[Congressional Record Volume 149, Number 41 (Thursday, March 13, 2003)]
[House]
[Pages H1817-H1829]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONSIDERATION OF H.R. 5, HELP EFFICIENT, ACCESSIBLE, LOW-
COST, TIMELY HEALTHCARE (HEALTH) ACT OF 2003
Mr. REYNOLDS. Mr. Speaker, by direction of the Committee on Rules, I
call up House Resolution 139 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 139
Resolved, That upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the bill (H.R. 5) to improve patient
access to health care services and provide improved medical
care by reducing the excessive burden the liability system
places on the health care delivery system. The bill shall be
considered as read for amendment. In lieu of the amendments
recommended by the Committees on the Judiciary and on Energy
and Commerce now printed in the bill, the amendment in the
nature of a substitute printed in the report of the Committee
on Rules accompanying this resolution shall be considered as
adopted. The previous question shall be considered as ordered
on the bill, as amended, to final passage without intervening
motion except: (1) two hours of debate on the bill, as
amended, with 80 minutes equally divided and controlled by
the chairman and ranking minority member of the Committee on
the Judiciary and 40 minutes equally divided and controlled
by the chairman and ranking minority member of the Committee
on Energy and Commerce; and (2) one motion to recommit with
or without instructions.
Sec. 2. House Resolution 126 is laid on the table.
The SPEAKER pro tempore (Mr. Thornberry). The gentleman from New York
(Mr. Reynolds) is recognized for 1 hour.
Mr. REYNOLDS. Mr. Speaker, for the purpose of debate only, I yield
the customary 30 minutes to the gentleman from Florida (Mr. Hastings),
pending which I yield myself such time as I may consume. During
consideration of this resolution, all time yielded is for the purpose
of debate only.
(Mr. REYNOLDS asked and was given permission to revise and extend his
remarks.)
Mr. REYNOLDS. Mr. Speaker, House Resolution 139 is a closed rule
providing 2 hours of debate for consideration of H.R. 5, Help
Efficient, Accessible, Low-cost, Timely Healthcare Act, more commonly
known as the HEALTH Act. The rule waives all points of order against
consideration of the bill and provides one motion to recommit with or
without instructions.
Mr. Speaker, my home State of New York has been designated by the
American Medical Association as one of the 18 crisis States because of
the staggering number of physicians that are unable to obtain or afford
liability insurance. It is not just physicians that are feeling the
crunch; hospitals and other providers have also reached their breaking
point.
Take, for example, family-run skilled nursing facilities in my
district that have not once had a claim brought against them, yet they
have seen their liability insurance rates climb over 200 percent during
the past 2 years alone. That is 200 percent in the last 2 years alone.
According to a study conducted by the American Hospital Association
and the American Society of Risk Management, one-third of the hospitals
experienced an increase of 100 percent or more in liability insurance
premiums in 2002. Meanwhile, patients are the ones losing choices,
access, and care.
Mr. Speaker, last September I stood on this floor to speak in favor
of the HEALTH Act. Since that time, my home community of Erie County,
New York, has lost 40 actively practicing physicians. Only 3 months
into the current year, they are anticipating a loss of another 20
physicians. If we do not solve the problems facing physicians in this
community and so many others across America, who will provide the
health care services so vital to all of our constituents?
The fact is that physicians are limiting their patients, moving to
States with lower insurance rates, or closing their practices
altogether. The fact is that astronomical costs and unpredictability in
the legal system are causing this alarming trend.
The effect? Doctors practice defensive medicine to avoid litigation
and think twice about openly discussing and reporting possible errors.
A study released by the Department of Health and Human Services last
week emphasizes that bolstering predictability in the legal system will
dramatically reduce the incentives for unnecessary lawsuits. Those who
need care will get it faster and more reliably, and those who may need
proper redress will get it faster and more reliably.
The HEALTH Act will provide that predictability, while at the same
time halting the exodus of providers from the health care industry,
stabilizing premiums, limiting astonishing attorney fees, and above
all, improving patient care.
[[Page H1818]]
Just as important is what HEALTH Act will not do. It will not preempt
any existing State laws that limit damages at a specific amount, and it
will not establish any new causes of action.
Also, it will not prevent juries from awarding unlimited economic
damages. This means that quantifiable lost wages, medical costs, pain-
reducing medications, therapy and lifetime rehabilitation can all be
recuperated as tangible economic damages. Patients that have been
wrongly injured will not be denied access to substantial amounts in
economic damages.
The HEALTH Act is modeled after legislation adopted by a Democratic
legislature and a Democratic Governor in the State of California nearly
30 years ago. While insurance premiums increased over 500 percent
nationwide, California's have risen only a third of that much, by 167
percent.
California's insurance market has stabilized, increasing patient
access to care and saving more than $1 billion per year in liability
premiums. Equally important, California doctors are not leaving the
State.
By following California's lead to place modest limits on unreasonable
economic damage awards, an estimated $60 billion to $108 billion could
be saved in health care costs each year. The Congressional Budget
Office calculated that medical liability insurance premiums would be
lowered an average 25 to 30 percent from what they are now under
current law. And CBO also predicts that reducing the occurrence of
defensive medicine would save anywhere from $25 billion to $44 billion
per year of taxpayers' money.
I want to thank the leadership of the Committee on Energy and
Commerce and the Committee on the Judiciary for working so
expeditiously to bring this important measure back to the floor and
focusing our attention on health care, particularly for coupling the
HEALTH Act this week with patient safety legislation. Physicians need
an environment where they can both share and learn, while at the same
time practicing medicine without the fear of burgeoning liability rates
and unnecessary lawsuits.
Mr. Speaker, spiraling medical liability insurance rates have
hemorrhaged in recent years. Today we have an opportunity to stop the
bleeding and maximize healthy patient outcomes. I urge Congress to
support this rule and the underlying legislation.
Mr. Speaker, I reserve the balance of my time.
Mr. HASTINGS of Florida. Mr. Speaker, I yield myself such time as I
may consume.
(Mr. HASTINGS of Florida asked and was given permission to revise and
extend his remarks.)
Mr. HASTINGS of Florida. Mr. Speaker, let me say to the gentleman
from New York (Mr. Reynolds) that the gentleman and I handled this
measure last fall when this bill was brought to the floor. It was a bad
bill then, and it is a bad bill now. I also want to clear up something
about so-called unnecessary lawsuits. There are penalties for lawyers
who bring frivolous claims into any courtroom; thus, I theorize that
the majority evidently does not understand that particular distinction.
Mr. Speaker, I rise today in strong opposition to this closed rule
for H.R. 5. This legislation requires a full and open debate. The
closed rule is abhorrent and cowardly. It denies the opportunity for
free and fruitful discussion that would uncover all this legislation's
deficiencies.
The current Committee on Rules chairman, the gentleman from
California (Mr. Dreier), said in 1994 when a Member of the minority,
and referring to the Democratic members of the Committee on Rules,
``But we should have a structure which allows Members to participate
more than they do now, and that it is again underscoring Lord Acton's
very famous line that power corrupts, and absolute power corrupts
absolutely. The arrogance of power with which they prevent Members,
rank-and-file Democrats and Republicans, from being able to offer
amendments, that is what really creates the outrage here.''
That was the gentleman from California (Mr. Dreier), and outrage
continues in the minority today. If the majority alleges that Democrats
were wrong in utilizing the closed rule when we were in the majority,
why not be the bigger party and end the practice? Why the political
games, or is it simply more fun to be principled when it is convenient?
There is no question that medical liability insurance rates are out
of control. Consequently, fine doctors, as well as other health care
providers, often do not properly attend to patients. However, the
underlying bill will not relieve doctors of high malpractice insurance
premiums. I am focused on giving Americans quality health care, as all
of my colleagues are, not increasing profits for the health insurance
industry; and there are good proposals to correct the situation. H.R. 5
is not one of them.
Instead of protecting patients, H.R. 5 protects HMOs and big
insurance companies. The so-called HEALTH Act of 2003 addresses the
health of the health care industry and not that of physicians and
patients. H.R. 5 is bad legislation; but like perennial flowers, its
contents sprout every Congress, replenishing the coffers of its
supporters. HMOs and big health insurers should not receive special
treatment. They are not above the law. Nor should they be exempt from
new legislation simply because they contributed millions of dollars in
the last two election cycles.
H.R. 5 applies to medical malpractice, medical products, nursing
homes, and health insurance claims because its supporters' true concern
is not the suffering of patients or victims. Instead, H.R. 5 advocates
want immunization from the consequences of irresponsible civil
behavior.
The top priority in reforming America's health care system should be
reducing the shameful number of preventable medical errors that kill
nearly 100,000 hospital patients a year.
Wrong-doers must remain accountable. When a stay-at-home mom dies or
a child dies or a senior citizen suffers irreparable harm, there is no
economic loss because it is impossible to prove damages from loss of
income. H.R. 5 takes away compensation for parents who lose children,
husbands who lose wives, children who lose parents, and patients who
lose limbs, eyesight and other very real losses that are not easily
measured in terms of money.
Despite a wide consensus, skyrocketing premiums are not due to bad
politics. The malpractice insurance market is having a predicament
because of the insurance industry. The other side of the aisle claims
that the lure of big wins prompts many to file frivolous lawsuits. But,
in fact, victims are already at a disadvantage. Two-thirds of patients
who file a claim do not get a dime. About 61 percent of cases are
dismissed or dropped, and 32 percent are settled; and too many of them
are on the courthouse steps when they could have been settled earlier.
Only 7 percent of all cases go to trial.
{time} 1030
Patients prevail in only one in five of the cases that are tried.
These are pretty staggering odds against the victims.
The American people would know these truths if their Representatives
could expose the selective use of data and statistics that the majority
uses in supporting H.R. 5. One classic example would be the notion that
in California, after 1975, premiums went down. Well, they did not go
down until California reformed the insurance laws. It did not go down.
It went up progressively for 12 years.
But under today's closed rule, the majority is committing the
greatest form of political malpractice. When the majority has finished
bullying its members into voting the party line today, the American
people will not only be barred from seeking compensation when a doctor
transplants an incorrect organ but they will realize that with closed
rules as the order of business, they cannot even seek compensation in
the People's House.
