[Congressional Record Volume 144, Number 68 (Monday, June 1, 1998)]
[Senate]
[Pages S5492-S5493]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PATIENTS' BILL OF RIGHTS
Mr. DORGAN. Mr. President, as we near the summer of this legislative
session and discuss the agenda remaining for this Congress, I want to
raise, as my colleagues and I have for many, many days in this Chamber,
one of the pieces of legislation we want considered in the Senate
during this session of the Senate. That legislation is the Patients'
Bill of Rights.
About 160 million Americans are now enrolled in managed care
organizations. HMOs--health maintenance organizations, one of the main
types of managed care--can save money and they can improve care. But by
the same token, managed health care organizations can cause real
serious problems for many Americans. I want to describe just a few of
them and describe why we believe a Patients' Bill of Rights should be
enacted by this Congress.
To describe part of the problem with managed care organizations, let
me tell the story of a woman who had just suffered a brain injury. As
she was lying in an ambulance being hauled to a hospital, with her
brain swelling, she advised the ambulance drivers that she wanted to be
taken to the hospital that was farther away, rather than the nearest
hospital.
She survived and was asked later why she issued directions to be
taken to the hospital farther away. She said she had learned a lot
about the hospital that was nearest to the ambulance at that point, and
it was a hospital that by reputation had made health care a function of
its profit and loss statement. She did not feel comfortable presenting
herself to an emergency room where her care was going to be a function
of someone else's profit and loss.
And that is something that concerns a lot of the American people
these days, especially as health care moves more towards for-profit
health care, more towards managed care. Let me give you another
example.
This example, whose name is Wendy Connelly, a wife and mother from
Sherwood, OR, is yet another reason why we need a Patients' Bill of
Rights.
In 1994, Wendy Connelly experienced symptoms of what she feared was a
heart attack, including heaviness in her chest and a heart that began
beating wildly, at a rate approaching 150 beats per minute. She thought
she was having a heart attack, so Wendy sought treatment at the local
hospital emergency room, as one would likely do in that situation.
Fortunately for Wendy, the doctors on call treated her for what was not
a heart attack, but rather, a previously undiagnosed thyroid imbalance.
When she first began to fear the worst, Wendy had contacted her HMO's
on-call physician for advice. Obviously, he was unable to make an over-
the-phone diagnosis for her, and he told her to seek emergency room
care if her symptoms did not subside. And so she did. But when the bill
came due, the HMO denied payment of Wendy Connelly's claim. They said
that her case was not deemed emergency care. The HMO was basing its
decision on the final diagnosis, not the heart-attack like symptoms
that sent her to the emergency room.
Wendy Connelly, to her credit, felt that the HMO was wrong in its
denial, and so, for more than a year, she sent letters explaining what
had happened. Even her doctors and the hospital that treated her urged
the HMO to cover that claim. Finally, the HMO conceded and she was no
longer liable for the costs that she incurred more than a year before.
But she decided that she would help others in this situation who were
being unfairly denied coverage, so she filed a complaint against the
HMO with the Oregon Department of Insurance. It was found by the
Department of Insurance that what had happened to Wendy Connelly was a
routine practice for this insurer. If a person went to the emergency
room but found that the final diagnosis is not something that would
require emergency care, despite what the presenting symptoms were, then
the claim was denied.
Here is what Wendy said:
I went to an emergency room (because) I thought I was
having a heart attack. . . . I felt that if I went somewhere
else or delayed longer, I would (have been) putting my life
in jeopardy.
But all across the country now we discover these cases, time after
time after time, of the managed care organizations deciding that they
won't cover someone showing up in an emergency room. Or, in fact, some
of them have clauses in their contracts with their doctors that say if
a doctor's patient shows up in the emergency room, it comes out of the
doctor's compensation for the managed care organization. You talk about
a terrible incentive; you talk about a conflict of interest; that is
it.
We have proposed a Patients' Bill of Rights, proposed by Democrats
and Republicans, in the Congress. Let me go through, just for a moment,
what some of these rights would be.
