all possible modalities of treatment. This 
legislation, while upholding the right of plans to work with physicians 
to improve the overall quality of care within a health plan, clearly 
restricts plans from impeding the free flow of medical information 
between State-licensed caregivers and patient.
  The Health Care Quality Improvements Act is endorsed by a number of 
groups including Families USA, Consumer Action, the National 
Association of Health Data Organizations, and the United Seniors Health 
Cooperative.
  The Patient Communications Protection Act is supported by the Oregon 
Medical Association, the American Association of Retired Persons, the 
Center for Patient Advocacy, Citizen Action, the Consumers Union, and 
the American College of Emergency Physicians.
  Mr. President, I ask unanimous consent that the text of the bills be 
printed in the Record.
  There being no objection, the bills were ordered to be printed in the 
Record, as follows:

                                S. 2004

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Health Care Quality 
     Improvement Act Amendments of 1996''.

     SEC. 2. STANDARDS FOR PROFESSIONAL REVIEW ACTIONS.

       Section 412(a) of the Health Care Quality Improvement Act 
     of 1986 (42 U.S.C. 11112(a)) is amended in the matter after 
     and below paragraph (4) by adding at the end the following 
     sentence: ``A motion for summary judgment that such standards 
     have been met shall be granted unless, considering the 
     evidence in the light most favorable to the opposing party, a 
     reasonable finder of fact could conclude that the presumption 
     has been so rebutted. The decision on such a motion may be 
     appealed as of right, without regard to whether the motion is 
     granted or denied, and the courts of appeals (other than the 
     United States Court of Appeals for the Federal Circuit) have 
     jurisdiction of appeals from such decisions of the district 
     courts.''.

     SEC. 3. REQUIRING REPORTS ON MEDICAL MALPRACTICE DATA.

       (a) In General.--Section 421 of the Health Care Quality 
     Improvement Act of 1986 (42 U.S.C. 11131) is amended--
       (1) by striking subsections (a) and (b);
       (2) by redesignating subsections (c) and (d) as subsections 
     (d) and (e), respectively; and
       (3) by inserting before subsection (d) (as so redesignated) 
     the following subsections:
       ``(a) In General.--
       ``(1) Requirement of reporting.--Subject to the subsequent 
     provisions of this subsection, each person or entity which 
     makes payment under a policy of insurance, self-insurance, or 
     otherwise in settlement (or partial settlement) of, or in 
     satisfaction of a judgment in, a medical malpractice action 
     or claim shall report, in accordance with section 424, 
     information respecting the payment and circumstances thereof.
       ``(2) Payments by practitioners.--The persons to whom the 
     requirement of paragraph (1) applies include a physician or 
     other licenses healthcare practitioner who makes a payment 
     described in such paragraph and whose acts or omissions are 
     the basis of the action or claim involved. The preceding 
     sentence is subject to paragraph (3).
       ``(3) Refind of fees.--With respect to a physician or other 
     licensed health care practitioner whose acts or omissions are 
     the basis of an action or claim described in paragraph (1), 
     the requirement of such paragraph shall not apply to a 
     payment described in such paragraph if--
       ``(A) the payment is made by the physician or practitioner 
     as a refund of fees for the health services involved, and
       ``(B) the payment does not exceed the amount of the 
     original charge for the health services.
       ``(4) Definition of entity and person.--For purposes of 
     this section, the term `entity' includes the Federal 
     Government, any State or local government, and any insurance 
     company or other private entity; and the term `person' 
     includes Federal officers and employees.
       ``(b) Information To Be Reported.--The information to be 
     reported under subsection (a) by a person or entity regarding 
     a payment and an action or claim includes the following:
       ``(1)(A) The name of each physician or other licensed 
     health care practitioner whose acts or omissions were the 
     basis of the action or claim; and (to the extent authorized 
     under title II of the Social Security Act) the social 
     security account number assigned to the physician or 
     practitioner.
       ``(B) The medical field of the physician or practitioner, 
     including as applicable the medical specialty.
       ``(C) The date on which the physician or practitioner was 
     first licensed in the medical field involved, and the number 
     of years the physician or practitioner has been practicing in 
     such field.
       ``(D) If the physician or practitioner could not be 
     identified for purposes of subparagraph (A)--
       ``(i) a statement of such fact and an explanation of the 
     inability to make the identification, and
       ``(ii) the name of the hospital or other health services 
     organization (as defined in section 431) for whose benefit 
     the payment was made.
       ``(2) The amount of the payment.
       ``(3) The name (if known) of any hospital or other health 
     services organization with which the physician or 
     practitioner is affiliated or associated.
       ``(4)(A) A statement that describes the acts or omissions 
     and injuries or illnesses upon which the action or claim was 
     based, that specifies whether an action was filed, and if an 
     action was filed, that specifies whether the action was a 
     class action.
       ``(B) A statement by the physician or practitioner 
     regarding the action or claim, if the physician or 
     practitioner elects to make such a statement.
       ``(C) If the payment was made without the consent of the 
     physician or practitioner, a statement specifying such fact 
     and the reasons underlying the decision to make the payment 
     without such consent.
       ``(5) Such other information as the Secretary determines is 
     required for appropriate interpretation of information 
     reported under this section.
       ``(c) Certain Reporting Criteria; Notice to 
     Practitioners.--
       ``(1) Reporting criteria.--The establishing criteria under 
     section 424(a) for reports under this section, the Secretary 
     shall establish criteria regarding statements under 
     subsection (b)(4). Such criteria shall include--
       ``(A) criteria regarding the length of each of the 
     statements,
       ``(B) criteria regarding the notice required by paragraph 
     (2) of this subsection, and
       ``(C) such other criteria as the Secretary determines to be 
     appropriate.
       ``(2) Notice of opportunity to make statement.--In the case 
     of an entity that prepares a report under subsection (a)(1) 
     regarding a payment and an action or claim, the entity shall 
     notify any physician or practitioner identified 
     under subsection (b)(1)(A) of the opportunity to make a 
     statement under subsection (b)(4)(B). Criteria under 
     paragraph (1)(B) of this subsection shall include criteria 
     regarding the date by which the reporting entity is to 
     provide the notice and the date by which the physician or 
     practitioner is to submit the statement to the entity.''.
       (b) Definition of Health Services Organization.--Section 
     431 of the Health Care Quality Improvement Act of 1986 (42 
     U.S.C. 11151) is amended--
       (1) by redesignating paragraphs (5) through (14) as 
     paragraphs (6) through (15), respectively; and

[[Page S9297]]

       (2) by inserting after paragraph (4) the following 
     paragraph:
       ``(5) The term `health services organization' means an 
     entity that, directly or through contracts, provides health 
     services. Such term includes hospitals; health maintenance 
     organizations and other health plans; and health care 
     entities (as defined in paragraph (4)).''.
       (c) Conforming Amendments.--
       (1) In general.--The Health Care Quality Improvement Act of 
     1986 (42 U.S.C. 11101 et seq.) is amended--
       (A) in section 411(a)(1), in the matter preceding 
     subparagraph (A), by striking ``431(9)'' and inserting 
     ``431(10)'';
       (B) in section 421(d) (as redesignated by subsection (a)(2) 
     of this section), by inserting ``person or'' before 
     ``entity'';
       (C) in section 422(a)(2)(A), by inserting before the comma 
     at the end the following: ``, and (to the extent authorized 
     under title II of the Social Security Act) the social 
     security account number assigned to the physician''; and
       (D) in section 423(a)(3)(A), by inserting before the comma 
     at the end the following: ``, and (to the extent authorized 
     under title II of the Social Security Act) the social 
     security account number assigned to the physician or 
     practitioner''.
       (2) Applicability of requirements to federal entities.--
       (A) Section 432 of the Health Care Quality Improvement Act 
     of 1986 (42 U.S.C. 11152) is amended--
       (i) by striking subsection (b); and
       (ii) by redesignating subsection (c) as subsection (b).
       (B) Section 432 of the Health Care Quality Improvement Act 
     of 1986 (42 U.S.C. 11133) is amended by adding at the end the 
     following subsection:
       ``(e) Applicability to Federal Facilities and Physicians.--
       ``(1) In general.--Subsection (a) applies to Federal health 
     facilities (including hospitals) and actions by such 
     facilities regarding the competence or professional conduct 
     of Federal physicians to the same extent and in the same 
     manner as such subsection applies to health care entities and 
     professional review actions.
       ``(2) Relevant board of medical examiners.--For purposes of 
     paragraph (1), the Board of Medical Examiners to which a 
     Federal health facility is to report is the Board of Medical 
     Examiners of the State within which the facility is 
     located.''.
       (C) Section 425 of the Health Care Quality Improvement Act 
     of 1986 (42 U.S.C. 11135) is amended by adding at the end the 
     following subsection:
       ``(d) Applicability to Federal Hospitals.--This section 
     applies to Federal hospitals to the same extent and in the 
     same manner as such subsection applies to other 
     hospitals.''.

     SEC. 4. REPORTING OF SANCTIONS TAKEN BY BOARDS OF MEDICAL 
                   EXAMINERS.