For example, if this bill were current law, no experienced trial
lawyer would take the case of the young Mexican girl who lost her life
at Duke University. The case would be complex, obviously, and expensive
to put on, there would be no economic damages, and the maximum
noneconomic award would be $250,000. H.R. 5 treats the health care
insurance businesses as the victims, and that is unacceptable.
The consequences of an injury are highly subjective and affect
different people in vastly different ways. Put another way, how much is
my arm worth? How much is your leg worth? This one-size-fits-all
solution contradicts the
[[Page H1819]]
promise of individualized justice and objectifies victims and the
uniqueness of their suffering. Different States have different
experiences with medical malpractice insurance and insurance remains a
largely State-regulated industry. The $250,000 cap that must have been
taken out of somebody's cap as a reason for going forward takes away
juries' abilities in our States to determine the appropriate level of
compensation for people who suffer grievous injuries at the hands of
their health care providers. The majority does not trust the people to
defend its political contributors.
Al Hunt of the Wall Street Journal quoted a Republican lawyer from
Houston as asking, ``Why are juries okay to take a man's life on the
criminal side but are not competent to put a dollar value on an
innocent victim's life on the civil side?'' That is shameful. H.R. 5 is
a health care immunity act that does not benefit physicians and
victimizes patients.
When Democrats were in the majority, Republicans complained time
after time that closed rules were unfair. On all of the radio
infrastructure, we heard closed rules were unfair, unpatriotic and
contrary to the goals of the framers. However, in more than 8 years
that Republicans have been in the majority, closed rules are preferred
and ruling with an iron fist is the practice. I am in strong opposition
to this closed rule and the underlying bill.
Mr. Speaker, I reserve the balance of my time.
Mr. REYNOLDS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the debate has begun. We are going to have an hour on
this rule. I believe after that we are going to have 2 hours of general
debate. It really cuts right down through the center. As I talked about
excessive court trial damage driving up the cost of patient health
care, I listened to the other side say it is the insurance companies
and the doctors that are the cause of so much of this. It will be a
good debate. It will be a full hour here on this rule and it will be 2
hours of general debate, and then we are going to have an up or down on
the HEALTH Act and we are going to find out whether it is passed and
sent to the other body.
But I must say that over 60 percent of the doctors in the United
States are insured by insurance companies that are owned and operated
by other doctors and which operate primarily for their benefit. The
idea that those companies would price-gouge the very physicians who own
them, I think, is absurd.
Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr.
Weldon).
Mr. WELDON of Florida. I thank the gentleman for yielding me this
time.
Mr. Speaker, I practiced defensive medicine for 15 years before I was
elected to Congress. Defensive medicine is extremely costly. The way it
works is very simple. The patient comes in. You think the patient has
something. And then you think of all the other things that it could be
and how you could be sued if you missed those things, so you order more
and more tests. You may say, well, this is just one doctor speaking
anecdotally, but actually this very issue was studied scientifically in
California. They looked at the reforms put in place in California and
its impact on charges in the Medicare plan. They discovered that over
time after the cap on damages went into place and the threat of very,
very excessive damages went away that charges for two diagnostic codes,
the two codes they looked at were unstable angina and myocardial
infarction, went down and there was no increase in morbidity and
mortality. In other words, quality was maintained while charges went
down.
This study was published in 1995 in the Journal of Economics. It was
done by economics professors at Stanford University. They argued that
the high cost of litigation cost the Medicare plan billions of dollars
a year in unnecessary procedures and tests. They further went on to say
that it cost, in 1995 dollars, our health care system $50 billion a
year. Today that figure is estimated at over $100 billion a year.
Mr. Speaker, this is not just an issue of access. We are going to
hear about access from the gentleman from Florida (Mr. Keller). He is
going to talk about the trauma facility in Orlando, Florida, being
closed down because of this problem. This is not just an issue of high
cost. This is an issue of the uninsured. As the costs go up because of
the high cost of litigation, more and more people are pushed out of the
insured market into the uninsured category. We all say here that we
care about the uninsured, the people who cannot afford health care, but
this is impacting them. This is impacting our competitiveness in the
global marketplace because all these costs of litigation get
transferred into the costs of health care that get transferred into the
costs of our products and services as we compete in the global
marketplace.
If we pass this bill and if the other body passes it, the President
has said he would sign it, it is going to allow more people to get
access to health care, it is going to reduce our costs through the
Medicare plan, and we may ultimately be able to better afford more
services through Medicare like prescription drugs. And, yes, it will
help our businesses and industries to be more competitive in the global
marketplace.
This is a good rule, it is a fair rule, and this is an extremely
important bill. I encourage all my colleagues to vote ``yes.''
Mr. HASTINGS of Florida. Mr. Speaker, I yield myself 30 seconds.
In response to my good friend and colleague regarding the fairness
and openness and the 1 hour of debate, 31 amendments were offered last
night in the Committee on Rules and my good friend the gentleman from
New York (Mr. Reynolds) and I were there. Not one, not one, was
permitted. What is fair about that?
In response to Dr. Weldon's defensive medicine argument, some people
claim that billions of dollars are being wasted on so-called defensive
medicine. Our own Congressional Budget Office has concluded that the
idea of defensive medicine is uncertain and hypothetical. You can find
that on page 74 of House Report 108-32.
Mr. Speaker, I yield such time as he may consume to the gentleman
from Texas (Mr. Frost), the distinguished ranking member of the
Committee on Rules.
(Mr. FROST asked and was given permission to revise and extend his
remarks.)
Mr. FROST. I thank the gentleman for yielding me this time.
Mr. Speaker, we all agree that there is a problem in America's
medical system, but Republicans are not taking a serious approach to
this problem. They are just playing politics and risking the rights of
patients in order to carry water for HMOs and insurance companies. We
know this, Mr. Speaker, because Republican leaders have brought this
bill to the floor under a closed rule.
Now, on this very important subject, let me quote from a statement
made 9 years ago by the distinguished chairman of the Committee on
Rules, the gentleman from California (Mr. Dreier), at a time that he
was in the minority. He said, and I quote, ``I oppose closed rules, Mr.
Speaker. I believe they are anathema to the concept of deliberative
democracy.''
Mr. Speaker, if Republicans wanted to deal with medical malpractice
in a serious and substantive way, would they be using a process that
is, as the gentleman from California himself said, anathema to the
concept of deliberative democracy? I do not think so. And would they be
preventing the House from voting on Democrats' comprehensive medical
malpractice reform plan? Certainly not. But that is exactly what
Republican leaders are doing today. As a result, the only bill made in
order by this rule today is the Republican one and it is a shocking
attempt to protect insurance companies while attacking the rights of
victims.
Make no mistake, Mr. Speaker, the Republican bill will not reduce
doctors' premiums, but it will protect HMOs and insurance companies,
and it will punish patients who suffer from medical mistakes, patients
like 17-year-old Jesica Santillan, who died because of a tragic medical
mistake in North Carolina earlier this year. Or patients like the 1-
year-old baby who died in Dallas last August after a surgical error.
That is right, Mr. Speaker. Instead of reducing malpractice premiums,
Republicans are reducing victims' rights. Instead of protecting
patients, they are protecting the profits of HMOs and insurance
companies. It is absolutely
[[Page H1820]]
outrageous, but that is what you get with this Republican Congress.
It did not have to be that way, Mr. Speaker. Democrats, led by the
two most senior Members of the House, the gentleman from Michigan (Mr.
Dingell) and the gentleman from Michigan (Mr. Conyers), offered a
comprehensive plan to bring down doctors' insurance rates and protect
patients. The Democratic plan combines tort reform and insurance
reform. It cracks down on frivolous lawsuits. And, just as importantly,
it forces insurance companies to pass on their savings to doctors.
Without this rate rollback provision, Mr. Speaker, insurance companies
can just pad their profit margins instead of passing the savings on.
That is a lesson we learned in Texas when we passed tort reform. So the
Texas legislature and then-Governor Bush agreed on a law that
specifically required that insurance companies reduce doctors'
premiums, and that is all we are trying to do here. But Republican
leaders decided to protect insurance company profits while they were
reducing patient protections. So they defeated our amendments in the
Committee on Rules last night.
Mr. Speaker, doctors and patients deserve better than this. So I urge
my colleagues to defeat the previous question. Then we can amend the
rule to bring up the only comprehensive plan to reform medical
malpractice, the Democratic substitute. And if Republicans succeed in
passing this rule, I urge a ``no'' vote on the underlying bill. Do not
let Republicans sacrifice victims' rights in order to protect HMO
profits.
I would make one other point. Last night in the Committee on Rules
when challenged by the gentleman from Michigan (Mr. Dingell), the
gentleman from California (Mr. Dreier), the chairman of the committee,
explained why the committee was not going to grant an open rule, why
they were going to grant a closed rule. What he said was, ``This is
payback. This is payback for what you did when you were in the
majority.''
Mr. DREIER. Mr. Speaker, will the gentleman yield?
Mr. FROST. I yield to the gentleman from California.
Mr. DREIER. I thank my friend for yielding. Would the gentleman state
the quote again that I said? I did not hear it correctly.
Mr. FROST. Mr. Speaker, I was sitting next to the gentleman from
California, and I believe that I heard him say that this was payback.
Mr. DREIER. I never said anything of the kind.
Mr. FROST. Mr. Chairman, I was sitting right next to you.
Mr. DREIER. I never said anything of the kind. I just would like the
record to show that, Mr. Speaker.
I thank my friend for yielding.
Mr. FROST. All I can say is I was sitting next to the gentleman. I
understand and I know what I heard last night.
Mr. Speaker, assuming that the Republicans are pursuing some sort of
payback because they do not like what we did when we were in the
majority, I would only point out that we rarely granted closed rules,
and they normally were bills out of the Committee on Ways and Means.
Bills of this nature, of this controversy, when we were in the
majority, we permitted the minority to have a substitute on the floor,
something which they have denied us today.
