[Congressional Record Volume 146, Number 10 (Tuesday, February 8, 2000)]
[Senate]
[Pages S489-S492]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. SPECTER (for himself, Mr. Harkin, and Mr. Inouye):
S. 2038. A bill to amend the Public Health Service Act to reduce
accidental injury and death resulting from medical mistakes and to
reduce medication-related errors, and for other purposes; to the
Committee on Health, Education, Labor, and Pensions.
medical error reduction act of 2000
Mr. SPECTER. Mr. President, on behalf of Senator Harkin and myself, I
am introducing legislation captioned the Medical Error Reduction Act of
2000. This legislation is introduced in response to a report from the
Institute of Medicine which shows a very high death rate as a result of
errors in hospitals.
The statistics show that the death rate from errors in hospitals may
be as high as 98,000 people. A chart has been prepared demonstrating
that at the 98,000 figure, which is the uppermost estimate, medical
errors are the fifth
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leading cause of death in the United States, problems which certainly
need to be addressed.
The legislation we are proposing follows a hearing which our
Subcommittee on Labor, Health and Human Services, and Education
conducted on December 13, 1999, and also a hearing conducted on January
25, 2000, in conjunction with the Veterans' Affairs Committee. Our
legislation has input--not support, but input--taking into account
concerns from the American Hospital Association, the American Medical
Association, the American Nurses Association, the Institute for Safe
Medication Practices, the American Psychological Association, and
others.
The core provisions of the bill will provide for 15 competitively
awarded research demonstration projects to make a determination of the
scope of medical errors and the ways to correct these medical errors
systemically. Five of these demonstrations will have a mandatory
reporting requirement with confidentiality when there is a medical
error. Five of these demonstration projects will have a voluntary
reporting program with confidentiality, and five of these demonstration
projects will have a mandatory reporting requirement and also a mandate
that the patient and/or the family be notified of the error.
This, we think, is fundamental in terms of the professional
responsibility of a doctor and the professional responsibility of a
hospital to notify the injured party where error has occurred.
Parenthetically, a similar obligation, I believe, is incumbent upon
professionals generally.
The legislation has further provisions for the studies to be
conducted in a way to make a determination as to what is feasible on
hand-held prescription pads and on other technical devices which will
look to the system's errors which are encapsulated and encompassed in
hospitals and medical care.
On November 29, 1999, the Institute of Medicine (IOM) issued a
report, ``To Err Is Human: Building a Safer Health System.'' The report
concluded that medical mistakes have led to numerous injuries and
deaths, affecting an estimated three to four percent of all hospital
patients. The IOM report also concluded that health care is a decade or
more behind other high-risk industries in its attention to ensuring
basic safety.
According to the IOM, at least 44,000 Americans die each year as a
result of medical errors, and the number may be as high as 98,000. We
must put this statistic into perspective, as noted in this chart: at
98,000 deaths per year, medical errors are catapulted into the ranking
of fifth leading cause of death nationwide. This total outnumbers
deaths from motor vehicle accidents, breast cancer, and AIDS. Further,
medical errors resulting in injury are estimated to cost the nation
between $17 billion and $29 billion, including additional health care
costs, lost income, lost household production, and disability costs.
The IOM findings are startling and beg for national attention to
determine ways to reduce the number of medical errors. We have all
heard and read media reports detailing the case of Betsy Lehman, a
health reporter for the Boston Globe, who died from a chemotherapy
overdose; or the tragedy of Willie King, who had the wrong leg
amputated in a Florida hospital. Unfortunately, these are not isolated
cases.
On December 13, 1999, I chaired a hearing of the Labor-HHS-Education
Appropriations Subcommittee to hear details of IOM's report findings.
On January 25, 2000, I chaired a joint Labor-HHS-Education
Appropriations Subcommittee/Veterans' Affairs Committee hearing to
consider mandatory and voluntary reporting requirements and to begin to
determine ways to reduce medical errors. Today, Senator Harkin and I
are introducing legislation that seeks to find solutions to the problem
of medical errors. This legislation was developed based on our hearings
and with input from many health groups and experts in the field,
including the American Hospital Association; American Medical
Association; American Nurses Association; Institute for Safe Medication
Practices; American Psychological Association; Federation of
Behavioral, Psychological, and Cognitive Sciences; American Osteopathic
Association; Association of American Medical Colleges; American
Association of Health Plans; Hospital and Healthsystem Association of
Pennsylvania; and Iowa Hospital Association. It is our hope that we can
continue to work together to reduce the number of injuries and deaths
related to medical mistakes.
Let me review the key provisions of this bill. It would:
Make grants available to states so they can establish their own error
reporting systems and collect data to provide to Federal researchers.
The compilation of such data will help researchers understand trends in
errors and determine ways to reduce them.
Require the Agency for Healthcare Research and Quality, in
conjunction with the Health Care Financing Administration, to establish
15 competitively-awarded research demonstration projects throughout the
nation, in geographically diverse areas, to assess the causes of
medical errors and determine ways to reduce those errors.