       Section 422(a) of the Health Care Quality Improvement Act 
     of 1986 (42 U.S.C. 11132(a)) is amended--
       (1) in paragraph (1)(A), by striking ``which revokes or 
     suspends'' and inserting ``which denies, revokes, or 
     suspends''; and
       (2) in paragraph (2)--
       (A) in subparagraph (B), by striking ``(if known)'' and all 
     that follows and inserting ``for the action described in 
     paragraph (1)(A) that was taken with respect to the physician 
     or, if known, for the surrender of the license,'';
       (B) by redesignating subparagraph (C) as subparagraph (E); 
     and
       (C) by inserting after subparagraph (B) the following 
     subparagraphs:
       ``(C) the medical field of the physician, if known, 
     including as applicable the medical specialty,
       ``(D) the date on which the physician was first licensed in 
     the medical field, and the number of years the physician has 
     been practicing in such field, if known, and''.

     SEC. 5. REPORTING OF CERTAIN PROFESSIONAL REVIEW ACTIONS 
                   TAKEN BY HEALTH CARE ENTITIES.

       Section 423(a)(3) of the Health Care Quality Improvement 
     Act of 1986 (42 U.S.C. 11133(a)(3)) is amended--
       (1) in subparagraph (B), by striking ``and'' after 
     ``surrender,'';
       (2) by redesignating subparagraph (C) a subparagraph (E); 
     and
       (3) by inserting after subparagraph (B) the following 
     subparagraphs:
       ``(C) the medical field of the physician, if known, 
     including as applicable the medical specialty,
       ``(D) the date on which the physician was first licensed in 
     the medical field, and the number of years the physician has 
     been practicing in such field, if known, and''.

     SEC. 6. FORM OF REPORTING.

       Section 424 of the Health Care Quality Improvement Act of 
     1986 (42 U.S.C. 11134) is amended by adding at the end the 
     following subsection:
       ``(d) Additional Requirements.--Not later than 30 days 
     after the effective date for this subsection under section 11 
     of the Health Care Quality Improvement Act Amendments of 
     1996, the information reported under sections 421, 422(a), 
     and 423(b) shall be available (to persons and entities 
     authorized in this Act to receive the information) in 
     accordance with the following:
       ``(1) The methods of organizing the information shall 
     include organizing by medical field (and as applicable by 
     medical specialty).
       ``(2) With respect to medical malpractice actions reported 
     under section 421(b)(4)(A), the methods of organizing shall 
     specify whether the action was a class action.''.

     SEC. 7. DUTY TO OBTAIN INFORMATION.

       Part B of the Health Care Quality Improvement Act of 1986 
     (42 U.S.C. 11131 et seq.) is amended by inserting after 
     section 425 the following section:

     ``SEC. 425A. DUTY OF BOARDS OF MEDICAL EXAMINERS TO OBTAIN 
                   INFORMATION.

       ``(a) In General.--Effective 2 years after the date of the 
     enactment of the Health Care Quality Improvement Act 
     Amendments of 1996, it is the duty of each Board of Medical 
     Examiners to request from the Secretary (or the agency 
     designated under section 424(b)) information reported 
     under this part concerning a physician--
       ``(1) at the time the physician submits the initial 
     application for a physician's license in the State involved, 
     and
       ``(2) at each time the physician submits an application to 
     continue in effect the license, subject to subsection (d).

     A Board of Medical Examiners may request information reported 
     under this part concerning a physician at other times.
       ``(b) Failure To Obtain Information.--With respect to an 
     action for mandamus or other cause of action against a Board 
     of Medical Examiners, a Board which does not request 
     information respecting a physician as required under 
     subsection (a) is presumed to have knowledge of any 
     information reported under this part to the Secretary with 
     respect to the physician.
       ``(c) Reliance on Information Provided.--With respect to a 
     cause of action against a Board of Medical Examiners, each 
     Board of Medical Examiners may rely upon information provided 
     to the Board under this title, unless the Board has knowledge 
     that the information provided was false.
       ``(d) State Option Regarding Continuation of Licenses.--
       ``(1) Establishment of electronic system for transmission 
     of data.--After consultation with the States, the Secretary 
     shall establish a system for electronically transmitting 
     information under this part to States that elect to install 
     equipment necessary for participation in the system. The 
     system shall possess the capability to receive transmissions 
     of data from such States.
       ``(2) State option regarding electronic system.--With 
     respect to compliance with subsection (a)(2) (relating to 
     applications to continue in effect physicians' licenses), if 
     a State is participating in the system under paragraph (1) 
     and provides the Board of Medical Examiners of the State with 
     access to the system, the Board may elect, in lieu of 
     complying with subsection (a)(2), to comply with paragraph 
     (3) of this subsection.
       ``(3) Description of option.--For purposes of paragraph 
     (2), a Board of Medical Examiners is complying with this 
     paragraph if--
       ``(A) through the system under paragraph (1), the Board 
     annually transmits to the Secretary (or the agency designated 
     under section 424(b)) data identifying all individuals who 
     hold a valid physician's license issued by the Board, without 
     regard to whether the licenses are expiring, and
       ``(B) after receiving from the Secretary (or such agency) a 
     list of physicians under paragraph (4)(B), the Board complies 
     with paragraph (5).
       ``(4) Identification by secretary of relevant physicians.--
     After receiving data under paragraph (3)(A) from a Board of 
     Medical Examiners, the Secretary (or the agency designated 
     under section 424(b)) shall--
       ``(A) from among the physicians identified through the 
     data, determine which of such physicians has been the subject 
     of information reported under this part, and the State in 
     which the incidents involved occurred, and
       ``(B) provide to the Board, through the system under 
     paragraph (1), a list of the physicians who have been such 
     subjects, which list specifies for each physician the States 
     in which the incidents involved occurred.
       ``(5) Request by state of information on relevant 
     physicians.--For purposes of paragraph
       (3)(B), a Board of Medical Examiners of a State is 
     complying with this paragraph if, after receiving the list of 
     physicians under paragraph (4)(B), the Board promptly--
       (A) identifies which of the physicians has had, for 
     purposes of paragraph (4), an incident in another State, and
       (B) requests for the Secretary (or the agency) information 
     reported under this part concerning each of the physicians so 
     identified.''.

     SEC. 8. ADDITIONAL PROVISIONS REGARDING ACCESS TO 
                   INFORMATION; MISCELLANEOUS PROVISIONS.

       (a) Access to Information.--Section 427(a) of the Health 
     Care Quality Improvement Act of 1986 (42 U.S.C. 11137(a)) is 
     amended to read as follows:
       ``(a) Access Regarding Licensing, Employment, and Clinical 
     Privileges.--The Secretary (or the agency designated under 
     section 424(b)) shall, upon request, provide information 
     reported under this part concerning a physician or other 
     licensed health care practitioner to--
       ``(1) State licensing boards, and
       ``(2) hospitals and other health services organizations--
       ``(A) that have entered (or may be entering) into an 
     employment or affiliation relationship with the physician or 
     practitioner, or
       ``(B) to which the physician or practitioner has applied 
     for clinical privileges or appointment to the medical 
     staff.''.
       (b) Fees.--Section 427(b)(4) of the Health Care Quality 
     Improvement Act of 1986 (42

[[Page S9298]]

