[Congressional Record Volume 144, Number 75 (Thursday, June 11, 1998)]
[Senate]
[Pages S6137-S6139]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. KENNEDY. Mr. President, I am deeply concerned about the 
continuing lack of commitment by the Republican Leadership to schedule 
floor debate on legislation to end abuses by health insurance managed 
care plans. Today, more than 100 groups have sent a letter to Senator 
Lott and Speaker Gingrich asking for quick, full and fair floor 
consideration of this legislation, which is called the Patients' Bill 
of Rights. These groups represent millions of patients, doctors, 
nurses, therapists, and working families.
  Yet, in a memo sent to all Senators and in recent floor statements, 
it appears that our patient protection legislation--the Patients' Bill 
of Rights--is not even on the Republican Leader's radar screen. It is 
not on the list of priorities designated by the Republican Leadership 
to be taken up this month, or even this session. I have here a list of 
more than 20 bills, ranging from regular appropriations bills and 
reauthorization bills to the nuclear waste disposal legislation and a 
constitutional amendment on flag burning.
  But, I have yet to see any interest from the Republican Leadership in 
taking action to ensure that medical decisions are made by treating 
physicians, and not by insurance company accountants. And I have yet to 
see any interest from the Republican Leadership in curbing abusive 
activities by the worst plans and insurance companies that are 
dedicated to their profits, not their patients. Instead, it appears 
that, by this inaction, the Republican Leadership is interested only in 
defending the indefensible, the status quo.
  In addition, the House Republican Leader, Dick Armey, recently lashed 
out at doctors, nurses and other health care professionals by grossly 
misinterpreting and distorting a provision in the Patients' Bill of 
Rights that allows health care professionals to support their patients 
in appeals procedures, and to report concerns about the quality of care 
without fear of retaliation. These are reasonable patient-oriented 
protections. Congressman Armey's misguided effort offends and impugns 
the character and professionalism of hundreds of thousands of nurses, 
doctors and patients.
  In fact, his harsh attack has helped mobilize even more organizations 
to support the bill. Representatives Lois Capps, Carolyn McCarthy and 
Eddie Bernice Johnson, who are former nurses, and nurses from 
communities around the country have rallied around the Patients' Bill 
of Rights. Today, they have sent a letter to Congressman Armey asking 
for a meeting on these critically important issues. They are supported, 
in a separate letter, by a number of groups who represent persons with 
disabilities, mental illness and HIV/AIDS, and other organizations that 
rely regularly on trained and devoted health care professionals.
  These issues matter a great deal to families across the country. Too 
often today, managed care is mismanaged care. In state after state 
across the country, patients are paying for these industry abuses with 
their lives.
  Just ask Frances Jennings of Andover, Massachusetts. In November, 
1992, at the age of 57, her husband Jack was diagnosed with mild 
emphysema by his pulmonologist. A few years later, in March, 1997, Mr. 
Jennings was hospitalized for a pneumothorax, which can lead to a 
collapsed lung. His physician, Dr. Newsome, determined that a lung 
reduction procedure would improve Jack's health and overall quality of 
life.
  Two months later, in May, 1997, Jack's condition was stable enough 
for the operation, and he was referred to Dr. Sugerbaker, a top surgeon 
who specialized in the procedure.
  But in late May, Jack's insurance plan--U.S. HealthCare--denied his 
referral to the specialist. Frances and Jack were disappointed that the 
plan refused to authorize the referral, and they requested a referral 
for consultation with a plan-approved physician. This appointment was 
finally scheduled for June 12. But, on June 11, the new doctor's office 
called Jack to cancel his appointment, stating that the physician no 
longer accepted patients from the health plan.
  Immediately following this cancellation, Jack's primary care 
physician--Dr. Newsome--contacted the health plan to obtain yet another 
referral. On June 18, a new appointment was confirmed for mid-July, 
four months after his initial hospitalization.