Facilities participating in these demonstrations will be required to
employ appropriate technologies to reduce the probability of future
errors. Such technologies might include hand-held electronic
prescription pads, training simulators for medical education, and bar-
coding of prescription drugs and patient bracelets.
Facilities participating in the demonstrations will also provide
staff training to reduce the number of errors, and encourage prompt
review of errors to determine ways to prevent them from recurring.
Of the 15 facilities who choose to participate in the demonstrations,
5 will have a mandatory reporting requirement of all medical errors to
HHS, 5 will have a voluntary reporting requirement to HHS, and 5 will
have a mandatory reporting requirement to HHS as well as to the patient
and/or his family.
Require the Secretary of HHS to provide information to all patients
who participate in Federally-funded health care programs, educating
them on ways to reduce medical errors. Require the Secretary to develop
patient education programs to encourage all patients to take a more
active role in their healthcare.
Make grants available to health professional associations and other
organizations to provide training and continuing education in order to
reduce medical errors.
Require the Secretary to report to the Congress within 180 days of
enactment on the costs of implementing a program that identifies
factors that reduce medical errors, including computerized health care
systems. Require the Secretary to report on the results of the fifteen
health system demonstration projects, focusing on best practices and
costs/benefits of applying these practices nationally.
Mr. President, patients must have confidence that when they seek
medical treatment, they will receive the highest quality health care in
the world. They should not be fearful of injuries or even death due to
medical mistakes. The Institute of Medicine panel projected that with
current knowledge and with implementation of medical error reduction
methods that are proven to work, we can achieve no less than a 50
percent reduction in medical errors over the next five years. I believe
that the research efforts authorized by this legislation will allow us
to far exceed this goal, and immeasurably improve patient safety. I
think my colleagues will agree that America has zero tolerance for
preventable medical mistakes, and that we should act immediately to
prevent further deaths and injuries.
I yield to my distinguished colleague from Iowa.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. HARKIN. Mr. President, I am pleased to join my colleague, Senator
Specter, in the introduction of the Medical Errors Reduction Act of
2000. Senator Specter just outlined the major provisions of the bill. I
will not go back over that; only suffice to say our bill addresses a
critical problem facing America's health care system, a problem that
places millions of Americans at risk of serious injury or death every
time they seek medical attention.
Again, I thank my distinguished chairman, Senator Specter, for
putting this bill together in such a timely
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fashion. This is something we have to address, and we have to focus on
this immediately.
Many of my colleagues are aware of the recently released Institute of
Medicine report which describes a health care industry plagued with
systems errors and provider mistakes. If you are familiar with the
report, then you have discovered something I do not think a lot of
people are aware of and of which I was not aware, and that is, we are
more likely to die from a medical mistake than diabetes, breast cancer,
or a traffic accident.
The report found that deaths due to medical errors are the fifth
leading cause of death in this country. This chart is from the Centers
for Disease Control and Prevention, National Center for Health
Statistics. It shows medical errors as the fifth leading cause of
death. Some say it is the eighth leading cause of death. More people
die from medical errors than pneumonia, diabetes, accidents, or kidney
disease.
Whether it is the fifth or eighth, we have been given a wake-up call.
The cost to our health care system and national economy from medical
errors is enormous.
The total cost, we are told by the Institute of Medicine, of injuries
due to medical errors is $17 billion to $29 billion annually. This
estimate cannot accurately reflect the true personal cost to patients
and their families when a diagnostic test is misread, a drug that is
known to cause an allergic reaction is prescribed, or a surgery goes
awry.
One does not have to look too far for stories. I know some personally
in my own family. Another came from one of my staff members who told me
about the disastrous outcome of a conventional gall bladder procedure
performed on her father in 1991.
It seems he went in for a laparoscopy and came out with a severed
bile duct. The gall bladder was removed surgically, and the patient was
sent home to recuperate. Within days, he experienced great abdominal
pain, could not eat, and began to lose weight. His wife is a
nutritionist and could tell something was very wrong. They kept going
back to the doctors who performed the surgery only to be told they
could not find anything wrong and that his problems were probably
psychological.
Finally, in great frustration, the man and his wife turned to a
neighbor, an old-fashioned country doctor who sent them to a surgeon
friend of his. Sure enough, this doctor discovered the problem and it
was corrected, but only after several months of pain and frustration.
Deaths from medication errors total more than 7,000 annually. These
errors erode the trust Americans have in their health care system.
Let me be clear, most medical errors that occur in our health care
system are not the fault of any one individual or institution. We have
the best trained, most sophisticated health care workforce in the
world. Thousands of highly skilled and conscientious doctors, nurses,
pharmacists, and other medical professionals operate under tremendous
pressure and time constraints.
It is a complex problem which must be addressed with comprehensive
solutions and rigorous changes that will help providers better perform
their jobs and prevent medical errors from happening in the future. It
is a problem that is systemic, not personal.
