[Congressional Record Volume 144, Number 92 (Monday, July 13, 1998)]
[Senate]
[Pages S8019-S8020]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. DORGAN. Mr. President, I would like to just talk briefly about 
two

[[Page S8020]]

short items today, the first of which is the Patients' Bill of Rights 
legislation, which we hope the Senate will take up perhaps as early as 
this week. Some suggest that there isn't a need for legislation to 
ensure the quality of care provided by managed care plans. They 
believe, I suppose, as some insurance companies do, that things are 
just fine in managed care and health care in this country. But others, 
and that includes most of the American people, know better. They worry 
that health care in this country is now often directed not by doctors 
or other medical professionals but by some accountant in an insurance 
office 500 or 1,000 miles away from where the patient is.
  Let me describe, as we have nearly every day for some weeks, a case 
that illustrates why the American people are so anxious about what is 
happening in our health care system. This is the example of Mr. Vaughn 
Dashiell. Vaughn Dashiell is one more reason why HMO reform, or managed 
care reform, in the form of the Patients' Bill of Rights, should be 
brought before the Senate.
  Vaughn lived with his wife, Patricia, and their three children in 
Alexandria, VA, not too far from the U.S. Capitol. He owned and 
operated his own printing company. On November 20, 1996, Vaughn stayed 
home from work. He had awakened that morning sick, suffering from a 
sore throat, a dry mouth and tunnel vision that limited his sight to 
only 18 inches. He tried to get an appointment to see a doctor within 
his HMO network but was told there were no appointments available at 
his designated facility. He was able to speak only to an HMO-employed 
nurse on duty over the phone. She could have told Vaughn to go to an 
emergency room for treatment, but instead she told him to make a 
regular appointment, even though none were available. So here is 
someone who has health care coverage, wakes up ill, calls the HMO, 
can't speak to a doctor, instead speaks to a nurse, and the nurse says, 
``Make an appointment,'' but no appointments are available.
  As Vaughn's symptoms worsened, he called his HMO again requesting 
permission to see a doctor somewhere, or to go to a nearby emergency 
room for treatment. He was told only to wait and that he would receive 
a call back from a doctor on duty. When the doctor on duty was 
consulted, he agreed that Vaughn should go to an emergency room, but 
neither made a call himself, nor followed-up to see that Vaughn was 
contacted. And that night Vaughn Dashiell was not contacted--not by the 
nurse, not by the doctor, or by any other HMO staff regarding his 
condition and the request he had made for health care.
  The next morning, Patricia Dashiell found her husband incoherent, 
with his eyes rolling. She hurriedly called the HMO hoping for an 
answer to Vaughn's problem, and they advised her to call 911. She 
called 911 and Vaughn arrived at the hospital at 9:18 a.m. in a 
diabetic coma. His blood sugar level was more than 20 times greater 
than the normal level. Just 2 hours after being rushed to the emergency 
room, Vaughn was dead from hyperglycemia. He was 39 years old. He had 
health insurance coverage, but he couldn't get care when he needed it, 
and he died.
  This should not happen in this country. Health insurers should not 
put profits ahead of patients. And too often these days, they do. 
Vaughn Dashiell's condition would have and could have been treated if 
his health plan had enabled him to get care when he needed it. But all 
over this country, we are hearing of patients who need health care and 
are told by those who have covered them with health insurance, ``It is 
not now available.''
  The Patients' Bill of Rights we have offered in the Senate is very 
simple. This legislation says that people who have health insurance 
coverage ought to get the health care they need when they have an 
urgent need for it. They ought to be able to seek emergency room care 
if a reasonable person would consider it an emergency. They ought to be 
able to see the doctor they need for the health care problem they are 
experiencing. Patients have a right to know all of the options for the 
treatment of their problem, not just the cheapest, and there are a 
whole series of other provisions to ensure that medical care will be 
practiced in a doctor's office or a hospital room, not an insurance 
office 1,000 miles away.
  I have told, often, of the woman who, having fallen from a horse and 
hitting her head severely, was in an ambulance, with her brain 
swelling, on the way to the hospital. She had the presence of mind to 
tell the ambulance driver that she wanted to be driven to the hospital 
further away rather than to the nearby hospital. And when she 
recovered, she was asked why she had insisted, as she was lying there 
injured in the back of the ambulance with her brain swelling, on being 
taken to the hospital further away. She said it was because she knew 
the reputation of the closer hospital, and she knew that it was a for-
profit institution with a reputation for being interested in its profit 
and loss margin than its patients' care. She did not want her body 
delivered to an emergency room where she would be looked at in terms of 
dollars and cents.
  That story and the tragic story of Vaughn Dashiell and so many others 
like it that we have presented to the Senate daily now for so many 
weeks, describes the anxiety and concern people have in this country. 
We have the best health care in the world in many respects, but it is 
available to people in need of health care only if they are able to 
access the kind of doctors they need when they have need for that 
medical specialty.
  It is available only if they are able to get to an emergency room 
when they have need for emergency care. When we have American 
citizens--thousands and thousand and thousands of them--who are denied 
care because someone in an office 500 miles away said, ``Well, gee, 
that care is not needed, it is not to be delivered, it is not 
available,'' then the American people have a right to say, ``What on 
Earth kind of health care system is this?''
  One of the stories we presented earlier on the floor of the Senate 
was of a young boy with cerebral palsy whose managed care officials 
determined that he had only a 50 percent chance of being able to walk 
by age 5. And because he had only a 50 percent chance of being able to 
walk by age 5, plan officials decided that was a minimal benefit and 
they would withhold it from that young child; it was not cost 
effective. It was a minimal benefit to have a 50 percent chance of 
being able to walk when you are 5 years old.
  Shame on the people who make those judgments. Shame on them.
  We are saying with the Patients' Bill of Rights that those who need 
medical treatment in this country have certain rights, and those who 
deliver medical treatment certainly should be cost conscious, but cost 
ought not take precedence over quality. Those who have coverage for 
their health care needs ought to be able to expect to get their needs 
taken care of and responded to adequately. That is, regrettably, not 
the case in many parts of our country today.
  We are led to believe that perhaps this week we will take up some 
form of the Patients' Bill of Rights. If that happens, it will be the 
right subject to be debated. It is a subject Americans expect to be 
addressed. I, as a cosponsor of the Patients' Bill of Rights, feel, as 
will many of my colleagues, that it is time for us to address this 
important issue on behalf of the American people.

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