  Tragically, Jack Jennings never had the opportunity to benefit from 
the procedure recommended by his doctor. Jack had been having trouble 
breathing, despite his continuous use of oxygen, and had been 
hospitalized at the end of June. During this hospitalization, they 
discovered a fast growing cancer in his chest. Lung surgery was out of 
the question, and it was too late for chemotherapy to be effective.
  Mr. Jennings died on July 10--four days before his long-awaited 
appointment with the specialist. In fact, this appointment would have 
been with Dr. Sugarbaker's group, the same physician that U.S. Health 
Care had prevented Jack from seeing in May.
  This is a clear case where needed health care was unnecessarily 
delayed, with tragic implications. Timely care could have saved Jack's 
life. The health plan's inability or unwillingness to provide it cost 
him his life.
  Unfortunately, such abuses are far too common in managed care plans

[[Page S6138]]

today. Congressional offices are flooded with letters and calls from 
constituents who need assistance. Newspapers tell story after story of 
the human costs of these abuses.
  The Patients' Bill of Rights will help solve these problems, and 
restore confidence in the health care system. The Patients' Bill of 
Rights is a common sense solution. Nearly all of its provisions were 
recommended by the Presidential Advisory Commission on Quality in the 
Health Care Industry. Many are included in the voluntary code of 
conduct for members of the American Association of Health Plans, the 
managed care trade association. Some of the provisions are already 
being implemented for federal health programs, including Medicare. 
Still others are included in model laws written by the National 
Association of Insurance Commissioners. The Senate should act on this 
important legislation, and it should act now.
  Mr. President, I ask unanimous consent that the letters I have 
mentioned may be printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                                    June 10, 1998.
     Hon. Richard K. Armey,
     Majority Leader, House of Representatives,
     Washington, DC.
       Dear Majority Leader Armey: As organizations representing 
     health care consumers, we strongly support efforts to 
     establish meaningful patient and quality protections. We 
     believe that an essential component of that effort is to 
     protect the rights of physicians, nurses and other health 
     care professionals to speak out about quality concerns 
     without fear of retribution. While the rise of managed care 
     has created strong incentives to reduce costs and cut 
     corners, many of those impacts are not evident to patients. 
     Instead, patients need to rely on the ability of health care 
     professionals to provide information and advocate on their 
     behalf.
       For that reason, we take strong exception to your May 15th 
     ``Dear Colleague'' expressing your opposition to H.R. 3605, 
     the Patient's Bill of Rights. First, we do not believe that 
     patients are served when those who care for them are gagged 
     or handcuffed, unable to speak out because of contractual 
     arrangements or the very real threat of retaliation. This is 
     not just a question of being informed of all available and 
     appropriate treatment options; it is also a question of 
     knowing when patient safety is the risk because of quality 
     problems.
       Second, we strongly believe disagree with your contentions 
     that nurses and doctors are only seeking financial gain and 
     would use ``good faith'' reporting protections ``to 
     rationalize a financially motivated lie.'' Nurses and doctors 
     across this country have had the courage to challenge managed 
     care and other health industry abuses, often at personal 
     risk. Those abuses will not disappear if the health industry 
     is allowed to continue using retaliatory threats to shield 
     itself from investigation. If nurses, physicians and other 
     health care professionals are afraid to speak out, quality 
     concerns will go unreported and problems will be ignored. If 
     this situation is allowed to continue, patients will be the 
     real losers.
       Our organizations understand that health care consumers 
     benefit when workers have the ability to report poor quality, 
     including medication errors, problems created by early 
     discharges from hospitals, or fraud and abuse. We hope that 
     you will come to realize the need for such patient 
     protections and reverse your opposition, both to this 
     provision and to the entire Patients' Bill of Rights. 
     Patients know that nurses and doctors have been their 
     advocates. It remains our hope that you and the Republican 
     leadership will demonstrate that you also are advocates in 
     the fight for quality care.
           Sincerely,
         AIDS Action Council; The Arc; Bazelon Center for Mental 
           Health Law; Center on Disability and Health; Children 
           and Adults with Attention Deficit Disorder (CHADD); 
           Communications Workers of America; Consumer Federation 
           of America; Consumers Union; Epilepsy Foundation of 
           America; Families USA; Friends Committee on National 
           Legislation; Gay Men's Health Crisis.
