[Congressional Record Volume 145, Number 91 (Thursday, June 24, 1999)]
[Senate]
[Pages S7554-S7557]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     PATIENTS' BILL OF RIGHTS PLUS

  Mr. GRAMS. Mr. President, I wish to talk this morning about health 
care. I find it ironic we are trying to get to a very important 
agricultural appropriations bill, and the Democratic side of the aisle 
is preventing the Senate from moving on that. Hopefully we can work out 
an agreement on these health care issues and discuss and debate them 
openly. I look forward to the debate.
  I find it humorous when Senator Kennedy calls our bill the ``Patient 
Bill of Wrongs''. It seems that if it is not his way, it is the wrong 
way. Our bill is the Patients' Bill of Rights Plus, which I think goes 
further in trying to encourage people to get health insurance and to 
have coverage, rather than leading America toward a government-type 
system of national health care.
  I am looking forward to the debate. I hope the agreement can be 
worked out and we can discuss the different views on health care 
reform, listen to Senator Kennedy on his Patients' Bill of Rights, and 
also to have adequate time to fully debate the Republican plan, Senator 
Nickles' bill, the Patients' Bill of Rights Plus. I think we must have 
time to compare and contrast those two plans. I think the American 
people are going to get a good idea where both parties stand on the 
direction of health care and health care reform in the near future.
  (The remarks of Mr. Grams pertaining to the introduction of S. 1274 
are located in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. TORRICELLI. Mr. President, I ask unanimous consent at the 
conclusion of my remarks that the Senator from North Carolina, Mr. 
Edwards, be recognized for 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. TORRICELLI. Mr. President, once again my Democratic colleagues in 
the Senate have joined this week in a discussion of the overwhelming 
national need for reform of managed health care. Once again, Senators 
from States across the Nation have shared the experiences of their 
constituents, the frustrations of their families at being denied the 
treatment and care through managed care for which they are paying.
  Once again, it has been a one-sided discussion. We have been talking 
about the need for reform of managed care while our friends and 
colleagues across the aisle have been preventing any real debate. The 
American people have waited long enough for a basic and fundamental 
reform of the managed health care system in America. We have allowed 
weeks, months and even years to pass while recognizing American 
families are in jeopardy and not receiving the care they need, deserve, 
or have even paid for. There is simply no further excuse for delay.
  During this session of the Congress, this Senate has spent 7 days 
considering 38 amendments on the relatively simple concept of 
educational flexibility. The Senate had 8 days available for 52 
amendments on juvenile justice; 4 days for 159 amendments on defense 
authorization; 13 days to consider 51 amendments on the Y2K problem. 
These were all important issues, all legitimate. But in each and every 
instance time was not an issue; the available amendments by Members of 
the Senate were fully considered. On this single issue, which affects 
as many or more Americans than any of these others, the Senate does not 
have time; it cannot give its attention.
  Like other Members of the Senate who have come to the floor to 
discuss the experiences of their constituencies, I want to share the 
experience of one of mine: A young woman from Spotswood, NJ, Kristin 
Bolinger. Kristin suffers from a unique condition that causes seizures 
and scoliosis, but it can be managed with proper treatment. The genius 
of medical science in America, the care of her doctors, can prevent 
these seizures that are interrupting her life. Her family is enrolled 
in an HMO. She was denied access to a specialist, the one with the 
knowledge to treat her illness. The procedure was deemed unnecessary. 
She was denied critical home nursing, denied physical therapy, denied 
reimbursement. The fact of the matter is, the care her parents were 
paying for, she was paying for, the benefit of the genius of American 
medical science, was denied to her.
  There are 161 million Americans just like Kristin, covered by managed 
care, who simply cannot wait any longer for this Senate to find their 
problems, the tragedies of their families, relevant. In my State, in 
New Jersey, 3.8 million people who are part of health maintenance 
organizations have no legal protections. Like their fellow citizens 
across America, they believe it is time for us to act. The American 
people have been polled and 79 percent are in favor of and demand some 
reform in the management of health care in America. They believe, as I 
believe, that doctors, specialists, people trained to care, should be 
making these medical judgments; not accountants, not financial 
managers. People should be making decisions to provide care who know 
what care is required.
  There is a lot that has changed in American health care through the 
years. The family doctor who in the middle of the night knocked on your 
door to help may be gone. By necessity, it may all have changed. But we 
do not have to abandon that one principle

[[Page S7555]]

that has always been at the foundation of private health care in 
America--doctors make health care decisions.
  Mr. President, 30 percent of the American people, an extraordinary 
number, claim they personally know someone who needed health care, who 
had a problem, and was denied that care although they were enrolled in 
and had paid for a managed care plan.

