[Congressional Record Volume 143, Number 1 (Tuesday, January 7, 1997)]
[Extensions of Remarks]
[Pages E43-E44]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    INTRODUCTION OF THE BREAST CANCER PATIENT PROTECTION ACT OF 1997

                                 ______
                                 

                          HON. ROSA L. DeLAURO

                             of connecticut

                    in the house of representatives

                        Tuesday, January 7, 1997

  Ms. DeLAURO. Mr. Speaker, I rise today to introduce the bipartisan 
Breast Cancer Patient Protection Act of 1997. I want to thank my 
colleagues Representatives Dingell, Roukema, Ackerman, Thomas, Barrett, 
Bentsen, Corrine Brown, Sherrod Brown, Clayton, Clement, Conyers, 
DeFazio, Eshoo, Evans, Faleomavaega, Farr, Foglietta, Jon Fox, Frank, 
Frost, Gejdenson, Gonzalez, Gordon, Green, Hinchey, Patrick Kennedy, 
Kennelly, Kildee, LaFalce, Lowey, McDermott, Carolyn Maloney, Carrie 
Meek, Patsy Mink, James Moran, Morella, Murtha, Nadler, Norton, 
Oberstar, Olver, Owens, Pallone, Payne, Pelosi, Quinn, Rahall, Rivers, 
Sanders, Slaughter, Towns, and Velazquez for joining me as original 
cosponsors.
  As an active participant in the fight for health care reform, I 
continue to believe that we 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 grandmothers, mothers, and daughters 
will be diagnosed with invasive breast cancer. Another 44,300 women 
will die from this disease. With one in every 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. This 
bill would require a minimum

[[Page E44]]

hospital stay of 48 hours for mastectomies and 24 hours for lymph node 
removals.
  Standard surgical treatment for breast cancer includes mastectomy, 
lymph node dissection, and lumpectomy. Over the least ten years, the 
length of hospitalization for patients undergoing mastectomies has 
dwindled significantly from 4-6 to 2-3 days. In the past, patients 
undergoing lymph node dissections generally 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 to having breast cancer, such as depression, 
anxiety, and hostility.
  Now, under incessant pressure from managed care organizations to 
reduce costs, surgeons have had to perform lymph node dissections and 
even mastectomies as outpatient surgery. Some health maintenance 
organizations [HMO's] send their patients home a few hours after their 
surgery groggy from anesthesia, in pain, and with drainage tubes still 
in place. Others even deny women hospitalizations on the day of their 
lymph node dissection or mastectomy, making the surgeon choose between 
giving the patient the individual care she needs or being penalized by 
the HMO for not following its guidelines. Doctors, concerned for their 
patients' well-being, even find themselves locked in battle with HMO's. 
One 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 many managed care companies are using today are 
written by a single actuarial consulting firm. And, while a few 
physicians are employed by this company, none are actively performing 
breast cancer surgery. These guidelines are designed to fit the ideal 
breast cancer surgery patient that is placed in the most optimal 
situation. However, both the American College of Surgeons and the 
American Medical Association believe that most patients can not satisfy 
these guidelines and will require a longer length of stay. Today, HMO's 
base their coverage on the recommendations of health care actuaries, 
not on those of surgeons who care for patients day in and day out. And 
the guidelines they use to do it are based on the bottom line, not on 
medically established standards of care.
  That 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 receive the 
medical attention they need and deserve. My bill ensures that health 
plans which provide medical and surgical benefits for the treatment of 
breast cancer provide a minimum length of hospital stay of 48 hours for 
patients undergoing mastectomies and 24 hours for those undergoing 
lymph node removals. Under this bill, physicians and patients, not 
insurance companies, can determine if a shorter period of hospital stay 
is appropriate.
  Beginning on the first day of the 105th Congress, with this 
bipartisan bill, we can ensure that women with breast cancer receive 
the best treatment and coverage available. And, we can ensure that 
crucial health care decisions are left in the hands of doctors, and not 
accountants.
  This legislation enjoys strong support from the National Breast 
Cancer Coalition, the National Association of Breast Care 
Organizations, the Y-Me National Breast Cancer Organization, the 
Families USA Foundation, the Women's Legal Defense Fund, and the 
American Society of Plastic and Reconstructive Surgeons, as well as 
from women across the country from Wisconsin to California to New 
Hampshire. I strongly urge all of my colleagues to endorse this widely-
supported bipartisan effort to help ensure that American women who have 
breast cancer receive the comprehensive and equitable health care 
coverage they deserve.

                          ____________________