Again, we must work together, in a bipartisan way, because all
Americans enjoy the right to be free from accidental injury, accidental
death, and medication-related errors when they need care.
Again, I thank my distinguished chairman for his leadership on this
issue, for putting this bill together. I am proud to be his chief
cosponsor.
In closing, this Congress now has an opportunity to join together to
address a problem that has the potential to impact the life of every
citizen who seeks health care. I hope all of my colleagues on both
sides of the aisle will join Senator Specter and me in supporting this
important legislation.
I yield the floor to my distinguished chairman.
Mr. SPECTER. I thank my distinguished colleague, Senator Harkin, for
his cosponsorship and his work on this very important piece of
legislation, coming principally out of the subcommittee which Senator
Harkin is the ranking Democrat and which I chair.
There are other Senators who are working on legislation arising out
of the Institute of Medicine report. There is no doubt that it is a
problem of enormous magnitude. It is a life-and-death matter. We have
taken the lead early to bring this legislation to the floor in the
hopes that this will stimulate other ideas, other legislative
proposals, so we may address this very serious issue.
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By Mr. HUTCHINSON:
S. 2039. A bill to amend the Consolidated Farm and Rural Development
Act to authorize the Secretary of Agriculture to provide emergency
loans to poultry producers to rebuild chicken houses destroyed by
disasters; to the Committee on Agriculture, Nutrition, and Forestry.
poultry farmer disaster relief act of 2000
Mr. HUTCHINSON. Mr. President, last month we had a very serious,
severe snow and ice storm in Arkansas. It brought life in Arkansas to a
halt. Schools and businesses closed, airports, including the Little
Rock Airport, were snowed in, and highways were littered with hundreds
of stranded motorists. It was not too unlike the situation we had in
the Nation's Capital, except it blanketed the entire State of Arkansas.
Fortunately, there were very few human fatalities that were reported,
but Arkansas's poultry farmers and the poultry industry suffered very
heavy losses. Snow and ice built up on poultry houses across the State,
and the sheer weight caused the roofs on almost 800 poultry houses to
collapse, killing an estimated 10.5 million chickens.
Dennis Richie, a poultry farmer in Nashville, AR, had six poultry
houses the morning of Thursday, January 27. By Friday evening, half of
his houses were destroyed, along with the income he needs to provide
for his family.
Hubert Hardin, another poultry farmer near Nashville, AR, and a
single parent, lost all of his poultry houses in the storm. That means
fewer options for him in supporting his family, his children.
The poultry industry is a pillar of Arkansas's agricultural industry
and one of my State's leading employers. These losses represent a very
real danger to my constituents and to Arkansas's economy. That is why,
today, I am introducing the Poultry Farmer Disaster Relief Act of 2000.
This bill would amend the Consolidated Farm and Rural Development Act
to allow a loosening of the restrictions currently in place for
emergency loans through FSA. It would allow active poultry producers
who were previously ineligible for insurance to apply for emergency
loans through FSA. The current law prohibits growers whose structures
were uninsured from receiving these low-interest loans. If the
individuals did not seek insurance and chose to risk not insuring their
structures, they would not qualify.
Under the bill I am introducing, these folks, who tried to get
insurance, tried to do the responsible thing, tried to do the right
thing and were unable to get insurance, would be allowed to qualify for
these low-interest loans. This act will also allow growers whose
structures were insured to apply for the same low-interest loans to
cover the difference between what the houses were insured for and the
cost of rebuilding their structures to current industry standards. It
is very important for them to be able to do that. The need for
upgrading poultry houses comes from the new regulations within the
industry. Many poultry producers must increase the size of their houses
and improve the safety of their facilities to meet these new
regulations.
Without the availability of these new low-interest loans to cover the
difference, FSA officials in Arkansas estimate almost half of the
growers who lost houses will not be able to rebuild, that is, half of
the poultry growers would be out of the business and unable to rebuild
unless we pass this legislation. Currently, the FSA requires those
seeking these emergency loans to prove they are unable to obtain
sufficient credit elsewhere before the loans are approved.
Due to the severity of the destruction and the impact it could have
on poultry producers throughout Arkansas, this bill waives that
requirement, should there be a disaster designation
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from the President. This would allow the victims of this storm to apply
for and receive aid in the most expeditious manner possible. Finally,
this bill would require farmers who receive these FSA loans to insure
the new structures.
Poultry farmers in Arkansas are critical to the survival of the
State's agricultural economy. Losses such as those suffered last month
not only create financial hardships for the growers, but dramatic
disruptions for poultry processors.
I ask my colleagues to look favorably upon this relief bill. The
poultry processors and growers in Arkansas and across this country
deserve that. It certainly is in an area where we had a natural
disaster that has affected literally thousands of individuals now in
the State. This is a compassionate act and something I trust we will
act upon in an expeditious manner.
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