     U.S.C. 11137(b)(4)) is amended to read as follows:
       ``(4) Fees.--In disclosing information under subsection (a) 
     or section 426, the Secretary may impose fees in amounts 
     reasonably related to the costs of carrying out the duties of 
     the Secretary regarding the information reported under this 
     part (including the functions specified in section 424(b) 
     with respect to the information), except that a fee may not 
     be imposed for providing a list under section 425A(d)(4)(B) 
     to any Board of Medical Examiners. Such fees are available to 
     the Secretary (or, in the Secretary's discretion, to the 
     agency designated under section 424(b)) to cover such costs. 
     Such fees remain available until expended.''.
       (c) Additional Disclosures of Information.--Section 427 of 
     the Health Care Quality Improvement Act of 1986 (42 U.S.C. 
     11137) is amended by adding at the end the following 
     subsection:
       ``(e) Availability of Information to Public.--
       ``(1) In general.--Not later than 30 days after the 
     effective date for this subsection under section 11 of the 
     Health Care Quality Improvement Act Amendments of 1996, and 
     every 3 months thereafter, the Secretary shall, except as 
     provided in paragraph (2), make available to the public all 
     information reported under sections 421, 422(a), and 423(b). 
     For such purpose, the information shall be published as a 
     separate document whose principal topic is such information, 
     and in addition the information shall be made available 
     through the method described in paragraph (3).
       ``(2) Limitations.--In the case of a physician or other 
     licensed health care practitioner with respect to whom one or 
     more incidents have been reported under sections 421, 422(a), 
     and 423(b), the following applies:
       ``(A) Information may not be made available under paragraph 
     (1) if, subject to subparagraph (B), the aggregate number of 
     discrete incidents reported under such sections is not more 
     than 2.
       ``(B) A discrete incident reported under section 421 may 
     not be counted under subparagraph (A) if the payment for the 
     medical malpractice action or claim involved was less than 
     $25,000.
       ``(C) If the number of discrete incidents counted under 
     subparagraph (A) is 3 or more, the resulting availability of 
     information under paragraph (1) with respect to such 
     practitioner shall include information reported on all the 
     discrete incidents that were so counted. Such availability 
     may not include information on any incident not counted by 
     reason of subparagraph (B).
       ``(D) Of the information reported under section 421, the 
     following information may not be made available under 
     paragraph (1) (regardless of the number of discrete incidents 
     counted under subparagraph (A) and regardless of the amount 
     of the payments involved):
       ``(i) The social security account number of the physician 
     or practitioner.
       ``(ii) Information disclosing the identity of any patient 
     involved in the incidents involved.
       ``(iii) With respect to information that the Secretary 
     requires under section 421(b)(5) (if any)--
       ``(I) the home address of the physician or practitioner, 
     and
       ``(II) the number assigned to the physician or practitioner 
     by the Drug Enforcement Administration.
       ``(iv) Information not required to be reported under such 
     section.
       ``(3) Use of internet.--For purposes of paragraph (1), the 
     method described in this paragraph is to make the information 
     involved available to the public through the 
     telecommunications medium known as the World Wide Web of the 
     Internet. The Secretary, acting through the Administrator of 
     the Health Resources and Services Administration, shall 
     provide for the establishment of a site on such medium, and 
     shall update the information maintained through such medium 
     not less frequently than once every 3 months.
       ``(4) Dissemination; fees.--The Secretary shall disseminate 
     each publication under paragraph (1) to public libraries 
     without charge. In providing the publication to other 
     entities, and in making information available under paragraph 
     (3), the Secretary may impose a fee reasonably related to the 
     costs of the Secretary in carrying out this subsection. Such 
     fees are available to the Secretary (or, in the Secretary's 
     discretion, to the agency designated under section 424(b)) to 
     cover such costs. Such fees remain available until 
     expended.''.
       (d) Conforming Amendments.--Section 427 of the Health Care 
     Quality Improvement Act of 1986 (42 U.S.C. 11137) is 
     amended--
       (1) in subsection (b)(1), in the first sentence, by 
     striking ``Information reported'' and inserting the 
     following: ``Except for information disclosed under 
     subsection (e), information reported''; and
       (2) in the heading for the section, by striking 
     ``MISCELLANEOUS PROVISIONS'' and inserting the following: 
     ``ADDITIONAL PROVISIONS REGARDING ACCESS TO INFORMATION; 
     MISCELLANEOUS PROVISIONS''.

     SEC. 9. OTHER MATTERS.

       The Health Care Quality Improvement Act of 1986 (42 U.S.C. 
     11101 et seq.) is amended--
       (1) by redesignating part C as part D; and
       (2) by inserting after part B the following part:

  ``PART C--OTHER MATTERS REGARDING IMPROVEMENT OF HEALTH CARE QUALITY

     ``SEC. 428. PROHIBITION AGAINST SETTLEMENT WITHOUT CONSENT OF 
                   PRACTITIONER.

       ``(a) Prohibition.--With respect to a physician or other 
     licensed health care practitioner whose acts or omissions are 
     the basis of a medical malpractice action or claim, an entity 
     may not make a payment described in section 421(a)(1) without 
     the written consent of the physician or practitioner, subject 
     to subsection (b).
       ``(b) Exceptions.--Subsection (a) shall not apply with 
     respect to a payment by an entity regarding an action or 
     claim, subject to subsection (c)--
       ``(1) if the payment is made in satisfaction of a judgment 
     in a court of competent jurisdiction,
       ``(2) if, with respect to the action or claim, the 
     physician or other licensed health care practitioner involved 
     enters a process of alternative dispute resolution, and the 
     process has been concluded or any of the individuals involved 
     has terminated participation in the process,
       ``(3)(A) the entity delivers directly, or makes a 
     reasonable effort to deliver through the mail, a written 
     notice to the physician or practitioner involved providing 
     the information specified in subsection (c), and
       ``(B) a 30-day period elapses, at the conclusion of which 
     the entity has a reasonable belief that the physician or 
     practitioner does not object to the payment.
       ``(c) Criteria Regarding Notice.--For purposes of 
     subsection (b)(3) regarding a written notice to a physician 
     or practitioner--
       ``(1) the notice shall be considered to have been delivered 
     if the notice was delivered to the home or business address 
     of the physician or practitioner, and to the attorney (if 
     any) representing the physician or practitioner in the action 
     or claim involved,
       ``(2) the notice shall be considered to have been delivered 
     directly if the notice was delivered personally by the entity 
     involved or by an agent of the entity,
       ``(3) the entity shall be considered to have made a 
     reasonable effort to deliver the notice through the mail if 
     the entity provided the notice through certified mail, with 
     return receipt requested,
       ``(4) the information specified in this paragraph for the 
     notice is that the entity intends to make the payment 
     involved; that the physician or practitioner has a legal 
     right to prohibit the payment; and that such right expires in 
     30 days, with a specification of the date on which the right 
     expires, and
       ``(5) the 30-day period begins on the date on which the 
     notice is delivered directly to the physician or 
     practitioner, or on the seventh day after the date on which 
     the notice is posted, as the case may be.
       ``(d) Civil Money Penalty.--An entity that makes a payment 
     in violation of subsection (a) shall be subject to a civil 
     money penalty of not more than $10,000 for each such payment 
     involved. Such penalty shall be imposed and collected in the 
     same manner as civil money penalties under subsection (a) of 
     section 1128A of the Social Security Act are imposed and 
     collected under that section.

     ``SEC. 429. EMPLOYMENT TERMINATION OF PHYSICIAN.

       ``(a) Requirement of Adequate Notice and Hearing.--
       ``(1) In general.--A health services organization may not 
     terminate the employment of a physician, and may not 
     terminate a contract with a physician for the provision of 
     health services, unless adequate notice and hearing 
     procedures have been afforded the physician involved.
       ``(2) Applicability.--Section 412(a)(3) applies in lieu of 
     paragraph (1) in the case of an employment termination that 
     is a professional review action. (With respect to the 
     preceding sentence, paragraph (1) does apply to an 
     employment termination that is an action described in 
     subparagraph (A) of section 431(10) or in the other 
     subparagraphs of such section.)
       ``(b) Safe Harbor.--
       ``(1) In general.--A health services organization is deemed 
     to have met the adequate notice and hearing requirement of 
     subsection (a) with respect to the employment of, or a 
     contract of, a physician if the conditions described in 
     paragraphs (2) through (4) are met (or are waived voluntarily 
     by the physician).
       ``(2) Notice of proposed action.--Conditions under 
     paragraph (1) are that the physician involved has been given 
     notice stating--
       ``(A)(i) that the health services organization proposes to 
     take action to terminate the employment or contract,
       ``(ii) reasons for the proposed action,
       ``(B)(i) that the physician has the right to request a 
     hearing on the proposed action,
       ``(ii) any time limit (of not less than 30 days) within 
     which to request such a hearing, and
       ``(C) a summary of the rights in the hearing under 
     paragraph (4).
       ``(3) Notice of hearing.--Conditions under paragraph (1) 
     are that, if a hearing is requested on a timely basis under 
     paragraph (2)(B), the physician involved must be given notice 
     stating--
       ``(A) the place, time, and date, of the hearing, which date 
     shall not be less than 30 days after the date of the notice, 
     and
       ``(B) a list of the witnesses (if any) expected to testify 
     at the hearing on behalf of the health services organization.
       ``(4) Conduct of hearing and notice.--Conditions under 
     paragraph (1) are that, if a hearing is requested on a timely 
     basis under paragraph (2)(B)--

[[Page S9299]]

       ``(A) subject to subparagraph (B), the hearing shall be 
     held (as determined by the health services organization)--
       ``(i) before arbitrator mutually acceptable to the 
     physician involved and the health services organization,
       ``(ii) before a hearing officer who is appointed by the 
     organization and who is not in direct economic competition 
     with the physician, or
       ``(iii) before a panel of individuals who are appointed by 
     the organization and are not in direct economic competition 
     with the physician,
       ``(B) the right to the hearing may be forfeited if the 
     physician fails, without good cause, to appear,
       ``(C) in the hearing the physician has the right--
       ``(i) to representation by an attorney or other person of 
     the physician's choice,
       ``(ii) to have a record made of the proceedings, copies of 
     which may be obtained by the physician upon payment of any 
     reasonable charges associated with the preparation thereof,
       ``(iii) to call, examine, and cross-examine witnesses,
       ``(iv) to present evidence determined to be relevant by the 
     hearing officer, regardless of its admissibility in a court 
     of law, and
       ``(v) to submit a written statement at the close of the 
     hearing, and
       ``(D) upon completion of the hearing, the physician has the 
     right--
       ``(i) to receive the written recommendation of the 
     arbitrator, officer, or panel, including a statement of the 
     basis for the recommendations, and
       ``(ii) to receive a written decision of the health services 
     organization, including a statement of the basis for the 
     decision.
       ``(c) Rule of Construction.--A health services 
     organization's failure to meet the conditions described in 
     paragraphs (2) through (4) of subsection (b) shall not, in 
     itself, constitute failure to meet the standards of 
     subsection (a).''.

     SEC. 10. DEFINITIONS.