         National Association of People with AIDS; National 
           Association of Protection and Advocacy Systems; 
           National Association of Social Workers; National 
           Council of Senior Citizens; National Multiple Sclerosis 
           Society; National Partnership for Women and Families; 
           Neighbor to Neighbor; Older Women's League; San 
           Francisco AIDS Foundation; Summit Health Coalition; 
           United Cerebral Palsy Association; United Church of 
           Christ, Office for Church in Society.
                                  ____

                                                     June 9, 1998.
     Hon. Richard K. Armey,
     Majority Leader, House of Representatives,
     Washington, DC.
       Dear Majority Leader Armey: On behalf of over 200,000 
     nurses, we would like to express our deep disappointment with 
     Your May 15 ``Dear Colleague'' letter accusing nurses and 
     other health care workers of being willing to lie about 
     quality concerns in order to improve their financial status. 
     Your letter demonstrates a profound lack of awareness of the 
     integrity and concerns of nurses as well as the problems 
     facing patients throughout this country.
       The major impetus behind the patient protection bill is 
     health care quality. An important part of that is providing 
     patients with accurate information and ensuring that the 
     health care professionals who treat them are able to meet 
     their professional and ethical obligations to advocate on 
     their behalf.
       Every day, nurses are confronted with situations that place 
     their patients in jeopardy. Insufficient numbers of nurses, 
     the replacement of skilled nurses with untrained personnel, 
     and incentives for early discharge are just a few of the 
     problems. In some facilities, the growing crisis in quality 
     has forced families to hire private duty nurses in order to 
     ensure that their loved ones receive adequate care.
       Nurses know about patient conditions and are justifiably 
     alarmed. Yet, nurses who speak out risk termination, cutbacks 
     in hours, and other forms of retaliation. The Patients' Bill 
     of rights, H.R. 3605, seeks to protect nurses, doctors and 
     other health care professionals who report quality problems 
     to their employers, public entities and private accreditation 
     organizations. It is an important first step in improving 
     patient conditions.
       Your opposition to even this limited provision is 
     surprising and disturbing. Your statements that this 
     provision is motivated by financial considerations is an 
     insult to every nurse who struggles to provide the best 
     possible care to her on his patients.
       As Congress considers legislation to improve health care 
     quality, we would like the opportunity to meet with you to 
     discuss our views and describe the real world situation 
     nurses see every day. We understand that your views as 
     majority Leader are likely to reflect, or at least influence, 
     those of the Republican leadership and the task force 
     appointed by the speaker to make quality care 
     recommendations. Therefore, we would appreciate meeting with 
     those representatives as well. Please contact Cathy Hurwit at 
     (202) 429-5006 if you have any questions or to arrange a 
     meeting.
           Sincerely,
         Martha Baker, RN, President SEIU Local 1991, Miami, 
           Florida, Candice Owley, RN, Wisconsin FNHP, President, 
           FNHP Local 5001, Milwaukee, Wisconsin, Kathy Sackman, 
           RN, President United Nurses' Association of California 
           Pomona, California, Sandra Alexander, LVN, Vice 
           President, AFSCME Local 839, Council 57, Daly City, 
           California, Norma Amsterdam, RN, Executive Vice 
           President Registered Nurse Division 1199NY/SEIU, New 
           York, New York, David Bailey, LPN, Director AFSCME 
           District #3, Mt. Vernon, Ohio, Sylvia Barial, RN, New 
           Orleans Public Schools, School Nurse Chapter Chair, AFT 
           Local 0527, New Orleans, Louisiana, Rowena Blackman-
           Stroud, NMS, SUNY-Brooklyn College of Medicine, 
           Treasurer, AFT Local 2190, Brooklyn, New York, Glenda 
           Canfield, RN, SETU Local 707, Santa Rosa, California.