Mr. REYNOLDS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I have only served under the distinguished chairmanship
of Chairman Dreier, but I am always pleased that in each rule that we
make there is always a recommit. Looking back at history, one of the
people that I think was a distinguished chairman of the Committee on
Rules, Joe Moakley, I am not sure he always had a recommit in the
legislation. I am not sure that former Speaker Tip O'Neill when he was
a member of the Committee on Rules always voted that there would be a
recommit. But I do believe that there has been a recommit in here. More
importantly, I think it is important that this legislation was
thoroughly vetted in two committees, the Committee on Energy and
Commerce and the Committee on the Judiciary, and even passed by voice
vote in the Committee on the Judiciary. Just weeks ago these same
committees once again took testimony and the bill passed through the
Committee on Energy and Commerce by voice vote.
{time} 1045
The Committee on Rules last night took testimony for over 2 hours and
reasonably provided 2 hours of general debate, in addition to the
standard motion to recommit, and I believe we will have a full hour on
this rule today.
Mr. Speaker, I yield 3 minutes to the gentleman from Kentucky (Mr.
Fletcher). The gentleman, a doctor, is an expert in this legislation.
Mr. FLETCHER. Mr. Speaker, I will have to say it is rather amazing
that when the minority is wrong on policy, they focus on process.
Mr. Speaker, as a family physician, I have always tried to do what is
best for patients, and as a Member of Congress I still try to do what
is best for patients in Kentucky and all across America.
Mr. HOYER. Mr. Speaker, will the gentleman yield on that point?
Mr. FLETCHER. Not at this time. I have 3 minutes.
Mr. HOYER. We yielded on our side.
Mr. FLETCHER. Mr. Speaker, what is best for the patient? I believe
that unlimited medical liability awards are bad for patients, because
they cause malpractice insurance prices to climb, resulting in more
expensive care, fewer doctors, and problems obtaining access to needed
care.
H.R. 5, the HEALTH Act of 2003, actually ensures fair compensation
for everyone. We need to keep in mind that everyone is entitled to full
compensation for their losses, medical bills and wages under H.R. 5.
It is not unusual to hear stories of doctors moving from Kentucky to
Indiana, where they have enacted comprehensive liability reform, to
take advantage of lower costs of medical liability insurance.
Passing the HEALTH Act, which reasonably reforms our liability
system, will hold premiums at a lower, more predictable rate. That will
ensure patients are not left without their local physician, who may be
otherwise driven out of their practice. And to say that this bill will
not reduce frivolous lawsuits and reduce malpractice premiums is truly
laughable. Lawsuits do not prevent injuries, they do not reduce medical
errors, but they do create an atmosphere of fear, defensiveness and
distrust in the doctor-patient relationship.
In fact, a recent study estimated that defensive medicine cost $163
per person per year in Kentucky. That means Kentucky spends about $655
million on unnecessary care due to fear of litigation.
Let me give you specific examples, too. Blue Grass Orthopedic Group
in my district has never lost any of the handful of claims filed
against its eight doctors. Yet their premiums, which were $222,000 last
year, shot up to $635,000, nearly tripling in a single year. Why?
Because personal injury lawyers, hoping to hit the jackpot, file
frivolous lawsuits.
More than 70 percent of Kentucky physicians say their medical
liability insurance premiums increased in 2002. Emergency physicians
saw increases greater than 200 percent, general surgeons and
orthopedists saw increases between 87 and 122 percent, and
obstetricians and internists saw increases between 40 and 64 percent.
Several saw several hundred percent increases in their premiums. In
other words, this is just unsustainable.
It is estimated that for every obstetrician that leaves a practice in
Kentucky, 140 women are left without their physician. That means that
women during prenatal care will have to drive an extra 30 or 50 minutes
to see a doctor. That also means during labor if that unborn child is
in fetal distress, there is an extra 30 minutes of fetal distress,
which could blankly rob that child of all their hopes and future of
what they potentially could be.
As a family physician, I took an oath to do no harm. The only bill
today that will help physicians keep that oath is one that ensures safe
and timely access to care through reasonable, comprehensive and
effective health care liability reform, and that is H.R. 5. I urge my
colleagues to support this rule and vote yes on H.R. 5.
Mr. HASTINGS of Florida. Mr. Speaker, I yield myself 10 seconds.
Mr. Speaker, there is a recent study reported in USA Today of medical
malpractice insurance that concluded that,
[[Page H1821]]
on average, doctors still spend less on malpractice insurance, 3.2
percent of their revenue, than on rent. I offer that for the gentleman
from Kentucky (Mr. Fletcher).
Mr. Speaker, I yield 3 minutes to my good friend, the gentleman from
Maryland (Mr. Hoyer), the distinguished Democratic whip.
Mr. HOYER. Mr. Speaker, I thank the gentleman for yielding.
I want to say to my friend from Kentucky, who says that we rise to
focus on process, I tell my friend from Kentucky there is a reason for
that, because your Committee on Rules does not have the courage to
allow us to debate substance. It does not have the courage to allow us
to offer a substitute and amendments to your bill so that we could
discuss substance. Have courage on your side, that substance is what
ought to be at risk here. We are prepared to debate it. Allow us to do
so.
Mr. Speaker, once again today the Republican leadership is employing
outrageous tactics that trample the rights of the minority and rig the
rules of this debate.
Mr. FLETCHER. Mr. Speaker, will the gentleman yield?
Mr. HOYER. As long as the gentleman yielded to me.
Mr. Speaker, these tactics demean the People's House. Hear me. Hear
me. These tactics demean the People's House, demean democracy, demean
freedom, and they fly in the face of commitments by Republicans when
they regained the majority to run an open and deliberative process.
These comments are on the record. Here is how Gerald Solomon, the
former Republican Chair of the Committee on Rules, explained it in
November of 1994 when you were just about to take power. This is a
quote, on the record:
``The guiding principles will be openness and fairness. The Rules
Committee will no longer rig the procedure to contrive a predetermined
outcome. From now on,'' the Republicans said, ``the Rules Committee
will clear the stage for debate and let the House work its will.''
The year before, Congressman Solomon remarked, ``Every time we deny
an open amendment process on an important piece of legislation, we are
disenfranchising the people and their representatives from the
legislative process.''
Mr. Speaker, this side of the aisle represents at least 140 million
people. This side of the aisle represents 140 million Americans, and
you have shut them up today, and you shut them up last week, and you
may be considering shutting us up next week. Not 204 or 205 Democrats,
but 140 million Americans.
I submit that this is precisely what we are doing today under this
closed rule, which is what Mr. Solomon said you would not do. But you
do it this day, and you demean this House.
I would say to the gentleman from Kentucky (Mr. Fletcher), yes, that
is why we talk about process, because we want to show why we are not
serving doctors this day; why in State after State after State that
have capped recovery premiums have not gone down. Doctors will not be
served by this legislation you offer, and you will not allow us an
amendment to do something that will protect doctors, that will protect
patients, that will protect injured people.
This is a travesty of democracy, and it is a travesty for people who
are injured severely by the negligence of others.
Vote against the previous question, vote against this bill, vote for
fairness and equity in this House.
Mr. REYNOLDS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, we are going to continue on the debate of the issue of
the day, which is medical liability. I must tell you, while I guess it
is important to listen to some of the process, and half of this debate
by the leadership of our House is on the process, I am hoping that we
can continue to hear the debate that was at least opened by myself and
my good friend from Florida who has a different view.
I look at it that we need to helm doctors and patients, and to make
sure we can control the costs of malpractice insurance. I have listened
to some of the debate on the other side that it is the doctors and
insurance companies that are at fault.
It is an important debate. This is a debate that was heard 7 months
ago in both the Committee on the Judiciary and the Committee on Energy
and Commerce. The Committee on the Judiciary voted by voice vote to put
the bill out. Only recently we have had those hearings again in the
Committee on Energy and Commerce and the Committee on the Judiciary,
and, in a bipartisan fashion, it was passed by a voice vote there.
Last night we took 2 hours of testimony. The Committee on Rules
responded with a 2-hour debate, plus what will be a full hour of the
resolution, now going forward here on the rule itself.
I look forward to the debate, I look forward to hearing it, and then
I look forward to voting up or down on whether we are going to help
patients or not.
Mr. Speaker, I yield 2 minutes to the gentlewoman from West Virginia
(Mrs. Capito).
Mrs. CAPITO. Mr. Speaker, I would indeed like to debate the issue, I
would like you all to live in my State of West Virginia over the last
year. Our Trauma I Medical Center in the State's Capital, Charleston,
West Virginia, closed. No specialist. It was reopened, but it was
closed for 2 or 3 months.
In September of 2002, a young boy who had something lodged in his
windpipe, his parents had to drive him 4 hours to get a specialist in
Cincinnati, Ohio. Thank goodness it had a good ending, but it might not
have.
In January, a group of Wheeling surgeons left the emergency room to
illustrate the deep and devastating problem that West Virginia doctors
are suffering with the high cost of medical liability. And, guess what
happened? Our State legislature, which is predominantly Democrat, in
probably the largest way of any State legislature, we have a Democratic
Governor, they passed and signed the day before yesterday a medical
liability bill that does in fact have caps on non-economic damages.
Because, you know what? When your grandmother, when your mother, when
your husband or wife cannot find medical care at a trauma center,
cannot find an OB/GYN, when their general practitioner leaves to go to
California, North Carolina, Georgia, that is a human problem. That is a
health problem.
So the answer to this is the legislation that we are going to pass
today. I proudly voted for it last year. I think it will help not only
my State of West Virginia, but it will help every State in the Union.
We cannot retain and recruit physicians in the State of West Virginia
because of this problem. We have had a brain drain because our older
physicians are leaving, they are practicing defensive medicine, and
they are afraid of the lawsuits that are pending in front of them.
Sixty-three percent of them say they considered moving to another
State, 41 percent are considering retiring early, and 30 percent are
considering leaving the practice of medicine altogether.
Mr. Speaker, this is a devastating problem. Come to West Virginia and
see. It is a quality of life issue, it is an economic issue.
Today I join with my colleagues to vote for H.R. 5, and I will be
extremely happy to see national legislation.
Mr. HASTINGS of Florida. Mr. Speaker, I am pleased to yield 2\1/4\
minutes to my good friend, the gentlewoman from New York (Ms.
Slaughter), who is an expert in this area, with a Master's of Public
Health.
Ms. SLAUGHTER. Mr. Speaker, I thank the gentleman for yielding me
time.
