[Congressional Record Volume 144, Number 54 (Tuesday, May 5, 1998)]
[Senate]
[Pages S4235-S4236]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              MANAGED CARE

  Mr. CONRAD. Mr. President, on another matter, I want to address the 
issue of a young man named Ethan Bedrick. Let me put up Ethan's picture 
so we can see who we are talking about. This is Ethan. Ethan was born 
on January 28, 1992. His delivery went badly, and as a result of 
asphyxiation, he has suffered from severe cerebral palsy and spastic 
quadriplegic which impairs motor functions in all of his limbs.
  You can see him. He is a fighter. Look at that look on his face. He 
is a happy young fellow, even though he faces severe restrictions.
  He was put on a regimen of intense physical, occupational and speech 
therapy to help him overcome some of these obstacles.
  At the age of 14 months, Ethan's insurance company abruptly cut off 
coverage for his speech therapy and limited his physical therapy to 
only 15 sessions per year. Mr. President, can you imagine, this little 
boy was damaged at birth, and when he is 14 months old, the insurance 
company cuts off coverage for his speech therapy, limits his physical 
therapy to 15 sessions a year. At 14 months, when the insurance company 
made these decisions to cut off this young child from the therapy he 
needed, the change was recommended by an insurance company 
representative performing a utilization review of his case. The 
reviewer cited a 50 percent chance that Ethan could walk by age 5 as a 
minimal benefit of further therapy.

  Further, the reviewer never met personally with Ethan, his family, or 
Ethan's team of regular doctors. Upon review, the insurer affirmed its 
position with a second company doctor, citing a single New England 
Journal of Medicine article on physical therapy and child development. 
That article was published in 1988, 4 years before Ethan was born.
  I want to go back to the point here that was made by the insurance 
reviewer. The change was recommended by the insurance company reviewer, 
citing a 50 percent chance that Ethan could walk by age 5 as a 
``minimal benefit.'' Shame on that reviewer; shame on that company. A 
50 percent chance of walking is a minimal benefit? How would they feel 
if it were their child? How would they feel then? A 50 percent chance 
of walking is a minimal benefit?
  Further, the doctor declared the prescribed therapeutic equipment, 
including a bath chair designed for aiding his parents and care 
providers in his bathing, and an upright walker to allow him upright 
movement and muscle development, were merely convenience items--
convenience items--and costs not to be covered by his insurance. Can 
you imagine if you were the parents of this little boy and you were 
told a walker is a convenience item? You were told that a device to 
help in the bathing of this multiply handicapped child was a 
convenience item?
  The Bedricks, the parents, didn't feel that way. They filed suit. In 
1996, the fourth circuit ruled that the insurer's decision to restrict 
therapy was arbitrary and capricious because the opinions of their 
medical experts were unfounded and tainted by conflict. Further, the 
court concluded that neither the insurance plan nor corporate 
guidelines require ``significant progress'' as a precondition to 
providing medically necessary treatments. The court noted, ``It is as 
important not to get worse as it is to get better. The implication that 
walking by age 5 would not be significant progress for this unfortunate 
child is simply revolting.'' Those are the words of the court, that the 
position of this insurance company ``is simply revolting.''
  This is a quote from the attorney for young Ethan. ``The implication 
that walking by age 5 would not be a `significant progress' for this 
unfortunate child is simply revolting. . . . The delivery of health 
care services should be based on the promotion of good health and not 
the margin of profit.''
  During the time of review and litigation, Ethan lost 3 years of vital 
therapy, and ERISA, the Employee Retirement Insurance and Savings 
Account which governs HMOs, left the Bedricks with no remedy for 
compensation for Ethan's loss of therapy. The Bedricks' ability to give 
justice for what the HMO did to Ethan was erased because of ERISA.
  I raise this issue today because very soon Congress is going to have 
a chance to act and we, in conscience, must insist that children like 
Ethan have a fair shot at fair treatment. This little boy, now 6 years 
old, should not be told that a 50/50 chance of being able

[[Page S4236]]

to walk is, as described by the insurance company, ``a marginal, 
minimal benefit.'' That simply cannot be what we do in this country to 
little boys like Ethan.
  I yield the floor.
  Mr. DORGAN. Mr. President, the story that was just described by my 
colleague, Senator Conrad, is one that occurs all too often across this 
country in this new era of managed care. Every day we intend to 
describe the circumstances of managed care in this country that require 
us to bring a Patients' Bill of Rights to the floor. Every day we will 
discuss this issue on the floor of the Senate, hoping that we will be 
able to persuade those who schedule the Senate to bring the Patients' 
Bill of Rights to the Senate.
  Every person in this country seeking health care ought to have a 
right to know all of their options for treatment, not just the cheapest 
option for treatment. Everyone seeking health care in this country 
ought to have a right to show up in an emergency room and get necessary 
treatment for an emergency medical need. The list goes on. That is why 
we want to see a piece of legislation called the Patients' Bill of 
Rights brought to the floor of the Senate.
  The PRESIDING OFFICER. Under a previous order, the Chair recognizes 
the Senator from North Dakota, Mr. Dorgan, for 9 minutes 31 seconds of 
the previously allotted time.

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