         Pia Davis, Vice President, SEIU Local 73, Chicago, 
           Illinois, Carol Flynn, RN, Danbury FNHP, President, 
           FNHP Local 5047, Danbury, Connecticut, Anne Goldman, 
           RN, Federation of Nurses/UFT, Special Representative, 
           AFT, Local 0002, New York, New York, Rhonda Goode, RN, 
           SEIU Local 535, Pasadena, California, Pat Greenberg, 
           RN, SEIU Local 200A, Fayettville, New York, Jacqueline 
           Himes, RN, Philadephia Public Schools, Executive Board 
           Member, AFT Local 00003, Philadelphia, Pennsylvania, 
           Doris Lee, RN, AFSCME Local 152, Mililani, Hawaii, 
           Bonnie Marpoe, LPN, President, AFSCME Local 2245, 
           Shippensburg, Pennsylvania, Linda McDonald, RN Rhode 
           Island Hospital, President, FNHP Local 5098, 
           Providence, Rhode Island.
         Mary Lou Millar, RN, President, CHCA/NUHHCE, Wallingford, 
           Connecticut, Carol Moore, LVN, AFSCME Local 1550, 
           Houston, Texas, Sylvia Rawson, LPN, AFSCME Council 71, 
           Sicklerville, New Jersey, Jan Salsich, RN, Westerly 
           Hospital, President FNHP Local 5075, Westerly, Rhode 
           Island, Katherine Schmidt, RN, Oregon FNHP, President, 
           FNHP Local 5017, Portland, Oregon, Darla Shehy, RN, 
           SEIU Local 1199P, Hummelstown, Pennsylvania, Diane 
           Sosne, RN, President, SEIU Local 1199NW, Seattle, 
           Washington, Al Thompson, RN, SEIU Local 660, Los 
           Angeles, California, Ann Twomey, RN, Health 
           Professionals and Allied Employees, President, HPAE/
           FNHP, Emerson, New Jersey, Nancy Yalanis, RN, CHCA/
           NUHHCE 1199, Southington, Connecticut.
                                  ____

                                                    June 11, 1998.
     Hon. Trent Lott,
     U.S. Senate, Washington, DC.
       Dear Mr. Majority Leader:
       The American people want and need the protection of 
     Patients' Bill of Rights. As more and more families face 
     unreasonable barriers to getting necessary health care 
     approved from health maintenance organizations (HMOs) and 
     other health insurance plans, it is clear that legislative 
     action is needed. Public opinion surveys repeatedly show that 
     the public's desire for managed

[[Page S6139]]

     care consumer protections is both wide and deep.
       It is more than half a year since the President's Advisory 
     Commission on Consumer Protection and Quality in the Health 
     Care Industry proposed, virtually unanimously, the adoption 
     of a Bill of Rights. For many months it has been clear that 
     strong support exists for the enactment of a genuine 
     Patients' Bill of Rights. A number of bills including the 
     Patients' Bill of Rights Act (S. 1890), the patients' Access 
     to Responsible Care Act (S. 644) and others have such support 
     and demonstrate that many members are in favor of bipartisan 
     patient protection legislation.
       It is therefore both troubling and puzzling that there has 
     been a delay in consideration of this legislation. We believe 
     that it is wrong to obstruct congressional consideration of 
     genuine patient protection legislation. Your colleagues want 
     such legislation. America's families need it. And it is a 
     violation of fundamental fairness, and a disservice to 
     families seeking health care, for you to block a vote on this 
     important legislation.
       We hope that you will lend your support to efforts to enact 
     genuine managed care patient protection legsilation--not a 
     watered-down version and not one that is combined with 
     ``poison pills.'' We urge you to schedule quickly a full and 
     fair debate on such legislation. Protecting America's 
     families should be your number one priority. We urge you to 
     act now.