Mr. Speaker, this is one of the debates that has gone on for many
years and it has always been characterized as a debate between
physicians and lawyers, leaving out one of the major players in all of
these problems, the insurance industry.
This health care act is wrongly named. It is the wrong prescription
for curing any malady in medical malpractice insurance. The proponents
want to claim jury awards for rising insurance premiums. But a study by
Americans for Insurance Reform reported that rising insurance premiums
are not tied to jury awards.
Let me for a moment talk about how an insurance company meets a
lawsuit that is filed against it. The money that is asked for in that
bill is set aside in a separate pot of money as though they
[[Page H1822]]
had lost the suit. Of course, only about one of nine of those cases is
ever brought to court, but that large pot of money still exists over
there for the insurance company, on which they pay a very low rate of
taxes. They should be a major player here.
Wait until your doctors hear back home that what we have done here
today, because I am sure it is going to pass, will not do a thing in
the world about lowering their insurance premiums. There is no mention
in here that insurance companies of any sort will have to give back
money to the physicians or to lower their rates. They are probably not
going to give up anything out of that large pot they have had all of
these years, and which we have no right, because the Federal Government
has no oversight over insurance, to see what is there.
One of the most egregious things in this legislation and this debate
is we have been told over and over that 5 percent of the physicians in
the United States are responsible for more than 55 percent of the
lawsuits. Would you not think that the sensible thing to do would be to
get rid of that 5 percent? If this law passes, the 5 percent still
continued to create malpractice, have bad outcomes on their patients.
The only difference after this bill is passed is that patients will
have no recourse at all.
{time} 1100
The caps are really extensive. There is no recourse. And in addition,
one more thing I would say. Not only are the insurance companies
protected, but also the people who manufacture medical devices, HMOs,
and pharmaceutical companies. It is very far-reaching and will do
nothing to lower premiums.
Mr. REYNOLDS. Mr. Speaker, I yield 2 minutes to the gentleman from
Florida (Mr. Keller).
(Mr. KELLER asked and was given permission to revise and extend his
remarks, and include extraneous material.)
Mr. KELLER. Mr. Speaker, I thank the gentleman for yielding me this
time.
Mr. Speaker, I rise today in strong support of H.R. 5, because there
is absolutely a medical liability crisis in Florida which will, among
other things, result in patients in Orlando with severe head injuries
not having access to a doctor. Let me give one example of the crisis.
The Orlando Regional Medical Center is a large hospital located in
the heart of my district in Orlando, Florida. It is home to the only
level-1 trauma center in the central Florida area. It specializes in
treating patients with severe head injuries. The trauma center was
praised last month by the State of Florida as delivering patient care
that is ``above and beyond'' that of other level-1 trauma centers. I
personally toured this trauma center, and I can tell my colleagues it
is a source of pride for many central Floridians.
Last week, Orlando Regional Medical Center announced that they were
closing in April 2003 because the neurosurgeons in the Orlando area can
no longer afford skyrocketing medical liability insurance premiums.
Now, how bad is the situation? Dr. Jonathan Greenberg, the chairman
of the Department of Neurosurgery at ORMC, personally told me that the
malpractice insurance premiums have risen five-fold over the past 2
years from $55,000 a year to $256,000 a year.
We do not have to guess what the consequences are when this sort of
facility is closed down. Just last week, Mrs. Leanne Dyess testified
before our Committee on the Judiciary. Her husband suffered one of
these severe head injuries in a car accident. There were no longer any
neurosurgeons in the area because they could not afford the liability
insurance. As a result, it took 6 hours to airlift Mr. Dyess to a
different location. It was too late. Mr. Dyess is now permanently brain
damaged. He is unable to talk, unable to work, unable to provide for
his family.
We must bring common sense back to the health care system so that
patients with severe head injuries have access to trauma centers. We
should care about each other more and sue each other less.
I ask my colleagues to vote ``yes'' on H.R. 5 and the rule. I will
also include in the Record an article dated March 11, 2003 from Dr.
Greenberg and published in the Orlando Sentinel.
[From the Orlando Sentinel, Mar. 11, 2003]
Neurosurgeon: Save Trauma Center
(By Jonathan Greenberg, M.D.)
A human tragedy of immense proportions is unfolding in
Central Florida, and my neurosurgical colleagues and I have
been unable to prevent it.
Less than two weeks after a state trauma-site review lauded
Orlando Regional Medical Center's Level I trauma center for
its high level of patient care and dedication ``above and
beyond'' that at other Level I centers, the ORMC
administration was compelled to inform the state that it will
go off-line as an adult Level I trauma center as of April 1
because of the lack of neurosurgical coverage.
Seven neurosurgeons resigned from the ORMC medical staff,
citing the physical stress of on-call requirements, medical
malpractice-insurance premiums, increased liability exposure
in treating trauma patients and the adverse impact that on-
call coverage has had on their private practices.
I cannot fault my neurosurgical colleagues for having taken
this action. They have complained that they were being
charged significantly increased malpractice-insurance
premiums--or were going to be denied malpractice insurance
altogether--for the privilege of getting up in the middle of
the night to take care of critically ill head and spine-
injured patients.
Three neurosurgeons have closed their practices and left
the community. Trying to replace them has been almost
impossible. What sane physician would move to a state known
to be in the throes of a ``medical malpractice-insurance
crisis,'' where insurance is either unobtainable or
exorbitantly priced, and where there is a constant threat of
frivolous but nonetheless disruptive lawsuits?
ORMC has lobbied vigorously for relief; we have
demonstrated to increase public awareness and spoken with
state representatives.
For those who denied that there was a ``physician drain''
or a problem with the tort system, who asserted that this was
only an insurance-industry, stock-market-cyclical financial
problem, who ignored the looming crisis, the end results of
denial, deception, apathy and procrastination are clear.
As of April 1, Central Florida will have lost one of its
most precious assets, the ORMC Level I trauma center. There
will not be enough neurosurgeons left to fully man the on-
call schedule.
We know that in the past many patients survived their
injuries because they were brought to ORMC; they would not
have survived elsewhere. After April 1, similarly injured
patients may not survive. I am profoundly saddened by this
prospect.
It will take more than an act of God to avert this
catastrophe. It will take responsible action by the governor,
the state Legislature, and county and regional leaders. Band-
Aid solutions will not save a health-care system that is
exsanguinating. ORMC has the only Level I trauma center in
the state without sovereign immunity. Relief from predatory
lawsuits and unaffordable insurance premiums and adequate
compensation for extraordinary medical care will be
necessary.
Mr. HASTINGS of Florida. Mr. Speaker, would the Chair announce the
remaining time on both sides, please?
The SPEAKER pro tempore (Mr. Thornberry). The gentleman from Florida
(Mr. Hastings) has 10\1/4\ minutes remaining; the gentleman from New
York (Mr. Reynolds) has 10\1/2\ minutes remaining.
Mr. HASTINGS of Florida. Mr. Speaker, I am pleased and privileged to
yield 3 minutes to my good friend, the gentleman from Michigan (Mr.
Dingell), the dean of the House, who I think can speak to both
substance and process.
(Mr. DINGELL asked and was given permission to revise and extend his
remarks.)
Mr. DINGELL. Mr. Speaker, I say to my colleagues, vote down this
iniquitous rule. It is unfair. It is demeaning. It strikes at the heart
of the parliamentary practices that are the proud tradition of this
body. It also tears at the throat of honorable and open and fair
debate. It denies every Member, not just Democrats, the right to offer
amendments to the bill. Mr. Speaker, 31 amendments were requested of
the Committee on Rules last night; not a one was given. A substitute
was given.
The chairman of the committee talks of the need to have a fair and
open process. Well, we do not have a fair and open process. Therefore,
vote down the rule, vote down the previous question. It is an outrage,
and it is inconsistent with the tradition and practices of the House.
I would point out that in the rules, rule XVI, clause 6 begins,
``When an amendable proposition is under consideration, a motion to
amend and a motion to amend that amendment shall be in order.'' It is
in the rules. The Committee on Rules should read it.
We are not discussing the substance of the legislation. We hope to
have a fair chance to do so. We hope to have a
[[Page H1823]]
fair chance to amend the basic proposition before this body. The
Committee on Rules has not given it to us.
I went before the Committee last night and I asked, am I wasting my
time and am I wasting your time by being here? The answer is, I was. I
was not told that I was, but the simple fact of the matter was the
decision had already been made. The process had already been carefully
cooked so that no opportunity to amend the bill is before this body at
this time.
We can talk about what it is that is wrong with this legislation and
how the amendments would improve it. That is really not important. What
is important is that the basic rights of the Members of this body, the
basic prerogatives of the institution to perfect legislation before it
has been denied by the majority, functioning through the organism of
the Committee on Rules.
In 14 years as the chairman of the Committee on Commerce, never once
did I go before the Committee on Rules to ask for anything other than
an open rule so that all Members might have a fair chance to
participate in the debate on the legislation and to offer amendments as
the need would require, no matter how complex or controversial the
legislation was. That is the way this institution should work.
This rule demeans this body. It demeans every Member here, and it
demeans the Committee on Rules and those who have inflicted this
outrage upon this body.
I say again, vote this rule down. It is wrong. It is arrogant. It is
without justification. I note that it comes up on a day when this is
the last item of business of the week and when this is the last item of
business that will be done. Let us vote it down, and let us then go
about the business of conducting the business of the House in a fashion
which is consistent with the traditions of this great democratic
institution.
Mr. REYNOLDS. Mr. Speaker, I yield 3 minutes to the distinguished
gentleman from California (Mr. Dreier), the chairman of the Committee
on Rules.
(Mr. DREIER asked and was given permission to revise and extend his
remarks.)
Mr. DREIER. Mr. Speaker, it is a great honor to be a Member of this
institution, and it is an honor for me to have the opportunity to
follow my very good friend, the gentleman from Michigan (Mr. Dingell),
the dean of the House.