  Here is the answer. Here is the legislation we would like to bring to 
the Senate that addresses these problems--it is overwhelmingly 
supported by the American people--but we are denied the opportunity to 
do so.
  No. 1, ensure that doctors, not the HMO, determine what is 
``medically necessary.''
  No. 2, guarantee access to a qualified specialist for those who need 
one, even if that specialist is not part of the HMO.
  No. 3, ensure independent medical appeals for treatment denied by the 
HMO, so when you are denied treatment, there is someone else to whom 
you can make your case to get care for yourself, your family, or your 
child.
  No. 4, guarantee wherever you are in America, if you need to get 
access to an emergency room, you can get into that emergency room.
  In sum, what this would provide is some new sense of security in 
health care in American life. Americans with cancer would be guaranteed 
access to an oncologist, not just a family doctor. If their HMO denied 
access, they could go on and appeal to ensure the right judgment was 
made, and the oncologist, not the HMO, would decide their treatment. In 
substance that is what this means. This is important for all Americans.
  Let me conclude by saying there is a category of Americans for whom 
these reforms are the most important. Mr. President, 75 percent of all 
the medical decisions in families in America are made by women, for 
themselves and for their children. One of the things that is required 
in our legislation is that an OB/GYN can be a primary health care 
provider, can make the necessary judgments on first impression. It is, 
perhaps, one of the most important reforms in the Democratic Patients' 
Bill of Rights. It is overwhelmingly supported by American women. But 
we also prohibit drive-through health procedures like mastectomies and 
guarantee access by children to pediatric specialists.
  From American children to American women to all American families, 
there is an overwhelming need to begin these reforms. It can be 
postponed for another year, another few years, maybe another decade. 
The only thing the Senate guarantees by postponement is that the list 
of millions of Americans who are not getting to specialists, who are 
denied access to emergency rooms, whose medical doctors are not allowed 
to make the ultimate determinations--that list is growing. It is 
growing, and so is the frustration of the American electorate.
  I hope in this session, in this year, in this Senate, the need for a 
Patients' Bill of Rights finally comes to be recognized and accepted.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. EDWARDS. I thank the Chair.
  Mr. President, I appreciated and enjoyed the remarks of my 
distinguished colleague from New Jersey. I come again to the Senate 
Chamber to talk about what I believe is a crisis in America today, 
which is the issue of health care and the desperate need for a 
Patients' Bill of Rights.
  If we need more glaring evidence of that, all any American needs to 
do today is open the front page of their newspaper and find that the 
American Medical Association is supporting doctors being allowed to 
form unions. Nothing can better exemplify the crisis with which we are 
confronted.
  Here are medical professionals, the last group anyone would imagine, 
forming a union or finding the need to form a union, who now find, in 
order to do what they believe is right--to make medical decisions about 
the patients they care so much about, to be allowed the autonomy to 
make those decisions and not have those decisions made by health 
insurance bureaucrats sitting behind a computer screen or a desk 
somewhere--it necessary to talk about the need to form unions.
  I listened to my colleague from California earlier this morning. I 
agree with everything she said. Only the most skeptical of us would 
have ever thought this was a possibility. The root cause for the 
doctors' need to form a union is that they want to make medical 
decisions about the care of their patients and, more specifically, they 
want to decide when a procedure is medically necessary and when a 
procedure is not.
  If I can use two examples which I think glaringly show the problem 
doctors in this country and patients are confronted with today, they 
are two I have mentioned before on the floor of the Senate. One 
involves a young man named Ethan Bedrick who developed cerebral palsy 
as a young child. One of the problems associated with cerebral palsy is 
the development of what is called muscle contractures. We have all seen 
adults with cerebral palsy who are all balled up, their arms held up 
against their bodies. They have little or no control over their limbs. 
The reason that happens is because, as children and as young adults, 
these patients do not receive physical therapy to extend their limbs on 
a regular basis to give them their best use.
  What happened with Ethan Bedrick is every single doctor who was 
treating him for his cerebral palsy--and there were myriad doctors--
said it was absolutely essential he receive physical therapy. This was 
a group of doctors who had seen him every day and was responsible for 
his care.
  Then some insurance company doctor, sitting behind the desk looking 
at a piece of paper, who had never seen Ethan Bedrick, never examined 
him and, I will add, unlike all the doctors who were treating him, had 
absolutely no expertise in treating kids with cerebral palsy or the 
issue of physical therapy for those kids, made the decision this was 
not medically necessary. Therefore, the insurance company decided it 
was not going to pay for any physical therapy for this boy.
  After some 2 odd years of going to court and going through a lot of 
litigation procedures which absolutely should never have been 
necessary, the U.S. Fourth Circuit Court of Appeals determined the 
obvious, which is that the treating doctors were correct, that Ethan 
desperately needed this physical therapy for the purpose of keeping him 
from becoming like so many adults with cerebral palsy who we have seen 
all balled up and unable to control their limbs in any way.

