[Congressional Record Volume 145, Number 101 (Friday, July 16, 1999)]
[Senate]
[Page S8736]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               MANAGED HEALTH CARE REFORM--HMO LIABILITY

  Mr. BINGAMAN. Mr. President, over the past few days, my Democratic 
colleagues and I presented a number of arguments which clearly laid out 
the need for managed health care reform.
  The ability to hold insurance companies accountable for their 
decisions is a critical element in ensuring the overall quality of 
patient protections.
  While we will continue to present our case in a variety of ways, I 
would like to take this opportunity to relate a story that was shared 
with me just a few weeks ago about a young girl from Albuquerque, New 
Mexico.
  Anna, 6 years old at the time, was a very active and energetic young 
girl and excited about entering first grade that year. One evening, 
Anna went with her parents and her brothers and sisters to a softball 
game. She and other children went off to play in an area near the 
softball field. Suddenly, some of the children came running towards the 
adults, screaming for help. Anna had caught her foot in a gate. Her 
foot was bleeding profusely and she was in agonizing pain. She was 
immediately rushed to the local emergency room.
  After Anna was examined by her doctor and after a conversation with 
her family's HMO, it was determined that Anna would not be admitted to 
the hospital that night.
  Anna's family reluctantly took her home that night where she was in 
pain throughout the evening. Her family was forced to watch their 
small, frail daughter lay in bed in agony.
  The next morning, her mother was worried because Anna's foot was 
purple, swollen, and cold. Anna was in tremendous pain and had a fever. 
Her parents did not hesitate any longer and Anna was rushed back to the 
emergency room.
  This time she was admitted immediately and treated on an emergency 
basis, but it was too late and her family's worst fears were realized. 
Anna had a raging infection that had already destroyed half of her foot 
which had to be amputated.
  Anna had two surgeries and spent 6 weeks in the hospital. She will 
live with this deformity forever.
  Unbelievably, her family's HMO has delayed paying for the 6 weeks she 
was in the hospital to have her foot amputated and grated at a cost of 
$23,000.00.
  Anna's family paid for the protection of health insurance. What they 
received in return was a possible delay of critical medical service 
which has left Anna disfigured and has ruined her family's credit.
  To the amazement of anyone who hears this story, under current law, 
Anna's HMO will not be held accountable for their decisions.

  Under the Democratic plan, Anna and her family would have legal 
recourse like any other American has in this country when they are 
wronged by a business.
  The Democratic plan simply states that if a patient is injured or 
killed as a result of an insurance company's decision, the insurance 
company can be held liable under state law.
  Let me be clear. This will not open the flood gates to more 
litigation and raise the cost of health insurance.
  It doe not override states' rights. It simply says that whatever 
rights a given state chooses to grant shall not be blocked by federal 
legislation.
  Without adoption of the Democratic plan, stories like Anna's will 
continue to be told. I understand Anna is quite a young girl and she 
will go on. But she and her family will struggle with this nightmare.
  The Democratic plan is not about lawyers--it is about people like 
Anna and protecting their rights.
  Anna, her family and millions like them in this country are waiting 
for us to do just that.

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