As we have listened to the arguments that have been provided about
the rights of the minority, I have to say that while the gentleman from
Michigan (Mr. Dingell) served for 14 years as chairman of the Committee
on Commerce, I served for 14 years as a member of the minority in this
institution. When we won the majority in 1994, I felt very strongly
about something that had existed under the democratic rule in this
place for 4 uninterrupted decades. I felt strongly about ensuring that
the minority had the right to come forward with at least an
opportunity, through an amendment and a motion to recommit, which was
denied us on many occasions.
Now, last night when we had the testimony in the Committee on Rules,
the gentleman from Michigan (Mr. Dingell) told me that he came here in
1955, and our good friend, the gentleman from Michigan (Mr. Conyers)
came here in 1965, and they had never known of any instance whatsoever
when the Democrats had denied the Republican minority the opportunity
to consider at least an opportunity to amend through a recommittal
motion.
I have to say that I have the greatest respect for the gentleman from
Michigan (Mr. Dingell), my friend; but I have a list right here of in
the 100th Congress, 16 examples of where this was denied.
Now, this issue of payback has come up. Well, so is this payback now
that we are imposing on the minority? Absolutely not. Because when we
passed our opening day rules package, having served 14 years in the
minority, I was very sensitive to make sure that we would guarantee the
minority that right to offer a motion to recommit with an amendment,
and that is exactly what is going to exist under this process.
Now, I believe that we should have as open and as fair a process as
we can, and I stand here continuing to be committed to our goal of
ensuring that the minority does have as many rights as possible, and I
will continue to fight in behalf of that, because I believe in the
Madisonian spirit of minority rights.
I also know that we have a responsibility to move our agenda. And we
are doing that, while guaranteeing these minority rights.
Now, when we opened this process last night, I am very happy that my
friend, the gentleman from Florida (Mr. Hastings), began by talking
about the fact that we did meet his request to provide 2 hours. There
will be a debate. There will be an opportunity for Members to voice
their concern, regardless of what side of this issue they are on. I
happen to think that it is very important for us to also recognize that
the Committee on the Judiciary and the Committee on Energy and Commerce
both had full markups with the exchange of ideas, and the people who
have stood up to speak against this rule are people who in fact offered
amendments through the committee process. The committee process has
worked very effectively here.
We have come together with a package which I believe, through both
committees, can, in fact, have an opportunity to be heard; and I urge
my colleagues to vote in support of this rule and for the underlying
legislation.
Mr. HASTINGS of Florida. Mr. Speaker, I would remind the
distinguished chairman, my friend, that we did have 31 amendments last
night; none of them have been allowed to come to the floor.
Mr. DREIER. Mr. Speaker, I thank the gentleman for reminding me.
Mr. HASTINGS of Florida. Mr. Speaker, I yield 1\1/2\ minutes to the
gentleman from Virginia (Mr. Scott), my very good friend.
(Mr. SCOTT of Virginia asked and was given permission to revise and
extend his remarks and include extraneous material.)
Mr. SCOTT of Virginia. Mr. Speaker, this closed rule does a
disservice to the legislative process. Medical malpractice is a very
complicated issue, there are many different provisions, and we cannot
possibly debate each one with a closed rule. The fact is that one-half
of the medical malpractice premiums represent \1/2\ of 1 percent of
health care costs, and those costs have been going up at the same rate
of health care inflation. California had medical malpractice reform,
but the rates did not go down until there was insurance reform.
This bill does nothing to eliminate frivolous lawsuits, but it makes
the bona fide lawsuits even more difficult to bring. The elimination of
joint and several liability means that you have to chase each and every
doctor for each and every portion of their liability. The young Mexican
girl with the transplant, one would have to prove a separate case
against each and every company, the transplant company, the hospital,
and everybody else before she could get anything. She would probably
use up the whole $250,000 cap before she could get anything.
The collateral source rule will shift the cost of malpractice onto
the employer. If one has a self-insured employer, if one of their
employees gets put in a malpractice-induced coma, the employer will
have to pay the bill. This bill prohibits subrogation so that the
employer cannot get the money back; the malpractice insurance company
will not have to pay that hospital bill.
Mr. Speaker, we need to debate that and discuss it; but we cannot,
because it is a closed rule.
I hereby attach to my statement, the additional dissenting views I
offered to the Judiciary Committee report on H.R. 5.
Additional Dissenting Views
In addition to the dissenting views, I would add the
following:
1. In addition to the comments on the bill's elimination of
joint and several liability, I would add that this new burden
on the plaintiff is administratively unfair to the plaintiff.
The apportionment of malpractice responsibility is routinely
made in the health care field by apportionment of insurance
coverage. Health care providers can and do decide in advance
who will pay for what coverage. The plaintiff, on the other
hand, is not in a position to apportion damages, because the
plaintiff often has no idea what happened, much less who was
responsible. The entire concept of res ipsa loquitur is based
on the fact that some cases are so obviously the result of
malpractice that the general burden of proof is eased for
such victims. With the elimination of joint and several
liability, and without knowing exactly what
[[Page H1824]]
happened, the plaintiff will have to make a separate case,
including establishing a standard of care, violation of that
standard and proximate cause for each conceivable participant
in his care and always have the possibility of defendants
pointing to an ``empty chair'' or an insolvent defendant at
the trial. This burden comes with the costs of expert
witnesses for each doctor, nurse and hospital even minimally
involved in the most egregious and obvious cases. As the
dissent mentions, any defendant can always seek contribution
without the elimination of joint and several liability.
2. In addition to the comments in the dissent on the
collateral source rule, I would add that there are three
interested parties: the plaintiff, the health care insurance
company and the defendant. Good arguments can be made for the
plaintiff to benefit from the provisions he has made to pay
his bills. Some may have saved money over the years,
including a medical savings account, and others may have paid
for insurance. Those persons who have invested in insurance
should be able to benefit from their thrift. If one is not
persuaded by that argument, and is offended by the plaintiff
``being paid twice'' for the same bill, then one could
reasonably say that the health insurance carrier should be
able to get its money back through subrogation, and charge a
smaller premium based on the anticipation that some of their
claims will not ultimately have to be paid, because a
tortfeasor will be responsible. The last person of interest
who should benefit from the plaintiff's insurance should be
the tortfeasor. In fact the prohibition against subrogation
in the bill creates the bizarre situation in which a self-
insured small business could have an employee in a
malpractice induced coma, and have to pay all of the hospital
bills, notwithstanding the fact that the negligent doctor is
fully insured.
3. Finally, one of the reasons why the ``average''
malpractice award is increasing is because smaller cases are
not brought. The complexity of the cases makes it impossible
to hire an attorney if the award is too small to generate a
meaningful attorney's fee. This ``average'' will undoubtedly
increase if this bill is enacted because of limitations on
damages, limitations on attorney's fees, elimination of joint
and several liability and elimination of collateral sources.
A better measure of the impact malpractice litigation has on
the health care system is the fact that all malpractice
awards and settlements have been approximately \1/2\ of 1
percent of the national health care costs and have been
recently increasing at the same rate as the health care costs
generally.
Robert C. Scott.
Mr. REYNOLDS. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Ohio (Ms. Pryce), a member of the Committee on Rules and Chair of the
Republican Conference.
Ms. PRYCE of Ohio. Mr. Speaker, I thank the gentleman for yielding me
this time.
Mr. Speaker, my home State of Ohio is one of a dozen States that is
facing a real crisis in health care. Simply put, doctors are leaving
and patients are suffering. One by one, facilities are closing their
doors, retiring early, and not performing various procedures because,
simply put, they cannot afford the insurance. The result is a pending
perfect storm, where all of the converging factors meet to create utter
and total chaos.
Among Ohio physicians surveyed last year, 96 percent expressed
serious concerns about the impact of rising liability insurance.
Seventy-two percent in high-risk specialties said insurance premiums
have affected their willingness to perform procedures, and 34 percent
have admitted that they have to order more tests, perform more
procedures, and practice defensive medicine just to protect themselves.
But as a result, health care costs soar. In Ohio alone, there is story
upon story of doctors retiring early or leaving the State just because
of liability premiums.
Take Brian Bachelder, who had to stop practicing obstetrics this year
because he simply could not afford it. As a result, his patients, many
of whom had trouble just paying for the gas to get to their appointment
with him, will now have to travel 50 or 65 miles further for prenatal
care. Or take Dr. Romeo Diaz, whose patients had to actually chip in
and raise $40,000 to cover his increased premiums. All of this
scrimping and saving for a doctor who had not had a malpractice claim
filed in over 10 years.
America's health care system is quickly approaching the eye of a
perfect storm, a world without doctors. They are becoming increasingly
hard to find in so many places; and even worse, when you find one, they
often cannot help. Their hands are tied.
Far too many Americans are unable to find a doctor to deliver a baby,
to perform a surgery, or to provide trauma care necessary to save a
loved one's life.
Mr. Speaker, Congress needs to act today and pass a medical liability
reform plan that keeps our doctors practicing, alleviates patients'
suffering, and restores medical justice to this system.
{time} 1115
Mr. HASTINGS of Florida. Mr. Speaker, how much time is remaining on
both sides?
The SPEAKER pro tempore (Mr. Thornberry). The gentleman from Florida
(Mr. Hastings) has 5\3/4\ minutes remaining. The gentleman from New
York (Mr. Reynolds) has 5\1/2\ minutes remaining.
Mr. HASTINGS of Florida. Mr. Speaker, I yield 1 minute to my good
friend, the gentlewoman from Texas (Ms. Jackson-Lee).
(Ms. JACKSON-LEE of Texas asked and was given permission to revise
and extend her remarks.)
Ms. JACKSON-LEE of Texas. Mr. Speaker, Nathaniel is in fact the face
of the devastation of H.R. 5. In the name of God and country, this rule
says to Nathaniel, 6 days old, he is brain damaged because physicians
and nurses failed to diagnose jaundice. In this bill he would be denied
under the capping of noneconomic damages that are capped. Nathaniel is
the face of the horror of what happened in the Committee on Rules last
night. There will be no response to our physician friends and doctor
friends on the question of reducing premiums because they rejected my
amendment that said 50 percent of the savings by insurance companies
should be reinvested into physicians to lower their premiums.
They know that California did not have those premiums go down until
California enacted insurance reform. This is an insurance giveaway
bill. This is not going to bring doctors into rural and urban America.