  They reversed the insurance company decision and said they had to 
provide this treatment. It took over a year after that decision before 
the insurance company actually began to do something.
  It is a perfect example of insurance company bureaucrats and 
accountants making health care decisions. That is the reason doctors 
feel the need to unionize, so they can make these decisions instead of 
insurance companies.
  A second example is a man named Steve Grissom from Cary, NC, who 
developed leukemia as a young man. As a result of his leukemia, he had 
a blood transfusion. During the course of his blood transfusion, he 
acquired AIDS. He became sicker and sicker with his AIDS to the point a 
pulmonary specialist, a leading authority in the world at Duke 
University Medical Center, prescribed oxygen for him 24 hours a day, 7 
days a week.
  What happened was during the time he was being treated, his HMO was 
providing coverage for him because the pulmonary specialist, the real 
expert, determined it was necessary. Then his employer changed HMOs. 
The new HMO--again with some person sitting behind a desk somewhere, 
not a medical doctor--decided based on a chart that he did not quite 
meet the numbers for oxygen saturation that were necessary and, 
therefore, cut off all coverage for the oxygen that his world-renowned 
specialist had ordered for him.
  Now Steve is working desperately--in fact, he is coming to Washington 
this week to see me and other Senators--to pay for the oxygen that 
keeps him alive. It is one of the reasons he is alive and able to be 
with his family, which he loves and cherishes so much.
  These are terrific examples of what is fundamentally wrong with our 
health care system in this country today. The judgments of what is 
medically necessary have to be made by people who are trained to do it. 
They have to be made by doctors who are seeing the patients, who have 
the clinical judgment to make those determinations.

[[Page S7556]]

  It is critically important for our doctors to do their job. It is 
critically important for the children, adults, and families they treat. 
In our Patients' Bill of Rights, we specifically provide that doctors 
make those decisions. Our opponents' bill does not do that, and that is 
why the bills are so dramatically different.
  One last thing I want to mention is the issue of financial incentives 
that are sometimes created in HMO contracts either explicitly or 
implicitly. I know specifically of an example in North Carolina where a 
mother was in labor. The doctor who was responsible for taking care of 
her had too many patients to care for. As a result of complications 
during labor, she needed her doctor. The nurse called for the doctor. 
The doctor did not come. She did not understand why.
  The reason was the doctor had other patients he could not leave. 
Instead of calling for a backup, the doctor continued to allow this 
woman to labor with her complications without a doctor by her bedside.
  The result of this was a child born severely brain injured. We later 
learned the reason this is done, the reason no backup doctor is called 
is because there is enormous pressure, financial and otherwise, put on 
these physicians by the HMO, by the health insurance company, not to 
call a backup doctor because it costs them money. It costs the health 
insurance company and the HMO money, and, further, that they can 
actually receive bonuses if they prescribe the least expensive 
treatment for patients, no matter what the patient needs, and if they 
fail to call backup doctors even though one may be needed. In other 
words, the HMOs have been putting doctors in the position of having to 
provide the cheapest treatment, not call other medical personnel who 
are necessary, solely so they could save a dollar.