           Sincerely,
         ACT UP Golden Gate, AIDS Action, AIDS Legal Referral 
           Panel, AIDS Policy Center for Children, Youth and 
           Families, AIDS Treatment News, Alzheimer's Association, 
           American Academy of Child & Adolescent Psychiatry, 
           American Academy of Neurology, American Academy of 
           Physician Medicine and Rehabilitation, American 
           Association for Marriage and Family Therapy, American 
           Association for Psychosocial Rehabilitation, American 
           Association for Respiratory Care, American Association 
           of Children's Residential Centers, American Association 
           of Pastoral Counselors, American Association of Private 
           Practice Psychiatrists, American Association of 
           University Women, American Association on Mental 
           Retardation, American Board of Examiners in Clinical 
           Social Work, American Cancer Society, American 
           Chiropractic Association, American Counseling 
           Association, American Dental Association, American 
           Federation of Labor-Congress of Industrial 
           Organizations (AFL-CIO).
         American Federation of State, County and Municipal 
           Employees (AFSCME), American Group Psychotherapy 
           Association, American Lung Association, American 
           Medical Association, American Medical Rehabilitation 
           Providers Association, American Nurses Association, 
           American Occupational Therapy Association, American 
           Protestant Health Alliance, American Psychiatric 
           Association, American Psychiatric Nurses Association, 
           American Psychoanalytic Association, American 
           Psychological Association, American Society for 
           Adolescent Psychiatry, American Society of Plastic and 
           Reconstructive Surgeons; American Speech-Language-
           Hearing Association; American Therapeutic Recreation 
           Association; American Thoracic Society, Anxiety 
           Disorders Association of America; Arc of the United 
           States, Asian & Pacific Islander Wellness Center, 
           Association for Ambulatory Behavioral Healthcare, 
           Association for the Advancement of Psychology, 
           Association of Women's Health, Obstetric and Neonatal 
           Nurses.
         Bazelon Center for Mental Health Law, Brain Injury 
           Association Inc (BIA), Center for Patient Advocacy, 
           Center on Disabilities and Health, Child Welfare League 
           of America, Children and Adults with Attention Deficit 
           Disorders (CHADD), Clinical Social Work Federation, 
           Consumer Coalition for Quality Health Care, Consumer 
           Federation of America, Corporation for the Advancement 
           of Psychiatry, Families USA, Family Voices, Friends 
           Committee on National Legislation (Quaker), Gay Men's 
           Health Crisis, Health Initiatives for Youth, Human 
           Rights Campaign, International Association of 
           Psychological Rehabilitation Services, League of Women 
           Voters of the United States, Legal Action Center, 
           Lutheran Office for Governmental Affairs of the 
           Evangelical Lutheran Church in America.
         National Alliance for the Mentally Ill, National 
           Association for Rural Mental Health, National 
           Association for the Advancement of Orthotics and 
           Prosthetics (NAAOP), National Association of Alcoholism 
           and Drug Abuse Counselors, National Association of 
           Developmental Disabilities Council, National 
           Association of People with AIDS, National Association 
           of Protection & Advocacy Systems, National Association 
           of Psychiatric Treatment Centers for Children, National 
           Assication of School Psychologists, National 
           Association of Social Workers, National Caucus and 
           Center on Black Aged, Inc., National Citizens' 
           Coalition for Nursing Home Reform, National Council for 
           Community Behavioral Health, National Council on Aging; 
           National Easter Seal Society, National Education 
           Association, National Marfan Foundation, National 
           Mental Health Association, National Minority Aids 
           Council, National Organization for Rare Disorders 
           (NORD), National Organization on Disability, National 
           Osteoporosis Foundation, National Parent Network on 
           Disabilities, National Partnership for Women & 
           Families, National Patient Advocate Foundation.
         National Therapeutic Recreation Society, National Women's 
           Law Center, Neighbor to Neighbor, OWL, Paralyzed 
           Veterans of America, Project Inform, RESOLVE, The 
           National Infertility Association, San Francisco AIDS 
           Foundation, Service Employees International Union 
           (SEIU), Summit Health Coalition, United Cerebral Palsy 
           Association, United Church of Christ, Office of Church 
           in Society, Women's AIDS Network.

                          ____________________