Mr. Speaker, this rule should be voted down in the name of Nathaniel,
now brain damaged. H.R. 5 is a devastation and a disgrace to this baby
who lost the ability to live a good quality of life.
Mr. Speaker, I am disgusted by this closed rule and call on my
colleagues to defeat the rule and the underlying bill. We have a health
care crisis on our hands. We need to work together in a democratic
fashion to address it: to improve access to care, to protect patients,
to ensure that good physicians can afford to continue treating those
patients, and to decrease frivolous lawsuits. The underlying bill does
nothing to address any of those issues, and I and many of my colleagues
came forth last night to present amendments that would have ensured
that it did. Not a single one of those excellent ideas will be even
considered today.
What in the name of God and Country is our Democracy coming to when
on the Floor of the House of Representatives, there is not a single
chance to debate and vote on one of many ideas that could save lives
and rescue our floundering health care system?
I hate the idea of putting a price tag on a human life, or a value on
pain and suffering. However, we all know that malpractice premiums are
outrageously high in some regions, for some specialities of medicine. I
understand that some physicians are actually going out of business
because the cost of practicing is too high, and that we run the risk of
decreasing access to healthcare if we do not find a way to decrease
malpractice insurance premiums.
But it would be doubly tragic if we did compromise the ability of
patients suffering from medical negligence from seeking recourse in our
courts, and did not achieve any meaningful decrease in malpractice
premiums. Therefore, I offered an amendment last night that would
require that all malpractice insurance companies make a reasonable
estimate each year of the amount of money they save each year through
the reduction in claims brought about by this Act. Then they would need
to ensure that at least 50% of those savings be passed down in the form
of decreased premiums for the doctors they serve.
I shared this concept with doctors and medical associations down in
Texas, and they were very enthusiastic, because this amendment would
ensure that we do what, I am being told, this bill is supposed to do--
lower premiums for doctors.
Without my provision, this bill could easily end up being nothing
more than heartbreak for those dealing with loss, and a giant gift to
insurance companies. Parents who lose a child due to a tragedy like the
one in North Carolina recently where the wrong heart and lung were
placed in a young girl--they don't lose any money--they lose a part of
their souls. We are going to tell them that their child was only worth
$250,000 in non-economic damages for all of their pain and suffering.
We are being told that we are going to do this to such devastated
families, in order to enable our doctors
[[Page H1825]]
to keep treating patients. However, the Rules Committee has decided to
prevent us from voting on amendments that would ensure that this bill
helps any doctor at all.
Without debate and votes, a Democracy is not a Democracy. I will vote
against this Closed Rule, and encourage my colleagues who care about
helping patients and good doctors to do the same.
Mr. REYNOLDS. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman
from Georgia (Mr. Linder), a distinguished member of the Committee on
Rules.
Mr. LINDER. Mr. Speaker, I thank the gentleman for yielding me time.
Mr. Speaker, I rise in support of the rule and the underlying
legislation, H.R. 5, the underlying medical malpractice reform bill.
This rule gives the minority party a motion to recommit with or without
instructions. This motion to recommit provides the minority with an
opportunity to amend H.R. 5 as it sees fits, something the House
Democrats often refused to give Republicans before 1995.
As a former dentist I understand the necessity for this particular
form of tort law and how the reality of judicial adventurism is a prime
cause of rising health care costs and reduced access in our country.
I absolutely believe that medical malpractice litigation has a
substantive effect on health care quality and costs.
In a recent survey of Georgia doctors, 18 percent said they would
stop providing high risk procedures to limit their liability; 33
percent of OB-GYNs and 20 percent of family practitioners said they
will abandon high-risk procedures such as delivering babies. In
addition, 11 percent of physicians will stop providing emergency room
services.
The benefits of capping malpractice damages are staggering. In
California it is estimated that MICRA has saved under those with high-
risk specialties as much as $42,000 per year, not to mention the $6
billion per year of savings to patients in California. According to the
U.S. Department of HHS, limits on noneconomic damages could yield
taxpayers 25- to $44 billion per year in savings.
Our founders incorporated explicit protections for citizens in
criminal trials in the sixth amendment. However, they foresaw the
potential abuse in civil trials and thus remained explicitly silent on
the rights of juries to operate in civil cases.
In Federalist 83 Alexander Hamilton went to great lengths to discuss
the absence of constitutional protections in civil cases, going so far
as to claim that he could not ``discern the inseparable connection
between the existence of liberty and the trial by jury in civil
cases.''
According to Hamilton, the genius of the constitution was not only
its flexibility in handling the changing nature of the American
judiciary but also its reliance on the legislature to prescribe the
effective checks on such changes.
Abuse in our judicial system can be remedied by the implementation
and power of trials by jury, but a balance must be struck between that
idea and the notions of common sense and personal responsibility.
Unfortunately, our current system does not strike that balance.
I urge, as such, my colleagues to join me in passing this rule and
the underlying legislation.
Mr. HASTINGS of Florida. Mr. Speaker, I yield 1 minute to the
gentleman from Massachusetts (Mr. Delahunt), who has studied this
problem long-standing as an attorney.
Mr. DELAHUNT. Mr. Speaker, I thank the gentleman for yielding me
time.
This is Linda McDougal, and like Nathaniel and many others she too
would be a victim of the underlying bill H.R. 5. She received an
unnecessary double mastectomy after doctors mixed up her results, her
lab results, and erroneously told her she had breast cancer.
Under this bill her lifetime of pain and disfigurement would be worth
$250,000 and not a penny more. I ask my friends, is that fair?
Well, if my friends have any doubts, I would suggest they ask their
mother, their sister or their daughter.
Mr. REYNOLDS. Mr. Speaker, I yield 45 seconds to the gentleman from
Nevada (Mr. Porter).
(Mr. PORTER asked and was given permission to revise and extend his
remarks.)
Mr. PORTER. Mr. Speaker, I rise in support of the HEALTH Act of 2003.
This bill will be the first step towards curing the escalating medical
liability costs.
The runaway litigation has forced a dozen States into near cardiac
arrest, including my home State of Nevada. In Nevada medical liability
costs have skyrocketed, forcing doctors to leave in droves. The trauma
center in our top hospital had to shut its doors because there were not
enough doctors to treat the patients. Just about every day you pick up
the paper and you turn on the TV and there is another story about a
pregnant woman or an emergency patient going into other States to have
their babies delivered or emergency care treated. It is just one
example.
In Las Vegas, Mr. Speaker, obstetrician Dr. Shelby Wilbourn packed up
a 12-year practice and moved to Maine, where insurance rates are more
affordable and doctors appear less likely to be sued.
Mr. Speaker, in order to remedy this, we must pass this legislation.
Mr. HASTINGS of Florida. Mr. Speaker, I would say to the gentleman
from Nevada (Mr. Porter), the gentlewoman from Nevada (Ms. Berkley),
who is married to a physician, does not find that H.R. 5 is going to
remedy her husband's problem.
Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from
California (Mrs. Capps), who is a registered nurse and has seen what we
are talking about.
Mrs. CAPPS. Mr. Speaker, I rise in opposition to the rule and the
underlying bill.
We should not be capping the awards for pain and suffering that an
injured patient receives when they have been harmed by their doctor.
This puts the burden of rising insurance rates onto the innocent
patient rather than the insurance company.
Mr. Speaker, I offered an amendment to the Committee on Rules which
was not made in order. My amendment would set caps in the bill of
$250,000 or the total compensation package of the CEO of the insurance
company representing the doctor in the case, whichever is highest.
It is not fair for insurance companies to pay their executives
millions of dollars, give them bonuses, increase their pay when they
are trying to deprive victims of their rightful compensation. In these
days of Enron and MCI WorldCom, I believe that Congress should be
siding with injured patients over corporate executives.
The Nation's largest medical malpractice insurance company pays their
CEO $9.7 million, but even so they apparently cannot keep paying for
the pain and suffering of patients their clients have injured and so
they keep raising their rates. You have to wonder about priorities.
This is about Nathaniel and Linda. This amendment that I propose
promotes corporate responsibility. It is a more fair approach, and I
urge my colleagues to defeat this rule and the underlying bill.
Mr. REYNOLDS. Mr. Speaker, I yield 1 minute to the gentleman from
Pennsylvania (Mr. Greenwood), who is an expert on the Committee on
Energy and Commerce on this issue.
Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me
time.
The gentlewoman from Texas (Ms. Jackson-Lee) showed me a picture of
Nathaniel, a young boy tragically brain damaged. I want my colleagues
to understand that this bill of ours is modeled after California law.
And in California law just last May under the same kind of law, a
little boy who was brain damaged at a very young age because of
malpractice was awarded $43.5 million. And our bill would do nothing to
prevent this young man from getting what they need, and that is
probably a lifetime of round-the-clock medical care, a lifetime of lost
wages.
All that would be recoverable in full, as it should be, and on top of
that at least a quarter of a million dollars in pain and suffering; and
if the State from which the child comes wanted to, that State could
raise that level to whatever it wants. We have a flexible cap. This is
a question of balance. This is a question of balance. We have to figure
out how do we properly pay for medical liability claims in a reasoned
way that still allows us to retain our doctors and hospitals.
[[Page H1826]]
Mr. HASTINGS of Florida. Mr. Speaker, I yield 1 minute to the
gentlewoman from Nevada (Ms. Berkley), my friend, who is an attorney
married to a physician, who has studied this problem actively and
carefully over a period of time, coming from a State with dramatic
problems.
(Ms. BERKLEY asked and was given permission to revise and extend her
remarks.)
Ms. BERKLEY. Mr. Speaker, I fear we are doing a terrible disservice
to our Nation's physicians and the patients who depend on them. We are
deceiving them by passing a bill that does not ensure that doctors will
actually benefit from these caps.
As a representative of southern Nevada I am all too familiar with the
medical liability issue. Nevada has faced a serious medical malpractice
crisis for years. Doctors cannot afford insurance premiums and they are
threatening to leave the State. Some have and some are refusing to
accept new patients.
In August of 2002, Nevada passed a carefully balanced tort reform
bill which limited noneconomic damages to $350,000 and allowed for
judicial discretion in particularly egregious cases. Nevada passed
caps. But the medical insurance companies have refused and have failed
to reduce their premiums.