       Section 431(6) of the Health Care Quality Improvement Act 
     of 1986, as redesignated by section 3(b)(1) of this Act, is 
     amended by inserting before the period the following: 
     ``(except that such term means an institution described in 
     such paragraph (1) (without regard to such paragraph (7)) if, 
     under applicable State or local law, the institution is 
     permitted to operate without being licensed or otherwise 
     approved as a hospital)''.

     SEC. 11. EFFECTIVE DATES.

       (a) Incorporation of Text of Amendments.--The amendments 
     described in this Act are made upon the date of the enactment 
     of this Act.
       (b) Substantive Effect.--Except as provided in subsection 
     (c)(1) and subsection (d), and except as otherwise provided 
     in this Act--
       (1) the amendments made by this Act take effect upon the 
     expiration of the 1-year period beginning on the date of the 
     enactment of this Act; and
       (2) prior to the expiration of such period, the Health Care 
     Quality Improvement Act of 1986, as in effect on the day 
     before such date of enactment, continues in effect.
       (c) Regulations.--
       (1) In general.--With respect to the amendments made by 
     this Act, the Secretary of Health and Human Services may 
     issue regulations pursuant to such amendments before the 
     expiration of the period specified in subsection (b)(1), and 
     may otherwise take appropriate action before the expiration 
     of such period to prepare for the responsibilities of the 
     Secretary to the amendments.
       (2) Absence of final rule.--The final rule for purposes of 
     paragraph (1) may not take effect before the expiration of 
     the period specified in subsection (b)(1), and the absence of 
     such a rule upon such expiration does not affect the 
     provisions of subsection (b).
       (d) Transitional Provisions Regarding Malpractice Payments 
     by Persons.--With respect to the reporting of information 
     under section 421 of the Health Care Quality Improvement Act 
     of 1986, the following applies:
       (1) The requirement of reporting by persons under section 
     421(a)(1) of such Act (as amended by section 3(a) of this 
     Act) takes effect 180 days after the date of the enactment of 
     this Act.
       (2) The requirement of reporting by persons applies to 
     payments under such section 421(a)(1) made before, on, or 
     after such date of enactment.
       (3)(A) The information received by the Secretary of Health 
     and Human Services on or before August 27, 1993, pursuant to 
     regulations requiring reports from persons (in addition to 
     reports from entities) shall be maintained in the same manner 
     as the information was maintained prior to such date, and 
     shall be available in accordance with the regulations in 
     effect under such Act prior to such date (which regulations 
     remain in effect unless a provision of this Act takes effect 
     pursuant to this section and requires otherwise).
       (B) Subparagraph (A) takes effect on the date of the 
     enactment of this Act.

                                S. 2005

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Patient 
     Communications Protection Act of 1996''.
       (b) Findings.--Congress finds the following:
       (1) Patients need access to all relevant information to 
     make appropriate decisions, with their physicians, about 
     their health care.
       (2) Restrictions on the ability of physicians to provide 
     full disclosure of all relevant information to patients 
     making health care decisions violate the principles of 
     informed consent and practitioner ethical standards.
       (3) The offering and operation of health plans affect 
     commerce among the States. Health care providers located in 
     one State serve patients who reside in other States as well 
     as that State. In order to provide for uniform treatment of 
     health care providers and patients among the States, it is 
     necessary to cover health plans operating in one State as 
     well as those operating among the several States.

     SEC. 2. PROHIBITION OF INTERFERENCE WITH CERTAIN MEDICAL 
                   COMMUNICATIONS.

       (a) In General.--
       (1) Prohibition of certain provisions.--Subject to 
     paragraph (2), an entity offering a health plan (as defined 
     in subsection (d)(2)) may not include any provision that 
     prohibits or restricts any medical communication (as defined 
     in subsection (b)) as part of--
       (A) a written contract or agreement with a health care 
     provider,
       (B) a written statement to such a provider, or
       (C) an oral communication to such a provider.
       ``(2) Construction.--Nothing in this section shall be 
     construed as preventing an entity from exercising mutually 
     agreed upon terms and conditions not inconsistent with 
     paragraph (1), including terms or conditions requiring 
     caregivers to participate in, and cooperate with, all 
     programs, policies, and procedure developed or operated by 
     the person, corporation, partnership, association, or other 
     organization to ensure, review, or improve the quality of 
     health care.
       (3) Nullification.--Any provision described in paragraph 
     (1) is null and void.
       (b) Medical Communication Defined.--In this section, the 
     term ``medical communication'' means a communication made by 
     a health care provider with a patient of the provider (or the 
     guardian or legal representative of such patient) with 
     respect to the patient's physician or mental condition or 
     treatment options.
       (c) Enforcement Through Imposition of Civil Money 
     Penalty.--
       (1) In general.--Any entity that violates paragraph (1) of 
     subsection (a) shall be subject to a civil money penalty of 
     up to $15,000 for each violation. No such penalty shall be 
     imposed solely on the basis of an oral communication unless 
     the communication is part of a pattern or practice of such 
     communications and the violation is demonstrated by a 
     preponderance of the evidence.
       (2) Procedures.--The provisions of subsections (c) through 
     (l) of section 1128A of the Social Security Act (42 U.S.C. 
     1320a-7a) shall apply to civil money penalties under 
     paragraph (1) in the same manner as they apply to a penalty 
     or proceeding under section 1128A(a) to a penalty or 
     proceeding under section 1128A(a) of such Act.
       (d) Definitions.--For purposes of this section:
       (1) Health care provider.--The term ``health care 
     provider'' means anyone licensed under State law to provide 
     health care services, including a practitioner such as a 
     nurse anesthetist or chiropractor who is so licensed.
       (2) Health plan.--The term ``health plan'' means any public 
     or private health plan or arrangement (including an employee 
     welfare benefit plan) which provides, or pays the cost of, 
     health benefits, and includes an organization of health care 
     providers that furnishes health services under a contract or 
     agreement with such a plan.
       (3) Coverage of third party administrators.--In the case of 
     a health plan that is an employee welfare benefit plan (as 
     defined in section 3(1) of the Employee Retirement Income 
     Security Act of 1974), any third party administrator or other 
     person with responsibility for contracts with health care 
     providers under the plan shall be considered, for purposes of 
     this section, to be an entity offering such health plan.
       (e) Non-Preemption of State Law.--A State may establish or 
     enforce requirements with respect to the subject matter of 
     this section, but only if such requirements are consistent 
     with the Act and are more protective of medical 
     communications than the requirements established under this 
     section.
       (g) Effective Date.--Subsection (a) shall take effect 180 
     days after the date of the enactment of this Act and shall 
     apply to medical communications made on or after such date.
                                 ______
                                 
      By Mr. HATCH (for himself, Mr. Biden, Mr. Thurmond, and Mr. 
        Grassley):
  S. 2006. A bill to clarify the intent of Congress with respect to the 
Federal carjacking prohibition.


                 the carjacking correction act of 1996

  Mr. HATCH. Mr. President, I rise to introduce the Carjacking 
Correction Act of 1996. This bill adds an important clarification to 
the Federal carjacking statute, which is to provide that a rape 
committed during a carjacking should be considered a serious bodily 
injury.
  I am pleased to be joined in this effort by the ranking member of the 
Judiciary Committee, Senator Biden. He

[[Page S9300]]

has long been a leader in addressing the threat of violence against 
women, and our partnership in enacting the Violence Against Women Act 
is evidence of strong bipartisan outrage at every incident of assault 
or domestic violence.
  This correction to the law is necessitated by the fact that at least 
one court has held that under the Federal carjacking statute, rape 
would not constitute a serious bodily injury. Few crimes are as brutal, 
vicious, and harmful to the victim than rape. Yet, under this 
interpretation, the sentencing enhancement for such injury may not be 
applied to a carjacker who brutally rapes his victim.
  In my view, Congress should act now to clarify the law in this 
regard. The bill we introduce today would do this by specifically 
including rape as serious bodily injury under the statute.
  I want to thank Representative John Conyers, the ranking member of 
the House Judiciary Committee, who brought this matter to my attention 
and is leading the effort in the House for passage of this legislation.
  I urge my colleagues to support swift passage of this bill.
                                 ______
                                 
      By Mr. DASCHLE (for himself, Mr. Rockefeller, Mr. Kerry, Mr. 
        Wellstone, Ms. Mikulski, Mr. Byrd, Mr. Dodd, Mr. Conrad, Mr. 
        Inouye, Mr. Pell, Mr. Simon, Mr. Feingold, Mr. Breaux, Mrs. 
        Boxer, Mr. Dorgan, Mrs. Feinstein, Mr. Glenn, Mr. Harkin, Mr. 
        Robb, and Mr. Kennedy):
  S. 2008. A bill to amend title 38, United States Code, to provide 
benefits for certain children of Vietnam veterans who are born with 
spina bifida, and for other purposes; to the Committee on Veterans 
Affairs.


