[Congressional Record Volume 144, Number 73 (Tuesday, June 9, 1998)]
[Senate]
[Pages S5767-S5768]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. DORGAN. Mr. President, I want to speak just for a moment about 
the Patients' Bill of Rights that we have introduced in the Senate and 
that many of us in the Senate hope can be considered on an expeditious 
basis by the U.S. Senate.
  The Patients' Bill of Rights is a piece of legislation designed to 
address some of the concerns we have about managed care. In many 
instances, health plans are denying patients the right to know all of 
the treatment options available for their not just the cheapest 
treatments available. The Patients' Bill of Rights would guarantee that 
right, along with the opportunity to understand your rights with 
respect to emergency care and a range of other rights that we believe 
should be inherent.
  I want to tell the Senate another story, as we have done almost every 
day the Senate has been in session, that describes, again, the urgent 
need for passage of the Patients' Bill of Rights.
  This is about a young woman named Paige Lancaster from Stafford, VA. 
In 1991, when Paige Lancaster was 11 years old, her mother took her to 
see her HMO pediatrician because she had complained of nausea and 
severe daily headaches for some long while.
  For the next 4 years, Paige repeatedly sought medical treatment for 
headaches from two other HMO pediatricians available. They prescribed 
adult-strength narcotics but never once consulted with a neurologist 
nor did they recommend during all this time an MRI, CAT scan, EEG, or 
any other diagnostic test, for that matter, to diagnose Paige's 
condition.
  Then in 1996, Paige's school counselor worried about this young 
girl's deteriorating high school performance. She recommended to the 
doctors that they perform some diagnostic tests to determine the cause 
of this young lady's debilitating symptoms.
  Mr. President, 4\1/2\ years after the first visit by this child 
complaining of severe headaches, the doctors finally ordered an EEG and 
an MRI. The MRI revealed a massive right frontal tumor and cystic mass 
that had infiltrated over 40 percent of her brain. One week later, 
Paige underwent surgery to remove the tumor. However, the surgery was 
unsuccessful because of the tumor's size and maturity. Paige then 
underwent a second and third surgery and radiation therapy, and she is, 
we are told, likely to require additional surgery and ongoing intensive 
care.
  What is so outrageous about this case is that the HMO covering Paige 
had in place a financial incentive program under which her physicians 
would receive bonuses for avoiding excessive treatments and tests.
  This is not something new. We know of managed care organizations in 
which the contracts with the physicians require that, if a patient of 
the physician shows up in an emergency room, the cost of that emergency 
treatment comes out of the payment to the physician--an unholy 
circumstance, in my judgment, because it creates exactly the wrong kind 
of incentive for physicians.
  In this case there is the same kind of incentive in reverse. The HMO 
had in place a financial incentive under which physicians would receive 
bonuses for avoiding excessive treatments and tests. Clearly, 
physicians should not prescribe excessive treatments and tests, but, 
just as clearly, physicians should not have to consider their own 
financial circumstances when determining whether they should prescribe 
a test.
  The Lancasters, Paige's parents, challenged the HMO's handling of 
Paige's case, but, unfortunately for them, the insurance for their 
children was provided by Mr. Lancaster's employer and was subject to 
something called ERISA, the Employee Retirement Income Security Act. 
Under ERISA, the only available remedy to the patient is the cost of 
the benefit denied, in this case the $800 cost of the MRI. In other 
words, under ERISA, the HMO cannot be sued. The piece of legislation 
that we have proposed in the U.S. Senate, the Patients' Bill of Rights, 
would hold HMOs accountable by allowing patients to sue when their 
HMO's coverage, or lack of it, has caused them harm. The bill will also 
require HMOs to disclose any financial

[[Page S5768]]

incentives that might cause the HMO doctors to skimp on patient care. 
Any incentives that exist between the HMO and the doctor must be 
disclosed to the patients.

  This young girl, Paige Lancaster, waited nearly 5 years for a 
diagnosis, one might argue, in part, because the wrong incentives 
existed between an HMO and a doctor. The incentives were about saving 
money rather than providing quality health care.
  We very much hope we can get back to the notion in this country that 
practicing medicine ought to be done in doctor's offices and hospitals, 
not in the office of some insurance company accountant 500 or 1,000 
miles away. It is our hope that we will be able to bring to the floor 
of the Senate the Patients' Bill of Rights because we think this 
country needs it. We hope the Senate can debate it and pass it in the 
coming weeks.
  Mr. President, I yield the floor.
  Mr. STEVENS addressed the Chair.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. STEVENS. Mr. President, I ask unanimous consent to speak as in 
morning business not to exceed 5 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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