This Congress cannot for a minute pretend that we have addressed the
real problem of skyrocketing insurance rates if we limit our
prescription to liability caps. We must also provide doctors with
insurance reforms as well.
Medical liability reform is worthless if we ignore all of the
evidence demonstrating that the current crisis is due more to insurance
company miscues than liability claims. We must combine them both and I
urge you to reject this rule.
Mr. Speaker, I rise in opposition to the rule.
As a Representative of southern Nevada, I am all too familiar with
this medical liability issue. Nevada has faced a serious medical
malpractice crisis for the last year. Doctors cannot afford insurance
premiums and are threatening to leave the State. Some have or are
refusing to accept new patients.
I convened discussion groups of doctors and lawyers at my home to try
to understand the medical malpractice issue, and it's a regular
conversation in my own home as my husband and I, a doctor and lawyer,
have searched for effective solutions to this crisis.
Nevada's problem is not one of obscene awards and lawsuits, but of
poor calculations and bad decisions on the part of insurers over the
past couple of decades.
Nevada's problem is the result of artificially inflated profits, over
saturation and price slashing by the insurance company and when Nevada
was no longer profitable, St. Paul Insurance Co. withdrew from the
market. When that happened, 60% of Nevada's doctors lost their
insurance carrier and the remaining medical malpractice insurance
companies raised their rates to unconscionable extremes.
In August of 2002, Nevada passed a carefully balanced tort reform
bill which limited non-economic damages to $350,000 and allowed for
judicial discretion in particularly egregious cases.
Nevada passed caps, but the medical insurance companies have refused
and have failed to reduce their premiums.
The evidence demonstrates that judgements are not the full, or even a
large measure of the problem. And therefore caps will have a very
limited effect on solving this problem.
This Congress cannot--for a minute--pretend that we have addressed
the very real problem of skyrocketing insurance rates if we limit our
prescription to liability caps. We must also provide doctors with
insurance reforms as well.
Medical liability reform is worthless if we ignore all the evidence
demonstrating that the current crisis is due more to insurance company
miscues than to liability claims.
It is fundamentally unfair and bad public policy to limit jury awards
without directly addressing reform of the insurance industry. If this
Congress is going to pass tort reform, it should be accompanied by
insurance reform so that insurance companies will pass along the
savings, and doctors become the direct beneficiaries of cap
limitations.
Anything less will fail to solve the malpractice crisis in my State
and in this Nation.
I urge my colleagues to vote against this Rule. We are doing a
terrible disservice to our Nation's physicians and to the patients that
depend on them. We are deceiving them by passing a bill that does not
insure that the doctors will actually benefit from caps.
Mr. REYNOLDS. Mr. Speaker, I reserve the balance of my time.
The SPEAKER pro tempore. The gentleman from New York has 1\1/4\
minutes remaining. The gentleman from Florida (Mr. Hastings) has 2
minutes remaining.
Mr. HASTINGS of Florida. Mr. Speaker, I yield 1 minute to the
gentleman from Texas (Mr. Edwards) and then I will be prepared to
close.
Mr. EDWARDS. Mr. Speaker, I am deeply disappointed that the
Republican House leadership refused last night to even let this House
consider my amendment, a reasonable amendment, to exclude the $250,000
caps only in cases where someone is guilty of gross negligence.
I support cracking down on frivolous lawsuits and I even favor
punishing attorneys who file them. But under the guise of stopping
frivolous lawsuits, it is wrong for the Republican leadership to
protect those guilty of gross negligence even when the consequence is
the loss of a child.
Jeanella Aranda was a 1-year-old baby. Last August Jeanella died
needlessly in Dallas, Texas, because the transplant liver team did not
check the fact that the father's liver and blood type were not
compatible. Had they checked they have would have found out little
Jeanella's mother could have donated part of her liver and Jeanella
would most likely be alive today.
Mr. Speaker, I hope every Member of this House will ask his or
herself this question before voting on this awful unfair rule: Had
Jeanella Aranda been your child, would you think it would be fair for
politicians in Washington to decide how to hold responsible those
involved in her death?
Mr. REYNOLDS. Mr. Speaker, I yield 30 seconds to the gentleman from
California (Mr. Cox).
Mr. COX. Mr. Speaker, everyone in this body knows why pregnant
mothers cannot find doctors to deliver their babies, why emergency room
and trama centers are closing and why physicians are leaving their
practices. The health care liability crisis has been worsening every
year since 1993, when I first introduced this legislation that we are
considering today.
The national median malpractice awards has been increasing 43 percent
a year. It is unsustainable. Today the average physician faces a new
lawsuit every year. The opponents of this legislation are convinced
that the best place to make split second medical decisions is in the
courtroom. But this bill is about getting better health care in America
for doctors and patients and all of the people who rely upon this
system. It is high time for medical justice and high time to enact this
legislation.
{time} 1130
Mr. HASTINGS of Florida. Mr. Speaker, I yield myself the remaining
time.
Mr. Speaker, if the previous question is defeated, I will offer an
amendment to the rule. My amendment will allow the House to consider
the Conyers-Dingell substitute to the medical malpractice bill. My
amendment will give Members an opportunity to vote on this substitute
which, unlike the majority, takes a comprehensive approach to rising
medical malpractice insurance premiums. It takes steps to weed out
frivolous lawsuits. It requires insurance companies to pass their
savings on to health care providers, and it provides targeted
assistance to the physicians and communities who need it most.
Let me make it clear that a ``no'' vote on the previous question will
not stop consideration of this bill. A ``no'' vote will allow the House
to consider and get a vote on the Conyers-Dingell substitute. However,
a ``yes'' vote on the previous question will shut out any opportunity
for a vote on the substitute. I urge a ``no'' vote on the previous
question.
Mr. Speaker, I ask unanimous consent that the text of the amendment
and a description be printed in the Record immediately prior to the
vote on the previous question, on which I urge a ``no'' vote on the
base rule.
The SPEAKER pro tempore (Mr. Thornberry). Is there objection to the
request of the gentleman from Florida?
There was no objection.
The SPEAKER pro tempore. The time of the gentleman from Florida has
expired.
Mr. REYNOLDS. Mr. Speaker, I yield myself the remaining time.
I hope my colleagues have had the opportunity to read the heart-
wrenching testimony presented by Leanne
[[Page H1827]]
Dyess earlier this month before the Committee on the Judiciary. I hope
their compassion will allow them to consider how it would feel if a
similar tragedy befell someone they love simply because doctors had
been pushed out of the area; and I hope they can recognize that, today,
we have the opportunity to prevent such tragedies from happening to
others.
The HEALTH Act is about patients getting the best possible care they
can when and where they need it. Dollar signs do not cure people;
doctors do. Let us make sure doctors and other providers all across the
country remain open for business.
I urge a ``yes'' vote on the rule and the underlying legislation. A
``yes'' vote is a vote for patients.
Mr. CONYERS. Mr. Speaker, there is one word that best describes this
closed rule: cowardly. This is a Republican leadership that fears a
real debate on this cold hearted proposal that would rob victims of
medical malpractice. They fear that too many of their own Members would
vote for a democratic bill because it makes sense and would address the
problem.
They have decided to dodge a clean vote on a real bill and bury real
debate in procedural doubletalk. They have decided to let their Members
hide behind parliamentary tricks.
The Republican leadership has shredded any semblance of fairness or
open debate. Just last year, for the first time since 1910, this
Republican leadership denied the Minority party a motion to recommit.
Today, the two most senior members of the House of Representatives, who
are also the two Ranking Democrats on the Committees of jurisdiction,
are being denied the opportunity to offer the amendment of their
choosing.
The Republican leadership's bill doesn't solve the problem of medical
malpractice insurance rates skyrocketing. It has no insurance reform at
all. Doctors who are being price gouged by insurance companies will not
see one cent of savings from this bill.
The simple fact is that draconian caps on damages do not reduce
insurance premiums. In a comparison of states that enacted severe tort
restrictions in the mid-1980s and those that resisted enacting any tort
reform, no correlation was found between tort reform and insurance
rates.
Our bill takes away the antitrust exemption for medical malpractice
insurance providers that has allowed those providers to collude to jack
up rates for doctors.
The Republican leadership's bill does nothing about the deadly
problem of medical malpractice that costs victims literally their life
and limb. Between 44,000 and 98,000 people die each year because of
medical negligence in hospitals and the Republican answer is to take
away the rights of surviving family members and accountability for bad
apple health care providers.
H.R. 5 does nothing about the fact that 5% of all doctors are
responsible for 54% of malpractice claims paid. H.R. 5 does nothing to
solve the problem that medical malpractice is the fifth leading cause
of death in the country.
Our bill preserves accountability in the health care system.
The Republican leadership's bill does nothing about frivolous
lawsuits, only hurts victims. All this bill does is take away
compensation from the most seriously injured plaintiffs. These are the
victims who have a case that has so much merit that a jury of their
peers decides they deserve more than $250,000 in non-economic damages.
Our bill requires an attorney to file a certificate of merit that an
action is not frivolous and, if that certificate is false, that
attorney can be disbarred.
The Republican bill takes a chain saw to the health care system
instead of a scalpel. It is no wonder they fear a fair and honest
debate and a clean vote.
I urge Members to:
(1) Vote ``no'' on the Previous Question so that we can make in order
a vote on Conyers-Dingell and other worthy Democratic amendments.
(2) If we are not successful in defeating the previous question, vote
``no'' on this one sided, anti-democratic rule.
The material previously referred to by Mr. Hastings of Florida is as
follows:
Previous Question for H. Res. 139--Medical Malpractice: H.R. 5--Help
Efficient Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003
In the resolution strike ``and (2)'' and insert the
following:
``(2) an amendment in the nature of a substitute consisting
of the text of H.R. 1219 if offered by Representative Conyers
or a designee, which shall be in order without intervention
of any point of order, shall be considered as read, and shall
be separately debatable for 60 minutes equally divided and
controlled by the proponent and an opponent; and (3)''
Conyers/Dingell Democratic Substitute--H.R. 1219, ``The Medical
Malpractice and Insurance Reform Act of 2003''
section-by-section analysis
Scope. The legislation narrowly defines ``medical
malpractice action'' to cover ``licensed physicians and
health professionals'' for only cases involving medical
malpractice. These definitions are intended to include
doctors, hospitals, nurses, and other health professionals
who pay medical malpractice insurance premiums. See, sec.