                 The Agent Orange Benefits Act of 1996

  Mr. DASCHLE. Mr. President, today, with 19 of my colleagues, I am 
introducing the Agent Orange Benefits Act of 1996. This legislation is 
an important step toward easing the burden of innocent, indirect 
victims of our country's use of agent orange during the Vietnam war. 
The bill would extend health care and related benefits, including a 
monthly monetary allowance, to Vietnam veterans' children suffering 
from spina bifida--a serious neural tube birth defect that requires 
lifelong care.
  This bill is a necessary followup to the Agent Orange Act of 1991, 
which I coauthored with Senators Kerry and Cranston and Representative 
Lane Evans and which unanimously passed the Senate. Among other things, 
the Agent Orange Act required the Department of Veterans Affairs [VA] 
to contract with the Institute of Medicine [IOM], which is part of the 
National Academy of Sciences [NAS], to conduct a scientific review of 
all evidence pertaining to exposure to agent orange and other 
herbicides used in Vietnam and the subsequent occurrence of disease and 
other health-related conditions. The law required an initial report, 
which was issued by NAS in 1993, followed by biennial updates for 10 
years. The first update was published by NAS last March.
  In accordance with the law, Vietnam veterans are not required to 
prove exposure to agent orange; the law presumes that all military 
personnel who served in Vietnam were exposed to agent orange. The 
Secretary is to provide presumptive disability compensation for 
diseases suffered by Vietnam veterans whenever he determines, based on 
all credible evidence, including the congressionally mandated NAS 
reports, that a positive association exists between exposure and the 
occurrence of such diseases in humans. For purposes of this law, a 
positive association must be found to exist whenever credible evidence 
for an association is equal to or outweighs the credible evidence 
against the association.
  We have been struggling for decades to provide compensation and 
health care for Vietnam veterans--and, if warranted, their children--
for health problems associated with exposure to agent orange. Since 
1985, Vietnam veterans have been eligible for free VA health care for 
conditions believed to be related to exposure to agent orange. Vietnam 
veterans are also eligible for presumptive disability compensation for 
several diseases, including chloracne and various cancers, associated 
with exposure to agent orange or other herbicides used in Vietnam. Most 
recently, in response to the March NAS report, the Secretary of 
Veterans Affairs awarded service-connected disability compensation for 
prostate cancer and acute and subacute peripheral neuropathy.
  An area of key concern to Vietnam veterans has been what they believe 
to be a high rate of birth defects in the children born to them since 
their service in Vietnam. The Agent Orange Act of 1991 specifically 
mandated that the area of reproductive disorders and birth defects be 
given special attention to determine whether or not compensatory action 
is warranted. The March NAS report showed new evidence suggesting a 
link between exposure to agent orange and the occurrence of spina 
bifida in Vietnam veterans' children. The report also noted that there 
is growing evidence, though not as strong as the evidence on spina 
bifida at this point, suggestive of an increase in other birth defects 
among Vietnam veterans' children.
  In response to the NAS report, the Secretary of Veterans Affairs 
assembled an interdepartmental task force, which consulted with 
interested veterans' service organizations and experts in spina bifida, 
to review the NAS findings and make policy recommendations to the 
Secretary.
  In May, the Secretary delivered to the President several policy 
recommendations based on the VA's review of the NAS report. These 
included recommendations to add prostate cancer and acute and subacute 
peripheral neuropathy to the list of presumptive diseases, and, if 
authority were granted, to treat spina bifida in veterans' children in 
the same manner. The VA does not currently have the authority to 
provide benefits to veterans' children. Subsequently, President Clinton 
announced that the administration would propose legislation to provide 
an appropriate remedy for Vietnam veterans' children who suffer from 
spina bifida. This bill reflects that effort.
  Clearly, the Government's responsibility does not end once veterans 
return from war. Effects of combat, even those passed down through 
reproductive disorders, are a direct result of our decisions to place 
our Nation's men and women in harm's way. We have a moral 
responsibility to help veterans whose children suffer from spina bifida 
and to meet those children's health care needs.
  It should be noted that spina bifida is a devastating, irreversible 
birth defect resulting from the failure of the spine to properly close 
early in pregnancy. It requires lifelong medical treatment, and the 
cost of caring for a child with spina bifida can be financially 
devastating for families. While spina bifida affects approximately one 
of every 1,000 newborns in the United States, a study of Vietnam 
veterans that was included in the NAS report showed three spina bifida 
cases in a group of only 792 infants of Vietnam veterans--a 
statistically significant result.
  The Agent Orange Benefits Act of 1996 would provide health care, 
limited vocational rehabilitation, and a monthly stipend to Vietnam 
veterans' children with spina bifida based on the severity of each 
child's condition. It includes the provision of essential medical care 
and case management services to coordinate health and social services 
for the child.
  Unfortunately, the NAS report confirmed what Vietnam veterans have 
long feared: the Vietnam war continues to claim innocent victims. 
Nothing can erase the physical and psychological wounds of the war, 
but, by providing limited benefits to affected children, the Agent 
Orange Benefits Act of 1996 will allow us to heal some of the lingering 
scars from Vietnam.
  The NAS report also serves as a valuable reminder that the impact of 
any war is felt decades beyond the final shots. Just as reproductive 
disorders and birth defects in their children have been among Vietnam 
veterans' greatest health concerns, health problems in their children 
is of great concern to veterans who served in the Gulf war. We must be 
prepared to learn from the scientific effort on agent orange and apply 
these lessons to the effort to discover the true health effects of 
environmental hazards on the men and women who served in the Gulf and 
on their children. Based on the NAS report's findings related to spina 
bifida in the children of Vietnam veterans,

[[Page S9301]]

the VA is establishing a reproductive outcomes research center to 
investigate potential environmental hazards of military service. I look 
forward to seeing those efforts come to fruition, and I am hopeful they 
will help us provide answers to the many outstanding questions in this 
area.
  I applaud the President and Secretary Jesse Brown, along with my 
colleagues who have been committed to this fight for years, for working 
together to develop a proposal that adequately addresses the needs of 
these children and their families, and for providing modest 
compensation for a wrong that can never fully be righted.
  With the passage of this legislation, we can begin to fulfill our 
promise to these most innocent victims and their families. Vietnam 
veterans' families have suffered for decades and now live with the pain 
of knowing that their military service may have jeopardized the health 
and welfare of their children. The very least we can do is ease their 
burden by providing this limited assistance and care.
  Mr. President, I ask unanimous consent that the text of the bill, a 
summary of the bill, a letter of support from the administration, and a 
table from the NAS report that explains the four-tiered classification 
system for agent orange-related illnesses, be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2008

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. REFERENCES TO TITLE 38, UNITED STATES CODE.

       Except as otherwise expressly provided, whenever in this 
     Act an amendment or repeal is expressed in terms of an 
     amendment or repeal is expressed in terms of an amendment to, 
     or repeal of, a section or other provision, the reference 
     shall be considered to be made to a section or other 
     provision of title 38, United States Code.

     SEC. 2. BENEFITS FOR THE CHILDREN OF VIETNAM VETERANS WHO ARE 
                   BORN WITH SPINA BIFIDA.

       (a) Short Title.--This section may be cited as the ``Agent 
     Orange Benefits Act of 1996.''
       (b) Establishment of New Chapter 18.--Part II is amended by 
     inserting after chapter 17 the following new chapter:

  ``CHAPTER 18--BENEFITS FOR THE CHILDREN OF VIETNAM VETERANS WHO ARE 
                         BORN WITH SPINA BIFIDA

     ``Sec.
     ``1801. Purpose.
     ``1802. Definitions.
     ``1803. Health care.
     ``1804. Vocational training.
     ``1805. Monetary allowance.
     ``1806. Effective date of Awards.

     SEC. ``1801. PURPOSE.

       ``The purpose of this chapter is to provide for the special 
     needs of certain children of Vietnam veterans who were born 
     with the birth defect spina bifida, possibly as the result of 
     the exposure of one or both parents to herbicides during 
     active service in the Republic of Vietnam during the Vietnam 
     era, through the provision of health care, vocational 
     training, and monetary benefits.

     ``SEC. 1802. DEFINITIONS.

       ``For the purposes of this chapter--
       ``(1) The term `child' means a natural child of a Vietnam 
     veteran, regardless of age or marital status, who was 
     conceived after the date on which the veteran first entered 
     the Republic of Vietnam during the Vietnam era.
       ``(2) The term `Vietnam veteran' means a veteran who, 
     during active military, naval, or air service, served in the 
     Republic of Vietnam during the Vietnam era.
       ``(3) The term `spina bifida' means all forms of spina 
     bifida other than spina bifida occulta.

     ``SEC. 1803. HEALTH CARE.