  These things are what are fundamentally wrong with the way health 
care is being conducted in this country today. There is a fundamental 
difference between our bill and our opponents' bill. Our bill 
specifically provides that these kinds of financial incentives are 
absolutely prohibited; they cannot occur. Our opponents' bill is silent 
on that issue.
  We cannot continue to allow the American people to be subjected to 
this. It is the reason we have this crisis. It has gotten to crisis 
proportions because we have gone this long and done nothing about it. 
Medical care should be about patients and not about profits.
  I say this, in a most nonpartisan way, to my colleagues on both sides 
of the aisle, for whom I have tremendous respect and who I know want to 
do the right thing for the people they represent and the American 
people.
  This is not a partisan issue for me. It was an important issue to me 
in being elected to the Senate. It is an issue I want to talk about 
while I am here. But I want to talk about it in an ongoing, meaningful 
dialogue. I am not interested in fighting about it. I am not interested 
in political bickering. What I am really interested in is what is done 
in the best interests of the people of North Carolina and what is in 
the best interests of the people of America.
  With that, I yield the floor.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I note the absence of a quorum.
  The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Several Senators addressed the Chair.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  The assistant legislative clerk continued with the call of the roll.
  Mr. DORGAN. I ask unanimous consent that the quorum call be 
rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  Mr. WELLSTONE. Since I hope we have debate, I ask unanimous consent 
that the order for the quorum call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  Mr. WELLSTONE. Mr. President, as much as I like my colleague from 
Arkansas, I am going to put in this request. I ask unanimous consent 
that the order for the quorum call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  Mr. WELLSTONE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  The assistant legislative clerk continued with the call of the roll.
  Mr. REID. I ask unanimous consent that the order for the quorum call 
be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  The assistant legislative clerk continued to call the roll.
  Mr. WELLSTONE. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  Mr. WELLSTONE. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  Mr. WELLSTONE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  Mr. WELLSTONE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded so we can have debate.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  Mr. WELLSTONE. Mr. President, so we can debate health care, I ask 
unanimous consent that the order for the quorum call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object.
  Mr. WELLSTONE. I ask unanimous consent that the order for the quorum 
call be rescinded so we can debate health care, a matter that is very 
important to the people in Minnesota.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object to the unanimous consent request.
  Mr. WELLSTONE. Mr. President, so we can speak as Senators, Democrats 
and Republicans, I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object to the unanimous consent request of the Senator from 
Minnesota.
  Mr. WELLSTONE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Acting, as in the past, in my capacity as a 
Senator from Arkansas, I object to the unanimous consent request of the 
Senator from Minnesota.
  Mr. WELLSTONE. Mr. President, I ask, please, unanimous consent that 
the order for the quorum call be rescinded.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I regrettably must object to the unanimous consent request.
  Mr. WELLSTONE. Mr. President, I know you regret that because you like 
debate. Mr. President, I ask unanimous consent that the order for the 
quorum call be rescinded so we can have a full-scale discussion on the 
Family Protection Act on the floor of the Senate as opposed to being 
gagged.
  The PRESIDING OFFICER. Acting in my capacity as a Senator from 
Arkansas, I object to the unanimous consent request of the Senator from 
Minnesota.
  Mr. WELLSTONE. Mr. President, even though I know Republicans don't 
want to debate this, I ask unanimous consent that the order for the 
quorum call be rescinded so we can debate.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. WELLSTONE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. WELLSTONE. Mr. President, so I can debate my colleague from 
Oklahoma and other Republicans, I ask

[[Page S7557]]

unanimous consent that the order for the quorum call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. DORGAN. On behalf of the Senator from Minnesota, I ask unanimous 
consent that the order for the quorum call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. WELLSTONE. Mr. President, on behalf of the Senator from North 
Dakota and all Senators who believe we should honestly debate issues, I 
ask unanimous consent that the order for the quorum call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. WELLSTONE. I ask unanimous consent that the order for the quorum 
call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. WELLSTONE. I ask unanimous consent that the order for the quorum 
call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. WELLSTONE. I ask unanimous consent that the order for the quorum 
call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. WELLSTONE. Mr. President, so we can debate the Patients' 
Protection Act, I ask unanimous consent that the order for the quorum 
call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  The assistant legislative clerk continued with the call of the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  The assistant legislative clerk continued with the call of the roll.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  The assistant legislative clerk continued with the call of the roll.
  Mr. INHOFE. Mr. President, I ask unanimous consent that the Senate 
stand in recess subject to the call of the Chair.
  The PRESIDING OFFICER. The Senate is in a quorum call.
  The assistant legislative clerk continued with the call of the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  The assistant legislative clerk continued with the call of the roll.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  Mr. INHOFE. I object.
  The PRESIDING OFFICER. Objection is heard.
  The assistant legislative clerk continued with the call of the roll.
  Mr. INHOFE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Is there objection?
  Mr. DORGAN. I object.
  The PRESIDING OFFICER. Objection is heard.
  The assistant legislative clerk continued with the call of the roll.
  Mr. INHOFE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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