[Congressional Record Volume 144, Number 98 (Tuesday, July 21, 1998)]
[Senate]
[Pages S8596-S8597]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. KERRY. Mr. President, countless Americans have come to understand 
that the health care system in this country is in a total state of 
disarray, if not crisis. It is a crisis of confidence. It is a crisis 
of coverage, bought and paid for with hard-earned dollars from our 
fellow taxpayers, but a coverage that seems to disappear when you need 
it the most.
  Our fellow citizens no longer believe that their insurance companies 
are prepared to provide them with the quality of service or the choice 
of doctors that they were promised or that they paid for with their 
premiums. Some health insurers have put saving costs way ahead of the 
prospect of saving lives.
  I think most people in the Senate have come to understand the nature 
of this crisis. The impact of the decisions of the insurance companies 
in countless stories across America and across my State of 
Massachusetts is immeasurable. Americans are suffering because the 
system puts the choices of the insurance company administrator far 
ahead of the choice of a doctor.
  The story of Ellen O'Malley, a mother of two, from Canton, MA, 
underscores the full measure of the problem that we face today. Ellen 
passed away in the summer of 1994, a victim of breast cancer at the age 
of 38. Her husband, Steve, a schoolteacher in Canton, and her two 
daughters, could tell anybody in the Senate about the trouble that 
people face today as a result of the way in which choices are made for 
the delivery of health care. They could also tell you about the 
struggle of what it is like to live without a mother and wife. I think 
all of us understand that happens and that there are sometimes 
unavoidable consequences of some diseases. But clearly there are 
totally avoidable consequences of what kind of care is delivered to 
somebody in the course of an illness.
  The O'Malley family's story is even more tragic than the loss of 
Ellen because they would tell every Senator about the new language that 
they learned, the experience that they went through, as a consequence 
of her illness--a vocabulary of the HMOs. Ellen O'Malley should not 
have had to spend her last year of life jumping through bureaucratic 
hoops just to get treatment for breast cancer. She shouldn't have had 
to be shuttled around the city of Boston from one hospital to another 
hospital, from one doctor to another doctor, because an HMO refused to 
take the word of her own family doctor or her oncologist. Ellen 
O'Malley was very, very brave in facing the struggle with a killer 
disease. She should not have been asked to be brave in facing a 
different struggle with the bureaucracy.
  The simple fact is that health insurers should not make the decisions 
that are fundamentally the decision of a doctor or a trained health 
care professional. The truth is that in times of family crisis, people 
should not have to worry about whether or not a bureaucrat is going to 
allow them to be able to see a doctor in whom they have placed trust. 
That is precisely the kind of turmoil that Ellen O'Malley suffered 
every single day of her illness.
  Steve O'Malley remembers his wife hearing the promises from their HMO 
when they were signing up, promising that she would undergo care with 
her doctor, Dr. Erban, who had treated her for the past 10 years, and 
the promise that she would be able to continue to be treated at the New 
England Medical Center.
  But the O'Malleys found that when push came to shove, when it came 
time for the promise to be delivered on, the promise disappeared. Steve 
O'Malley knows full well about an HMO that sent Ellen all over the 
city, to one hospital for a mammogram, to another hospital for a 
biopsy, and to still another hospital for treatment. Steve O'Malley 
remembers hours spent painstakingly writing lengthy appeal letters to 
the HMO, begging them to reconsider their decisions. He also remembers 
what it felt like to receive a 5-line form letter rejecting his wife's 
appeal.
  Steve would tell you that the personal and painful decisions for his 
family were merely business decisions for the HMO, and that is 
unacceptable. It is unacceptable for the O'Malleys, as Steve remembers 
his late wife saying, ``HMOs are great unless you're sick. They're fine 
if you have a cold, get the flu, break your arm, or stub your toe, but 
they are not fine if you're dying.''
  Steve and Ellen O'Malley and their two daughter suffered an enormous 
personal tragedy when breast cancer dashed their hopes and dreams for 
the future. I believe they should have been able, as a family, to 
endure that tragedy secure in the knowledge that Ellen could make her 
medical decisions side by side with the doctor she trusted--not a 
bureaucrat who never went to medical school and, more importantly, 
never knew Ellen O'Malley.
  I believe that no HMO should rob a family of peace of mind in times 
of crisis. HMOs should be more than organizations that are great unless 
you are sick. For every person who buys into an insurance program, 
there ought to be the confidence that the coverage that you buy is the 
coverage that you will get. That is why we have proposed the Patients' 
Bill of Rights. We recognize we have built a system that currently puts 
paperwork ahead of patients and ignores the real life-and-death 
decisions being made in our health care system. We have to do better.
  All across Massachusetts, I hear from people who are angry at how 
hard it is to find the health care that they believe they have 
purchased. And they are frustrated with policies that say that our 
elderly can't go to the doctor of their choice. They are convinced 
their HMOs don't give them straight answers about their coverage, and 
working families across the country believe it is time to take 
decisions out of the hands of the insurance companies and put them back 
with patients and doctors where they belong.
  The U.S. Senate should agree with them. I believe it is vital for us 
to take up and pass meaningful patient protections now, in this 
Congress. There are judges all across the country who have watched in 
their courts as patients and families, victimized by HMOs, come before 
them, to beg for restitution, for a fair shake in getting the health 
care

[[Page S8597]]

they were promised in the terms of the policy that they purchased. 
Those judges were helpless because they didn't write the laws that 
limit the ability of working families to appeal the decisions by HMOs.
  In Boston, we have a U.S. district judge, William Young, a Reagan 
appointee to the bench, who ruled on an HMO case not very long ago.
  Judge Young knew the law and he knew that insurers could, in our 
current structure, put paperwork and profit ahead of patients. He knew 
he could send a message to those of us who write the laws in this 
country. That is why he wrote in his highly publicized decision in 
Clarke v. Baldplate Hospital that ``while the insurer's conduct is 
extraordinarily troubling, even more disturbing to the court is the 
failure of Congress to amend the laws.'' Judge Young was challenging us 
to act on behalf of hundreds of thousands of families left unprotected 
today. He had never met Ellen O'Malley, but he challenged the Congress 
of the United States to stand up for her.
  Mr. President, we have the Patients' Bill of Rights, S. 1890, which 
would prevent senseless tragedies in the health care system from 
happening. Under our plan, Ellen O'Malley would have been able to 
immediately appeal her insurer's rejection of her doctor's prescribed 
treatment. Under our plan, the decision of Ellen O'Malley's doctors 
would have come first in the insurer's decisions. There is little, 
obviously, we can do for the O'Malley family, except to perhaps in her 
memory pass a bill that will change the way in which all of these 
choices are made in the future. We could pass a Patients' Bill of 
Rights. The clock is ticking. I hope this Congress will do so in the 
next days.
  I yield the floor.
  Mr. ASHCROFT addressed the Chair.
  The PRESIDING OFFICER (Mr. Brownback). The Senator from Missouri is 
recognized.
  Under the previous order, there are 22 minutes remaining on the time 
that was equally divided by a previous order.
  Mr. ASHCROFT. Mr. President, I ask unanimous consent that we be able 
to speak until 10 o'clock on the issue of the marriage penalty.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________