       ``(a) In accordance with regulations the Secretary shall 
     prescribe, the Secretary shall provide such health care under 
     this chapter as the Secretary determines is needed to a child 
     of a Vietnam veteran who is suffering from spina bifida, for 
     any disability associated with such condition.
       ``(b) The Secretary may provide health care under this 
     section directly or by contract or other arrangement with a 
     health care provider.
       ``(c) For the purposes of this section--
       ``(1) the term `health care' means home care, hospital 
     care, nursing home care, outpatient care, preventive care, 
     habilitative and rehabilitative care, case management, and 
     respite care, and includes the training of appropriate 
     members of a child's family or household in the care of the 
     child and provision of such pharmaceuticals, supplies, 
     equipment, devices, appliances, assistive technology, direct 
     transportation costs to and from approved sources of health 
     care authorized under this section, and other materials as 
     the Secretary determines to be necessary.
       ``(2) the term `health care provider' includes, but is not 
     limited to, specialized spina bifida clinics, health-care 
     plans, insurers, organizations, institutions, or any other 
     entity or individual who furnishes health care services that 
     the Secretary determines are covered under this section.
       ``(3) the term `home care' means outpatient care, 
     habilitative and rehabilitative care, preventive health 
     services, and health-related services furnished to an 
     individual in the individual's home or other place of 
     residence.
       ``(4) the term `hospital care' means care and treatment for 
     a disability furnished to an individual who has been admitted 
     to a hospital as a patient.
       ``(5) the term `nursing home care' means care and treatment 
     for a disability furnished to an individual who has been 
     admitted to a nursing home as a resident.
       ``(6) the term `outpatient care' means care and treatment 
     of a disability, and preventive health services, furnished to 
     an individual other than hospital care or nursing home care.
       ``(7) the term `preventive care' means care and treatment 
     furnished to prevent disability or illness, including 
     periodic examinations, immunizations, patient health 
     education, and such other services as the Secretary 
     determines are necessary to provide effective and economical 
     preventive health care.
       ``(8) the term `habilitative and rehabilitative care' means 
     such professional, counseling, and guidance services and 
     treatment programs (other than vocational training under 
     section 1804 of this title) as are necessary to develop, 
     maintain, or restore, to the maximum extent, the functioning 
     of a disabled person.
       ``(9) the term `respite care' means care furnished on a 
     intermittent basis in a Department facility for a limited 
     period to an individual who resides primarily in a private 
     residence when such care will help the individual to continue 
     residing in such private residence.

     ``SEC. 1804. VOCATIONAL TRAINING.

       ``(a) Pursuant to such regulations as the Secretary may 
     prescribe, the Secretary may provide vocational training 
     under this section to a child of a Vietnam veteran who is 
     suffering from spina bifida if the Secretary determines that 
     the achievement of a vocational goal by such child is 
     reasonably feasible.
       ``(b)(1) If a child elects to pursue a program of 
     vocational training under this section, the program shall be 
     designed in consultation with the child in order to meet the 
     child's individual needs and shall be set forth in an 
     individualized written plan of vocational rehabilitation.
       ``(2)(A) Subject to subparagraph (B) of this paragraph, a 
     vocational training program under this subsection shall 
     consist of such vocationally oriented services and 
     assistance, including such placement and post-placement 
     services and personal and work adjustment training, as 
     the Secretary determines are necessary to enable the child 
     to prepare for and participate in vocational training or 
     employment.
       ``(B) A vocational training program under this subsection--
       ``(i) may not exceed 24 months unless, based on a 
     determination by the Secretary that an extension is necessary 
     in order for the child to achieve a vocational goal 
     identified (before the end of the first 24 months of such 
     program) in the written plan formulated for the child, the 
     Secretary grants an extension for a period not to exceed 24 
     months;
       ``(ii) may not include the provision of any loan or 
     subsistence allowance or any automobile adaptive equipment; 
     and
       ``(iii) may include a program of education at an 
     institution of higher learning only in a case in which the 
     Secretary determines that the program involved is 
     predominantly vocational in content.
       ``(c)(1) A child who is pursuing a program of vocational 
     training under this section who is also eligible for 
     assistance under a program under chapter 35 of this title may 
     not receive assistance under both of such programs 
     concurrently but shall elect (in such form and manner as the 
     Secretary may prescribe) under which program to receive 
     assistance.
       ``(2) The aggregate period for which a child may receive 
     assistance under this section and chapter 35 of this title 
     may not exceed 48 months (or the part-time equivalent 
     thereof).

     ``SEC. 1805. MONETARY ALLOWANCE.

       ``(a) The Secretary shall pay a monthly allowance under 
     this chapter to any child of a Vietnam veteran for disability 
     resulting from spina bifida suffered by such child.
       ``(b) The amount of the allowance paid under this section 
     shall be based on the degree of disability suffered by a 
     child as determined in accordance with such schedule for 
     rating disabilities resulting from spina bifida as the 
     Secretary may prescribe. The Secretary shall, in prescribing 
     the rating schedule for the purposes of this section, 
     establish three levels of disability upon which the amount of 
     the allowance provided by this section shall be based. The 
     allowance shall be $200 per month for the lowest level of 
     disability prescribed, $700 per month for the intermediate 
     level of disability prescribed, and $1,200 per month for 
     the highest level of disability prescribed.
       ``(c)(1) Whenever there is an increase in benefit amounts 
     payable under title II of the Social Security Act (42 U.S.C. 
     401 et seq.) as a result of a determination under section

[[Page S9302]]

     215(i) of such Act (42 U.S.C. 415(i)), the Secretary shall, 
     effective on the date of such increase in benefit amounts, 
     increase each rate of allowance under this section, as such 
     rates were in effect immediately prior to the date of such 
     increase in benefits payable under title II of the Social 
     Security Act, by the same percentage as the percentage by 
     which such benefit amounts are increased.
       ``(2) Whenever there is an increase in the rates of the 
     allowance payable under this section, the Secretary shall 
     publish such rates in the Federal Register.
       ``(3) Whenever such rates are so increased, the Secretary 
     may round such rates in such manner as the Secretary 
     considers equitable and appropriate for ease of 
     administration.
       ``(d) Notwithstanding any other provision of law, receipt 
     by a child of an allowance under this section shall not 
     impair, infringe, or otherwise affect the right of such child 
     to receive any other benefit to which the child may otherwise 
     be entitled under any law administered by the Secretary, nor 
     shall such receipt impair, infringe, or otherwise affect the 
     right of any individual to receive any benefit to which he or 
     she is entitled under any law administered by the Secretary 
     that is based on the child's relationship to such individual.
       ``(e) Notwithstanding any other provision of law, the 
     allowance paid to a child under this section shall not be 
     considered income or resources in determining eligibility for 
     or the amount of benefits under any Federal or federally 
     assisted program.

     ``SEC. 1806. EFFECTIVE DATE OF AWARDS.

       ``Effective date for an award for benefits under this 
     chapter shall be fixed in accordance with the facts found, 
     but shall not be earlier than the date of receipt of 
     application therefor.''.
       (c) Effective Date.--The amendments made by this section 
     shall become effective on October 1, 1996.
       (d) Clerical Amendment.--The tables of chapters before part 
     I and at the beginning of part II are each amended by 
     inserting after the item referring to chapter 17 the 
     following new item:

``18. Benefits for children of Vietnam veterans who are born with spina 
    bifida..................................................1801''.....

     SEC. 3. CLARIFICATION OF ENTITLEMENT FOR BENEFITS FOR 
                   DISABILITY RESULTING FROM TREATMENT OR 
                   VOCATIONAL SERVICES PROVIDED BY DEPARTMENT OF 
                   VETERANS AFFAIRS.

       (a) Section 1151 is amended--
       (1) by striking out the first sentence and inserting in 
     lieu thereof the following:
       ``(a) Compensation under this chapter and dependency and 
     indemnity compensation under chapter 13 of this title shall 
     be awarded for qualifying additional disability to or death 
     of a veteran in the same manner as if such additional 
     disability or death were service-connected. For purposes of 
     this section, additional disability or death is qualifying 
     only if it was not the result of the veteran's willful 
     misconduct and--
       ``(1) it was caused by hospital care, medical or surgical 
     treatment, or examination furnished the veteran under any law 
     administered by the Secretary, either by a Department 
     employee or in a Department facility as defined in section 
     1701(3)(A) of this title, where the additional disability or 
     death proximately resulted--
       ``(A) from carelessness, negligence, lack of proper skill, 
     error in judgment, or similar instance of fault on the part 
     of the Department in furnishing the hospital care, medical or 
     surgical treatment, or examination; or
       ``(B) from an event not reasonably foreseeable; or
       ``(2) it was incurred as a proximate result of the 
     provision of training and rehabilitation services by the 
     Secretary (including by a service-provider used by the 
     Secretary for such purpose under section 3115 of this title) 
     as part of an approved rehabilitation program under chapter 
     31 of this title.''; and
       (2) in the second sentence--
       (A) by redesignating that sentence as subsection (b);
       (B) by striking out ``, aggravation,'' both places it 
     appears; and
       (C) by striking out ``sentence'' and substituting in lieu 
     thereof ``subsection''.
       (b) The amendments made by subsection (a) shall govern all 
     administrative and judicial determinations of eligibility for 
     benefits under section 1151 of title 38, United States Code, 
     made with respect to claims filed on or after the date of 
     enactment of this Act, including those based on original 
     applications and applications seeking to reopen, revise, 
     reconsider, or otherwise readjudicate on any basis claims for 
     benefits under section 1151 of that title or predecessor 
     provisions of law.
                                                                    ____


  Agent Orange Benefits for Vietnam Veterans' Children Suffering From 
                              Spina Bifida

       The Agent Orange Act of 1996 would extend health care and 
     related benefits, including a monthly monetary allowance, to 
     Vietnam veterans' children suffering from spina bifida--a 
     serious neural tube birth defect that requires life-long 
     care--provided the children were conceived after the veterans 
     began their service in Vietnam.