107(8).
Title I--Reducing frivolous lawsuits
Sec. 101.--Statute of Limitations. This section limits the
amount of time during which a patient can file a medical
malpractice action to the later of three years from the date
of injury or three years from the date the patient discovers
(or through the use of reasonable diligence should have
discovered) the injury. Children under the age of 18 have the
later of three years from their eighteenth birthday or three
years from the date the patient discovers (or through the use
of reasonable diligence should have discovered) the injury.
Sec. 102.--Health Care Specialist Affidavit. This section
requires an affidavit by a qualified specialist before any
medical malpractice action may be filed. A ``Qualified
Specialist'' is a health care professional with knowledge of
the relevant facts of the case, expertise in the specific
area of practice, and board certification in a specialty
relating to the area of practice.
Sec. 103.--Mandatory Sanctions for Frivolous Actions and
Pleadings. This section requires all plaintiff attorneys who
file a medical malpractice action to certify that the case is
meritorious. Attorneys who erroneously file such a
certificate are subject to strict civil penalties. For first
time violators, the court shall require the attorney to pay
costs and attorneys fees or administer other appropriate
sanctions. For second time violators, the court shall also
require the attorney to pay a monetary fine. For third time
violators, the court shall also refer the attorney to the
appropriate State bar association for disciplinary
proceedings.
Sec. 104.--Mandatory Mediation. This section establishes an
alternative dispute resolution (ADR) system for medical
malpractice cases. Participation in mediation shall be in
lieu of any other ADR method required by law or by
contractual arrangements by the parties. A similar approach
is recommended by the Committee for Economic Development
(CED), which suggests that defendants make and victims accept
``early offers.'' The effect of the ``early offer'' program,
according to the CED, is that defendants will reduce the
likelihood of incurring litigation costs, and victims would
obtain fair compensation without the delay, expense or trauma
of litigation.
Sec. 105.--Punitive Damages. This section limits the
circumstances under which a claimant can seek punitive
damages in a medical malpractice action. It also allocates 50
percent of any punitive damages that are awarded to a Patient
Safety Fund managed by HHS. HHS will administer the
Patient Safety Fund through the Agency for Healthcare
Research and Quality. The Secretary will promulgate
regulations that will establish programs and procedures to
carry out this objective. See also, Sec. 221-223.
Sec. 106.--Reduction in Premiums. This section requires
medical malpractice insurance companies to annually project
the savings that will result from Title II of the bill.
Insurance companies must then develop and implement a plan to
annually dedicate at least 50 percent of those savings to
reduce the insurance premiums that medical professionals pay.
Insurance companies must report these activities to HHS
annually. The section provides for civil penalties for the
non-compliance of insurance companies.
Title II--Medical malpractice insurance reform
Sec. 201.--Prohibition on Anti-competitive Activities by
Medical Malpractice Insurers. This section would repeal
McCarran-Ferguson Act to ensure that insurers do not engage
in price fixing. The Act, enacted in 1945, exempts all anti-
competitive insurance industry practices, except boycotts,
from the Federal antitrust laws. Over the years, uneven
oversight of the insurance industry by the States, coupled
with no possibility of Federal antitrust enforcement, have
created an environment that fosters a wide range of anti-
competitive practices.
Sec. 202.--Medical Malpractice Insurance Price Comparison.
This section creates an internet site at which health care
providers could obtain the price charged for the type of
coverage the provider seeks from any malpractice insurer
licensed in the doctor's state. This section specifies the
availability of online forms and that all information will
remain confidential.
Title III--Enhancing patient access to care through direct
assistance
Sec. 301.--Grants and Contracts Regarding Health Provider
Shortages. This section authorizes the Secretary of Health
and Human Services (HHS) to award grants or contracts through
the Health Resources and Services Administration (HRSA) to
geographic areas that have a shortage of one or more types of
health care providers as a result of dramatic increases in
malpractice insurance premiums.
Sec. 302.--Health Professional Assignments to Trauma
Centers. This section amends the Public Health Service Act to
authorize the Secretary to send physicians from the National
Health Service Corps to trauma centers that are in danger of
closing (or losing
[[Page H1828]]
their trauma center status) due to dramatic increases in
malpractice premiums.
Title IV--Independent advisory commission on medical
malpractice insurance
Sec. 401-402.--Independent Advisory Commission on Medical
Malpractice Insurance. This section establishes the national
Independent Advisory Commission on Medical Malpractice
Insurance. The Commission must evaluate the causes and scope
of the recent and dramatic increases in medical malpractice
insurance premiums, formulate additional proposals to reduce
those premiums, and make recommendations to avoid any such
increases in the future. In formulating its proposals, the
Commission must, at a minimum, consider a variety of
enumerated factors.
Sec. 403.--Report. This section requires the Commission to
file an initial report with Congress within 180 days of
enactment and to file annual reports until the Commission
terminates.
Sec. 404.--Membership. This section specifically
establishes the number and type of commissioners that the
Comptroller General of the United States must appoint to the
Commission. Generally, the membership of the Commission will
include individuals with national recognition for their
expertise in health finance and economics, actuarial science,
medical malpractice insurance, insurance regulation, health
care law, health care policy, health care access, allopathic
and osteopathic physicians, other providers of health care
services, patient advocacy, and other related fields, who
provide a mix of different professionals, broad geographic
representations, and a balance between urban and rural
representatives.
Sec. 407.--Authorization of Appropriations. This section
authorizes that such sums be appropriated to the Commission
for five fiscal years.
(Prepared by the Democratic staffs of the Committee on the
Judiciary and the Committee on Energy and Commerce.)
Mr. REYNOLDS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The SPEAKER pro tempore. The question is on ordering the previous
question.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. HASTINGS of Florida. Mr. Speaker, I object to the vote on the
ground that a quorum is not present and make the point of order that a
quorum is not present.
The SPEAKER pro tempore. Evidently a quorum is not present.
The Sergeant at Arms will notify absent Members.
Pursuant to clause 9 of rule XX, the Chair will reduce to 5 minutes
the minimum time for electronic voting, if ordered, on the question of
adoption of the resolution.
The vote was taken by electronic device, and there were--yeas 225,
nays 201, not voting 8, as follows:
[Roll No. 61]
YEAS--225
Aderholt
Akin
Bachus
Baker
Ballenger
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Castle
Chabot
Chocola
Coble
Cole
Collins
Cox
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
DeMint
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Dreier
Duncan
Dunn
Ehlers
Emerson
English
Everett
Feeney
Ferguson
Flake
Fletcher
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gibbons
Gillmor
Gingrey
Goode
Goodlatte
Goss
Granger
Graves
Green (WI)
Greenwood
Gutknecht
Harris
Hart
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hulshof
Hunter
Isakson
Issa
Istook
Janklow
Jenkins
Johnson (CT)
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (KY)
Lucas (OK)
Manzullo
McCotter
McCrery
McHugh
McInnis
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Nethercutt
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Ose
Otter
Oxley
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Stearns
Sullivan
Sweeney
Tancredo
Tauzin
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Toomey
Turner (OH)
Upton
Vitter
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Young (AK)
Young (FL)
NAYS--201
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Carson (OK)
Case
Clay
Clyburn
Conyers
Cooper
Costello
Cramer
Crowley
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Dooley (CA)
Doyle
Edwards
Emanuel
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Filner
Ford
Frank (MA)
Frost
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Hall
Harman
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lynch
Majette
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
Scott (GA)
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Smith (WA)
Solis
Spratt
Stark
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
Wynn
NOT VOTING--8
Combest
DeGette
Gephardt
Gilchrest
Hyde
Johnson (IL)
Rush
Snyder
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (Mr. Thornberry) (during the vote). Members
have 2 minutes to record their votes.
{time} 1154
Ms. WATSON, Messrs. SANDLIN, MATSUI, HINOJOSA, SHERMAN, KUCINICH,
Mrs. JONES of Ohio, Messrs. RUPPERSBERGER, BALLANCE, DEUTSCH, OWENS,
Ms. MAJETTE, and Mr. DAVIS of Florida changed their vote from ``yea''
to ``nay.''
Mr. PETRI and Mr. PAUL changed their vote from ``nay'' to ``yea.''
So the previous question was ordered.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore. The question is on the resolution.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Recorded Vote
Mr. HASTINGS of Florida. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This is a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 225,
noes 201, not voting 8, as follows:
[Roll No. 62]
AYES--225
Aderholt
Akin
Bachus
Baker
Ballenger
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
[[Page H1829]]
Bonilla
Bonner
Bono
Boozman
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Castle
Chabot
Chocola
Coble
Cole
Collins
Cox
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
DeMint
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Dreier
Duncan
Dunn
Ehlers
Emerson
English
Everett
Feeney
Ferguson
Flake
Fletcher
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gibbons
Gillmor
Gingrey
Goode
Goodlatte
Goss
Granger
Graves
Green (WI)
Greenwood
Gutknecht
Harris
Hart
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hulshof
Hunter
Isakson
Issa
Istook
Janklow
Jenkins
Johnson (CT)
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (KY)
Lucas (OK)
Manzullo
McCotter
McCrery
McHugh
McInnis
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Nethercutt
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Ose
Otter
Oxley
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Stearns
Sullivan
Sweeney
Tancredo
Tauzin
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Toomey
Turner (OH)
Upton
Vitter
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Young (AK)
Young (FL)
NOES--201
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Carson (OK)
Case
Clay
Clyburn
Conyers
Cooper
Costello
Cramer
Crowley
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Dooley (CA)
Doyle
Edwards
Emanuel
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Filner
Ford
Frank (MA)
Frost
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Hall
Harman
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lynch
Majette
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
Scott (GA)
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Smith (WA)
Solis
Spratt
Stark
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
Wynn
NOT VOTING--8
Combest
DeGette
Gephardt
Gilchrest
Hyde
Johnson (IL)
McIntyre
Snyder
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore. (Mr. Thornberry) (during the vote). Members
are advised 2 minutes remain in this vote.
{time} 1207
So the resolution was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________