Patients in this country ought to have an opportunity to know all of
the medical options available to treat their illness or disease--all of
the medical options, not just the cheapest. A number of managed care
organizations have gag rules in their contracts with their doctors.
They will only allow their doctors to tell patients what they want the
patients to know. If there are other treatments available, perhaps
better treatments, treatments that are more appropriate but perhaps
more expensive, then they have no obligation to tell the patient that
there are other treatment options. Many patients worry, and some
investigations confirm, that often the patients learn not all of the
treatments available but only those which are the cheapest.
You have a right to choose the doctor you want for the care you need,
including specialty care. One person from my home state of North Dakota
whose employer recently switched to a closed network health plan has a
chronic heart condition. But his new health plan has refused to allow
him to see the cardiologist who has been caring for him for this heart
condition for a decade. This employee has no option to choose a health
plan that will allow him to continue seeing his cardiologist, even
though he says he is willing to pay for that right. So under the
Patients' Bill of Rights, patients will have the right to choose the
doctor they want for the care they need.
You have the right to emergency room care whenever and wherever you
need it. In fact, a Missouri managed care organization plan sent all of
its customers a letter saying a trip to the emergency room with a
broken leg, or a baby running a high fever, should not generally be
assumed to be covered. The letter read like this:
An emergency room visit for medical treatment is not
automatically covered under your benefit plan.
An Arkansas woman suffered a broken neck in a car wreck and was
rushed to the hospital. Her managed care company refused to pay for her
emergency room care--this is a patient with a broken neck from a car
accident--because she failed to get prior authorization. Managed care
organizations think that the first thing to do when you break your neck
in a car accident is to seek prior authorization to get to an emergency
room? So, another of the patients' rights is the right to emergency
room care whenever and wherever you need it.
You also have the right to a fair and speedy process for resolving
disputes with your health care plan. You have the right to considerate,
respectful care without discrimination. You have the right to keep your
medical records confidential.
Why is it important that these rights be made available to patients?
Because too many managed care organizations are denying those basic
rights to American citizens and to those who are sick right now. We
have a proposal that has been dealt with by the Senate, dealing with
mastectomies. Why should the Senate be talking about the length of
hospital stays available for a woman who has a mastectomy? Because
managed care organizations are taking these women into hospitals for
mastectomies, radical mastectomies, and 8, 10, 12 hours later, with
tubes coming from their bodies, sending them home. And the same is true
with
[[Page S5493]]
drive-through baby deliveries. That is why Congress addressed that
particular problem in 1996.
Is this body part by body part legislation the best way to address
these issues? No, not for Congress to be dealing with these specific
procedures. But why are we even confronted with this? Because health
care all too often--regrettably, for those who are sick, for those who
are in need of health care--has become more a function of dollars and
cents, more a function of someone's profit and loss, than someone
else's critically needed health care. That is why we want a Patients'
Bill of Rights passed by this Congress.
Some say this will cost a lot of money. No it will not. The ultimate
cost for the American people is to deny treatment, to deny coverage,
and deny opportunity for those who are sick to get the treatment they
need. If you want to mushroom the health care bill in this country,
then keep doing what we are doing and say to the American people: If
you break your neck, we won't pay for emergency services for you
because your first stop should be some accountant's desk to get prior
authorization. Your first stop, before the doctor's office or the
hospital room, is to appeal to some accountant in an insurance office
500 miles away to ask what kind of health care delivery that managed
care plan will give you, your child, your parents, or your family. That
doesn't make any sense.
Doctors all across my State and across this country support the
Patients' Bill of Rights, because they understand medicine ought to be
practiced in the doctor's office and in the hospital room, not in some
insurance company's office by some junior accountant who is 500 or
1,000 miles away from the problem the patient is suffering.
Mr. President, I hope very much that in the coming weeks this
Congress will include on its agenda a Patients' Bill of Rights so that
all Americans will understand their rights and all managed care
organizations will understand their obligations to people in this
country when they need health care.
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