                               background

       A March National Academy of Sciences (NAS) report cited new 
     evidence that supports a link between exposure to Agent 
     Orange and the occurrence of spina bifida in children of 
     veterans who served in Vietnam. This report was required by 
     the Agent Orange Act of 1991.
       Since 1985, Vietnam veterans have been eligible for free VA 
     health care for conditions believed to be related to exposure 
     to Agent Orange. Veterans' disability compensation for 
     several Agent Orange-related illnesses--including non-
     Hodgkin's lymphoma, soft-tissue sarcoma, Hodgkin's disease, 
     chloracne, respiratory cancers, and multiple myeloma--has 
     been awarded as a result of either congressional or VA 
     action, some of which was based on a 1993 NAS report. Earlier 
     this year, Secretary Brown and the President, in response to 
     the March NAS report, extended service-connected benefits to 
     veterans suffering from prostate cancer and acute and sub-
     acute peripheral neuropathy.
       Reproductive disorders and birth defects in their children 
     have been among veterans' greatest Agent Orange-related 
     health concerns. This legislation is necessary because, while 
     the VA has recommended that spina bifida in veterans' 
     offspring be service-connected, the VA does not currently 
     have the authority to extend health care or other benefits to 
     children of veterans.


                                  cost

       CBO has not yet provided an estimate for this proposal. 
     However, costs would be offset by overturning the Gardner 
     case, which would limit the VA's liability for non-
     malpractice-related injuries occurring in VA facilities. This 
     non-controversial provision was included in Democratic and 
     Republican budget proposals for FY 96. Excess savings would 
     be directed to deficit reduction.


                role of the national academy of sciences

       The Agent Orange Act of 1991 directed the VA to contract 
     with the National Academy of Sciences to conduct for 10 years 
     biennial, comprehensive evaluations of the scientific and 
     medical information regarding the health effects of exposure 
     to Agent Orange and other herbicides used in Vietnam.
       The first report, ``Veterans and Agent Orange: Health 
     Effects of Herbicides Used in Vietnam,'' was published in 
     1993. It created the following categories to classify the 
     level of association between certain health conditions and 
     exposure to Agent Orange: Category I (``sufficient evidence 
     of an association''); category II (``limited/suggestive 
     evidence of an association''); category III (``inadequate/
     insufficient evidence to determine whether an association 
     exists''); category IV (``limited/suggestive evidence of NO 
     association'').
       Following the 1993 report, the VA began to compensate 
     Vietnam veterans suffering from three diseases in categories 
     I and II that had not been service-connected through previous 
     congressional or administrative action: porphyria cutanea 
     tarda, respiratory cancers, and multiple myeloma.
       The 1996 update, which was issued in March, confirmed many 
     of the findings in the 1993 report, and found new evidence to 
     link spina bifida in veterans' children with exposure to 
     Agent Orange. The NAS panel placed ``spina bifida in 
     offspring'' in category II, supporting a connection between 
     birth defects and military service. The NAS report currently 
     places birth defects other than spina bifida in category III.
       After reviewing the NAS report and other information, the 
     VA has recommended that all remaining conditions in 
     categories I and II, including spina bifida, be service-
     connected.
                                                                    ____



                            The Secretary of Veterans Affairs,

                                     Washington, DC, July 5, 1996.
     Hon. Christopher S. (Kit) Bond,
     Chairman, Subcommittee on VA, HUD, and Independent Agencies, 
         Committee on Appropriations, U.S. Senate, Washington, DC.
       Dear Mr. Chairman: I am pleased to share with you a copy of 
     legislation we provided earlier today to Senator Daschle. 
     This legislation, the ``Agent Orange Benefits Act of 1996,'' 
     would provide benefits to certain children of Vietnam 
     veterans who are born with the birth defect spinal bifida. 
     Enacting this legislation is a Presidential priority.
       Under Public Law 102-4, and with the benefit of a National 
     Academy of Sciences report, I determined that a positive 
     association exists between the exposure of Vietnam veterans 
     to herbicides (such as a Agent Orange) and spinal bifida in 
     their children. In approving this determination, the 
     President promised to submit ``an appropriate remedy'' for 
     these veterans' children. This legislation fulfills that 
     commitment. It provides for health care, vocational training, 
     and monthly monetary allowance for these children.
       As set forth in the legislation, the Administration 
     proposes to offset the costs associated with these new 
     benefits with a savings proposal that would effectively 
     reverse the U.S. Supreme Court decision in Gardner v. Brown 
     which held that monthly VA disability compensation must be 
     paid for any additional disability or death attributable to 
     VA medical treatment even if VA was not negligent in 
     providing that care.
       Enactment of this legislation is a top Presidential 
     priority. I strongly urge the Senate to include it in the 
     earliest appropriate legislative vehicle.
       Thank you for your assistance in ensuring prompt and 
     immediate action on this important legislation.
       The Office of Management and Budget has advised that there 
     is no objection from the standpoint of the Administration's 
     program to the presentation of this letter.
           Sincerely,
     Jesse Brown.
                                                                    ____


[[Page S9303]]

                           Executive Summary


TABLE 1-1--Updated Summary of findings in occupational, Environmental, 
and Veterans Studies Regarding the Association Between Specific Health 
                  problems and Exposure to Herbicides

     Sufficient evidence of an association
       Evidence is sufficient to conclude that there is a positive 
     association. That is, a positive association has been 
     observed between herbicides and the outcome in studies in 
     which chance, bias, and confounding could be ruled out with 
     reasonable confidence. For example, if several small studies 
     that are free from bias and confounding show an association 
     that is consistent in magnitude and direction, there may be 
     sufficient evidence for an association. There is sufficient 
     evidence of an association between exposure to herbicides and 
     the following health outcomes: Soft-tissue sarcoma; Non-
     Hodgkin's lymphoma; Hodgkin's disease; Chlorance.
     Limited/suggestive evidence of an association
       Evidence is suggestive of an association between herbicides 
     and the outcome but is limited because chance, bias, and 
     confounding could not be ruled out with confidence. For 
     example, at least one high-quality study shows a positive 
     association, but the results of other studies are 
     inconsistent. There is limited/suggestive evidence of an 
     association between exposure to herbicides and the following 
     health outcomes: Respiratory cancers (lung, larynx, trachea); 
     Prostate cancer; Multiple myeloma; Acute and subacute 
     peripheral neuropathy (new disease category); Spina bifida 
     (new disease category); Porphyria cutanea tarda (category 
     change in 1996).
     Inadequate/insufficient evidence to determine whether an 
         association exists
       The available studies are of insufficient quality, 
     consistency, or statistical power to permit a conclusion 
     regarding the presence or absence of an association. For 
     example, studies fail to control for confounding, have 
     inadequate exposure assessment, or fail to address latency. 
     There is inadequate or insufficient evidence to determine 
     whether an association exists between exposure to herbicides 
     and the following health outcomes: Hepatobiliary cancers; 
     Nasal/nasopharyngeal cancer; Bone cancer; Female reproductive 
     cancers (cervical, uterine, ovarian); Breast cancer; Renal 
     cancer; Testicular cancer; Leukemia; spontaneous abortion; 
     Birth defects (other than spina bifida); Neonatal/infant 
     death and stillbirths; Low birthweight; Childhood cancer in 
     offspring; Abnormal sperm parameters and infertility; 
     cognitive and neuropsychiatric disorders; Motor/coordination 
     dysfunction; Chronic peripheral nervous system disorders; 
     Metabolic and digestive disorders (diabetes, changes in liver 
     enzymes, lipid abnormalities, ulcers); Immune system 
     disorders (immune suppression and autoimmunity); Circulatory 
     disorders; Respiratory disorders; Skin cancer (category 
     change in 1996).
     Limited/suggestive evidence of no association
       Several adequate studies, covering the full range of levels 
     of exposure that human beings are known to encounter, are 
     mutually consistent in not showing a positive association 
     between exposure to herbicides and the outcome at any level 
     of exposure. A conclusion of ``no association'' is inevitably 
     limited to the conditions, level of exposure, and length of 
     observation covered by the available studies. In addition, 
     the possibility of a very small elevation in risk at the 
     levels of exposure studied can never be excluded. There is 
     limited/suggestive evidence of no association between 
     exposure to herbicides and the following health outcomes: 
     Gastrointestinal tumors (stomach cancer, pancreatic cancer, 
     colon cancer, rectal cancer); Bladder cancer; Brain tumors.

       Note: ``Herbicides'' refers to the major herbicides used in 
     Vietnam: 2,4-D (2,4-dichlorophenoxyacetic acid); 2,4,5-T 
     (2,4,5-trichlorophenoxyacetic acid) and its contaminant TCDD 
     (2,3,7,8-tetrachlorodibenzo-p-dioxin); cacodylic acid; and 
     picloram. The evidence regarding association is drawn from 
     occupational and other studies in which subjects were exposed 
     to a variety of herbicides and herbicide components.

