[Congressional Record Volume 144, Number 72 (Friday, June 5, 1998)]
[Senate]
[Pages S5665-S5666]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         THE NEED FOR MANAGED CARE REFORM: A TRAGEDY IN GEORGIA

  Mr. CLELAND. Mr. President, the distinguished Senator from New 
Hampshire has spoken eloquently about young people and the lives of 
young people and how we ought to be concerned on their behalf. I would 
like to spend a moment of the Senate's time speaking about a young boy 
in my State, James Adams, of Fairburn, GA, who is now 5 years old. 
Because of the rules of his parents' HMO, what happened to him in March 
of 1993, when he was only 6 months old, has changed his life forever.
  The Senator from New Hampshire was speaking of right and wrong about 
young people. What happened to James Adams of Fairburn, GA, was not 
right.
  James was suffering from a fever of over 100 degrees. Like 160 
million other Americans, his parents were enrolled in a managed health 
care plan. James' mother took him to his HMO plan pediatrician, who 
diagnosed only a respiratory ailment and post-nasal drip. He prescribed 
only saline drops, vaporizer use, and Tylenol every four hours. James' 
mother was told not to worry, that high fevers in young children do not 
necessarily mean serious illness.
  Later that night, his temperature was still rising and he was in 
great discomfort. James' worried mother called her HMO directly. The 
nurse on duty recommended bathing James in cold water. A pediatrician 
then placed a follow-up call, advising the parents to bring James to an 
HMO-participating hospital--42 miles away.
  On the way to the hospital, as his parents' car sped past multiple 
other hospitals in Atlanta not covered by the Adams' HMO, James 
suffered full cardiac and respiratory arrest, and lost consciousness. 
His parents decided they simply couldn't wait to get him to the HMO 
hospital--James needed care immediately. His parents pulled into the 
closest hospital they could find--still 6

[[Page S5666]]

miles from their target destination. Upon his arrival at that hospital, 
doctors were able to restore his pulse and breathing. But the 
circulation to his hands and feet was cut off, and never returned.
  James suffered irreparable damage to his extremities. Both his hands 
and feet had to be amputated. The delay of care caused by driving 
almost an hour to an affiliated hospital had taken its toll.
  Today, James is doing really well. He was able to get to a hospital 
just in time enough to save his life, and has worked hard ever since to 
rehabilitate himself. I am confident he will be able to lead a full and 
productive life. But could things have turned out better for James? 
Probably so.
  The question I have is, if S. 1890, the Patients Bill of Rights had 
been in effect, could it have helped James Adams and his family? The 
answer: probably so.
  First, the Patients Bill of Rights would have covered access to and 
payment for emergency services. That is, regardless of what the outcome 
looked like at the time, since James' parents reasonably believed that 
emergency care was needed, they would have been able to get it, 
accessibly, in time. I believe that an individual should be assured 
that if they have an emergency, those services will be covered by their 
plan. This bill states that individuals must have access to emergency 
care, without prior authorization, in any situation that a ``prudent 
lay person'' would regard as an emergency.

  Second, the Adams family's HMO could not have restricted their choice 
in service provider. They would have been able to have their own 
doctor--a regular doctor--convenient to where they live, and covered by 
their HMO plan.
  Third, the Adams' HMO would have been more clearly liable. Luckily, 
the lawsuit against the HMO that James' family went through was 
successful, but under current law such an outcome is far from 
guaranteed. The Patients Bill of Rights includes a provision for health 
plans that make medical decisions which result in harm to the patient, 
just as doctors and hospitals are held accountable today.
  In addition, the Patients Bill of Rights would mandate a fair and 
timely appeal process both within the plan and to an independent 
external body when health plans deny care. It would also provide for 
access to medical specialists, continued care when a plan or provider 
is terminated and protection for providers who advocate on behalf of 
their patients.
  Most important, the Patients Bill of Rights would help restore some 
of the confidence consumers have lost in their health care plans. It 
would ensure that Americans receive the care they were promised when 
they enrolled in their plan, and that they paid for with their monthly 
premiums.
  I believe it is imperative that as lawmakers, we work with health 
professionals, insurance providers and the American people, to create 
the most efficient, accessible and responsive health care system 
possible. To that end I am cosponsoring S. 1890, the Patients' Bill of 
Rights Act of 1998, which would reform the delivery of managed care. We 
have a responsibility to ensure that the best health care system in the 
world remains accessible and affordable to all Americans. Though 
managed care has changed the nature of the health care industry by 
providing a more coordinated approach to medical care which reduces 
costs and waste, many beneficiaries believe, with cause, that their 
quality of care has been diminished.
  As the debate over health care reform continues, I will continue to 
fight to refocus our health care system on patients--like James Adams--
and away from the bottom line.
  The ultimate goal of any health care provider, including managed care 
providers, should be to provide the best possible care for the patient. 
Anything less is unacceptable. Although the financial aspects are 
important, we cannot let patient care be sacrificed just because of a 
bottom line issue. I believe that Congress must take swift action to 
address the issue of managed care reform and I believe that the 
Patients' Bill of Rights Act of 1998 is a significant step in that 
direction.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Grams). The Senator from Minnesota.
  Mr. WELLSTONE. Mr. President, I thank my colleague from Georgia. Not 
that there are not other Senators who are connected to people back in 
their States, but the Senator from Georgia, I think, among us, stands 
out as a Senator who is really connected to people he represents. When 
he uses the word ``fight,'' I think he will be fighting very hard for 
people and I think we will have really a historically significant 
debate on this legislation.
  This is a very personal issue for people we are talking about, I say 
to my colleague, their health and the health of their children. So I 
thank the Senator from Georgia for his very strong words.

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