[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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