  Mr. BYRD. Mr. President, I am proud to cosponsor the legislation 
introduced by the able Democratic leader, Senator Daschle, which 
provides health care and assistance to the children of Vietnam veterans 
who suffer from spina bifida. This legislation provides the needed 
authority for the Department of Veterans Affairs to treat these 
children for their service-connected disabilities arising from their 
father's exposure to agent orange during the Vietnam conflict. This is 
an unprecedented but appropriate action, since scientific research is 
now sufficiently sophisticated to allow us to understand the effects of 
toxic exposures on ourselves and on future generations.
  As a result of the Agent Orange Act of 1991, the Department of 
Veterans Affairs and the National Academy of Sciences have at regular 
intervals reviewed the ongoing research on Agent Orange exposure. The 
report update issued this spring found ``limited/suggestive evidence'' 
linking the birth defect spina bifida to agent orange exposure. The 
report notes that all three epidemiologic studies reviewed suggest an 
association between herbicide exposure and increased risk of spina 
bifida in offspring. It further notes that in contrast to most other 
diseases, for which the strongest data have been from occupationally 
exposed workers, these studies focused on Vietnam veterans. All the 
studies were judged to be of relatively high quality, although they did 
suffer from some methodologic limitations.
  On the basis of this finding, Secretary Jesse Brown recommended that 
a service connection be granted to Vietnam veterans' children with 
spina bifida. It is the right decision, and I applaud him for it. The 
research and the legislation are long overdue for families that have 
been struggling for some twenty years. Some one has observed that 
``procrastination is the thief of time.'' These children and their 
families have already lost time, lost long years of doubt and 
wondering, of financial hardship that they bore alone because the 
government procrastinated in investigating and acknowledging its role 
in this tragedy. The legislation introduced today by Senator Daschle 
attempts to correct that injustice, and I commend him for it. The poet 
Edward Young (1683-1796) has said: ``Be wise today; 'tis madness to 
defer.'' Support this legislation, take responsibility for the tragic 
aftermath of our involvement in Vietnam, and take care of these 
children.
  Mr. KERRY. Mr. President, I am pleased to join my distinguished 
colleague from South Dakota, Senator Daschle, in cosponsoring the Agent 
Orange Benefits Act of 1996. This bill takes another crucial step 
forward in repaying our debt to those who have served their country and 
are still suffering as a result of their service in Vietnam many years 
ago. In May, President Clinton announced that legislation would be 
proposed to aid Vietnam veterans' children who suffer from the disease 
spina bifida. This bill fulfills that commitment by recognizing and 
accepting natural responsibility for one of the serious health care 
needs of veterans' families that stem from the tragic effects of agent 
orange.
  Senator Daschle and I and many others have worked for the past decade 
to try to bring to a fair and just resolution the questions surrounding 
agent orange and the effects it has had on the men and women who 
faithfully served this country. I know that there is still controversy 
about the effects of agent orange. There may always be controversy, 
just as there may always be controversy about the Vietnam war itself. 
But we must set aside the controversy--or put it behind us--to enable 
suffering children to receive the care and treatment they need when 
that suffering can be followed back to a service person's exposure to 
agent orange.
  After years of hard work, I believe we have reached an acceptable 
consensus on the effects of agent orange through numerous studies--and 
independent scientific reviews of the many studies--which have been 
made on the effects of this dangerous chemical that contains deadly 
dioxin. I might add that it has been 30 years since agent orange was 
sprayed in Vietnam and we must stop debating over the bias of each 
individual analyzing the information. As I said back in May of 1988, 
``It is offensive to veterans to tell them that there is not enough 
`scientific evidence' to justify compensation * * * The evidence is in 
their own bodies, and even worse, in the bodies of their children.''
  We have made great strides in reaching a consensus in some areas of 
health care for Vietnam veterans. Since 1985, Vietnam veterans have 
been eligible for free health care from the Veterans Administration for 
conditions that are related to exposure to agent orange. Veterans' 
disability compensation has been awarded to veterans affected by 
several agent orange-related illnesses including non-Hodgkins lymphoma, 
soft tissue sarcoma, Hodgkin's disease, chloracne, respiratory cancers, 
multiple myeloma, and, most recently, prostate cancer and acute and 
subacute peripheral neuropathy.
  Today, Mr. President, we are addressing a particularly heinous effect 
of agent orange--an effect that unfortunately will carry the legacy of 
the Vietnam war to yet another generation. The bill we are introducing 
today would extend health care and related

[[Page S9304]]

benefits to children of Vietnam veterans who suffer from spina bifida, 
a serious neural tube birth defect that requires life-long care--
provided, of course, the children were conceived after the veterans 
began their service in Vietnam.
  The National Academy of Sciences released a report in March of this 
year, citing new evidence supporting the link between exposure to agent 
orange and the occurrence of spina bifida in children of veterans who 
served in Vietnam. This report, Mr. President, warrants our action.
  Both the President and the Secretary of Veterans Affairs, Jesse 
Brown, have asked that spina bifida in veterans' offspring be 
considered service connected. However, the VA currently does not have 
the authority to extend the health care and other related benefits to 
these children that they so greatly need. This bill will grant the VA 
the necessary authority to finally start providing needed care to these 
children who are suffering.
  Mr. President, these are children whose misery stems from physical 
damage caused to one of their parents who was fighting for this country 
in Vietnam. We should do no less than provide them with the care and 
treatment they need. We must not make some of the children of our 
Vietnam veterans the last victims of the Vietnam war. I urge my 
colleagues to support this bill.
                                 ______
                                 
      By Mr. ASHCROFT:
  S.J. Res. 58. A joint resolution proposing an amendment to the 
Constitution of the United States relative to granting power to the 
States to propose constitutional amendments; to the Committee on the 
Judiciary.


       state-initiated constitutional amendment joint resolution

  Mr. ASHCROFT. Mr. President, I rise this afternoon to talk about 
first principles, about fundamental truths, about a battle that helped 
give birth to a nation. The amendment I have sent to the desk 
represents an effort to restore the federal system conceived by the 
Framers over two centuries ago by giving the States the capacity to 
initiate constitutional reforms.
  In considering my remarks earlier this morning, I was reminded of a 
trip my family and I made several years ago when I was Governor of the 
State of Missouri. In 1989, we were extended an opportunity to visit 
the site where the Continental Army, led by Gen. Atemas Ward, fought to 
seize Bunker Hill on the Charlestown peninsula.
  It was a moving experience. One cannot help but recall the monument, 
dedicated by Daniel Webster, that stands as a tribute to the lives that 
were lost. I recommend the trip to both Members and the viewing 
audience alike.
  I must confess, however, that the expansive field you will find fails 
to fully capture the raw carnage that visited Bunker Hill in June of 
1775. Close to 2,000 lives were lost in less than 2 hours. And, while 
General Howe's regulars were masters of the peninsula at the end of the 
day, the casualties they sustained were more than twice that of the 
American militia.
  Historians, Mr. President, have come to record Bunker Hill as a 
bloody if indecisive contest, an early salvo in a conflict which Dr. 
Jonathan Rossie has characterized as a ``glorious cause.'' Glorious, if 
warfare can be called that, because the issue that animated the 
colonists that day was freedom, for themselves and generations yet to 
come; God, courage, and posterity were their invisible allies.
  And as I reflect on those events, I cannot help but wonder what has 
become of the first principles for which our forefathers fought? What 
has become of the fundamental truths that compelled those great 
patriots up that hill, bayonets flashing, voices shouting ``push on, 
push on.''
  For that battle outside of Boston helped give birth to a nation, a 
constitutional republic that was the first of its kind. A system where, 
as Madison suggested in ``Federalist'' No. 46, ``the federal and state 
governments are in fact but different agents of the people, constituted 
with different powers, and designed for different purposes.''
  Unfortunately, Mr. President, Madison's vision is being lost. 
Judicial activism, Federal intervention, and past constitutional 
reforms have led to a gradual erosion of State power. In particular, 
the passage of the 16th and 17th amendments have had a disastrous 
effect on the capacity of the States to check Federal expansion. The 
former, establishing the income tax, gave the central government a 
virtually unlimited spending power, while the latter, providing for the 
direct election of Senators, worked to undermine the Senate's 
contemplated role as the protector of State autonomy.
  One of the single, greatest challenges we face as a country and as a 
Congress, is addressing the constitutional imbalance that has arisen 
from the convergence of these trends. Allowing the States to initiate 
amendments on issues ranging from a balanced budget to congressional 
term limits would do just that.
  The operation of the proposed amendment is as simple as its intent is 
clear. Whenever two-thirds of the States propose an amendment, in 
identical terms, it is submitted to the Congress for review. If two-
thirds of both Houses fail to disapprove the amendment during the 
session in which it is received, the proposal is then forwarded to the 
States for ratification by three-fourths of the legislatures thereof.
  If adopted, the proposed amendment would have tremendous value on 
several different fronts. First, it would force the cold corridors of 
power on the Potomac to respond to the will of the people--no more 
mandates, no more deficits, no more careerist in the Congress. 
Similarly, the amendment would allow the States to once again share the 
constitutional agenda of the Nation. And finally, it would provide a 
potential for addressing the problems of federalism in a context which 
could conceivably augment State power.
  In Gregory versus Ashcroft, Justice O'Connor opined that ``in the 
tension between Federal and State power lies the promise of liberty.'' 
And so it does. I believe reconstituting the federal system of which 
Madison wrote must become conservatives' new glorious cause. This 
amendment is a measured, moderate step toward achieving that end. For 
these reasons, Mr. President, I beg its adoption.

                          ____________________