[Congressional Record Volume 142, Number 138 (Monday, September 30, 1996)]
[Extensions of Remarks]
[Page E1866]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    INTRODUCTION OF THE BREAST CANCER PATIENT PROTECTION ACT OF 1996

                                 ______
                                 

                          HON. ROSA L. DeLAURO

                             of connecticut

                    in the house of representatives

                      Saturday, September 28, 1996

  Ms. DeLAURO. Mr. Speaker, I rise today to introduce the Breast Cancer 
Patient Protection Act of 1996. I want to thank my colleagues, 
Representatives Dingell, Sanders, Costello, Foglietta, Moran, Lowey, 
Pallone, Meek, LoBiondo, Pelosi, Nadler, Eshoo, Maloney, Norton, 
Clayton, and Slaughter, for joining me as original cosponsors.
  As an active participant in the fight for health care reform, I 
continue to believe that were must reform the health care system to 
provide quality care for all Americans. Particularly important is 
ensuring that women receive equitable treatment in our Nation's health 
care system.
  This year, approximately 184,300 mothers, daughters, and grandmothers 
will be diagnosed with invasive breast cancer. Another 44,300 women 
will die from this disease. With every one in eight women developing 
breast cancer, virtually every family in America is vulnerable to this 
disease. That's why today I am filing a bill that sets a minimum length 
hospital stay for patients undergoing breast cancer treatment such as 
mastectomies at 48 hours and at 24 hours for lymph node removals.
  Standard surgical treatment for breast cancer includes mastectomy, 
lymph node dissection, and lumpectomy. Over the last 10 years, the 
length of hospitalization for patients undergoing mastectomies has 
dwindled from 5-6 to 2-3 days. Patients undergoing lymph node 
dissections were hospitalized for 2-3 days. Hospitalization is 
essential for pain control and for the management of fluid drainage 
from the operative site. The less tangible, but still important benefit 
of hospitalization is to provide a supportive surrounding for the 
patient to address the psychological and emotional reactions inherent 
to having breast cancer, that is, depression, anxiety, and hostility.
  Now, under pressure from managed care organizations to reduce costs, 
surgeons have had to perform lymph node dissections as outpatient 
surgery, and the length of stay for a patient having undergone 
mastectomy has been cut to 1 day, with the patient sent home with 
drainage tubes in place. Some HMO's send their patients home a few 
hours after their surgery. Others even deny women hospitalizations the 
day of lymph node dissection or mastectomy, making the surgeon choose 
between giving the patient the individual care she needs or being 
punished by the HMO for not following guidelines. A doctor in my 
district had to spend over 7 hours--not in surgery treating women for 
breast cancer--but rather making phone calls pleading with HMO staff 
members to get a mastectomy patient admitted to the hospital for 24 
hours.

  The guidelines that some managed care companies are using today to 
support their cost-cutting strategy of shipping women out of the 
hospital after breast cancer surgery are the product of an actuarial 
consulting firm in health care. This firm publishes guidelines for 
breast cancer treatment that are written by actuaries and a few 
physicians employed by their company who are not actively performing 
breast cancer surgery. According to physicians, these guidelines are 
designed to fit the ideal breast cancer surgery patient that is placed 
in the optiomal situation. The American College of surgeons is 
reviewing these guidelines and believes that 80 percent of the time the 
normal patient will not satisfy these guidelines and will require a 
longer length of stay. Today HMO's are basing their coverage on health 
care actuaries, and not on surgeons who care for patients day in and 
day out and follow medically established standards of care.
  The is simply unacceptable. Accepted practice has shown that victims 
of breast cancer need to remain in the hospital at least 48 hours after 
a mastectomy and 24 hours after a lymph node dissection. This 
legislation would ensure that women with breast cancer get the medical 
attention they need and deserve. This bill ensures that health plans 
which provide medical and surgical benefits for the treatment of breast 
cancer provide a minimum length of hospital stay for patients 
undergoing mastectomies at 48 hours and at 24 hours for lymph node 
removals. Under this bill, physicians and patients, not insurance 
companies, can determine if a shorter period of hospital stay is 
appropriate.
  Although it is the end of session, our commitment to breast cancer 
patients remains absolute. Beginning with today, with this bill, we 
need to ensure that women with breast cancer receive the best treatment 
and coverage available. We will continue to work with surgeons and 
other medical groups to ensure that the highest standards of care and 
coverage are achieved.
  This legislation enjoys strong support of the National Breast Cancer 
Coalition, and I strongly urge all of my colleagues to join in their 
support of this bill. It will go a long way toward helping to ensure 
that American women receive comprehensive and equitable health care 
coverage should they be diagnosed with breast cancer.

                          ____________________