[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Extensions of Remarks]
[Page E1979]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                    DALLAS LIVER TRANSPLANT PROGRAM

                                 ______
                                 

                       HON. EDDIE BERNICE JOHNSON

                                of texas

                    in the house of representatives

                       Thursday, October 8, 1998

  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I submit the 
attached materials to be included in the Congressional Record:

         Dallas Liver Transplant Program, Baylor University 
           Medical Center, Children's Medical Center of Dallas, 
           Dallas, TX,
                                               September 22, 1998.
     Congresswoman Eddie Bernice Johnson,
     Longworth House Office Building,
     Washington, DC.
       Dear Congresswoman Johnson: I am aware that the House 
     recently passed H.R. 4250, the Patient Protection Act of 
     1998. I understand that the Patient's Bill of Rights Act, S. 
     2330, is currently under consideration as the companion bill.
       Managed care is here to stay, but it has, as you are well 
     aware, caused many significant problems. I have had personal, 
     intimate experience with health care plans ever since they 
     were first introduced into the Dallas health care market in 
     the late 1980s. I support the provisions in the bill as it is 
     currently worded. However, I find it very troublesome that 
     the private insurance plans would not be required to emulate 
     the same restrictions against financial incentives as the 
     current Medicare rules provide. To allow a system that awards 
     or penalizes physicians depending on how ``cost effective'' 
     the care is they provide I believe is unethical. The simple 
     thought of paying physicians extra if they do not provide 
     health care is, in effect, repugnant to me. In addition, we 
     must prevent the development of separate requirements for 
     public and private health care sectors.
       In my own particular field, that of transplantation, it is 
     very obvious that transplant patients, i.e. recipients of 
     kidneys, pancreas', livers, hearts, lungs and other organs, 
     are so sick and have such serious disorders that they need to 
     be cared for by specialists in their respective fields, both 
     before and after the transplant. There are areas of the 
     country where a specialist's care is not available. In those 
     circumstances, the local physicians work very closely with 
     the super-specialists at the transplant institutions. I think 
     it is essential to allow chronically ill patients to have 
     specialists designated as their primary care physicians.
       On a separate vein, the basis for improvement of care and 
     the safety of treatment we can provide to patients is to 
     allow the patients to participate in scientific, peer-
     reviewed, controlled trials. It is essential for medicine, 
     and to have health care plans forbid patient participation 
     because of whatever reason they deem fit is unthinkable. They 
     always want to participate and reap the benefits of any 
     advances, especially if they can save a few dollars for 
     themselves. However, they don't ever want to participate and 
     help such developments along.
       Finally, since I have seen health care being prevented and 
     withheld by health care providers so many times, I believe it 
     is imperative to allow patients to sue their carrier. The 
     unconscionable way that many health care providers approach 
     health care today is upsetting. One situation I bring to your 
     attention is several years ago open of the biggest HMOs in 
     the country had patients who were 20% more expensive to 
     transplant than other patients. The reason was simply that 
     the patients coming from this particular HMO were so much 
     farther advanced and therefore more complex when they finally 
     arrived for transplantation. The patients were simply 
     prevented from having the transplants when they were in 
     optimum condition, thus jeopardizing their lives. Clearly 
     this was not the fault of the referring physicians or the 
     physicians involved in the transplantation, but the HMOs 
     corporate policy in trying to avoid the cost that would be 
     incurred. Thus, the right to sue the carrier is absolutely 
     essential to insure the patient's right to prevent 
     withholding of care that is so widely prevalent today.
       As always I appreciate your work in Congress and your 
     involvement In the health care problems.
           Yours most sincerely,
                                          Goran B. Klintmalm, M.D.
                       Medical Director, Transplantation Services,
                         Baylor University Medical Center--Dallas.


     
                                  ____
                                                     Department of


                                      Health & Human Services,

                               Washington, DC, September 23, 1998.
     Hon. Eddie Bernice Johnson,
     House of Representatives, Washington, DC.
       Dear Ms. Johnson: Thank you for your letter regarding 
     implementation of the surety bond requirement for home health 
     agencies (HHAs) included in the Balanced Budget Act of 1997. 
     I regret the delay in this response.
       In response to concerns raised by Members of Congress and 
     the home health industry, the Health Care Financing 
     Administration (HCFA), in a rule published in the Federal 
     Register on July 31, announced the indefinite suspension of 
     the compliance date by which home health agencies must obtain 
     a surety bond. As a result, home health agencies no longer 
     have a date by which they must obtain a surety bond. The 
     Congress has requested that the General Accounting Office 
     conduct a study of the home health surety bond requirement, 
     and upon completion of that study, HCFA will work in 
     consultation with the Congress about the surety bond 
     requirement. Following this review and consultation, the new 
     date by which home health agencies must obtain bonds will be 
     at least 60 days after HCFA publishes a revised rule 
     requiring bonds, but will not be earlier than February 15, 
     1999.
       I hope this information is helpful, and I appreciate your 
     letter. A similar letter is being sent to the other members 
     of the delegation who co-signed your letter.
           Sincerely,
                                            Nancy-Ann Min DeParle,
                                                    Administrator.

     

                          ____________________