[Congressional Record Volume 150, Number 103 (Thursday, July 22, 2004)]
[Senate]
[Pages S8627-S8633]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PATIENT SAFETY AND QUALITY IMPROVEMENT ACT OF 2003
Mr. FRIST. Mr. President, I ask unanimous consent the Senate now
proceed to consideration of Calendar No. 387, S. 720.
The PRESIDING OFFICER. The clerk will report the bill by title.
The legislative clerk read as follows:
A bill (S. 720) to amend title IX of the Public Health
Service Act to provide for the improvement of patient safety
and to reduce the incidence of events that adversely affect
patient safety.
There being no objection, the Senate proceeded to consider the bill
which had been reported from the Committee on Health, Education, Labor,
and Pensions, with an amendment to strike all after the enacting clause
and insert in lieu thereof the following:
(Strike the part shown in black brackets and insert the part shown in
italic.)
S. 720
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
[SECTION 1. SHORT TITLE.
[This Act may be cited as the ``Patient Safety and Quality
Improvement Act''.
[SEC. 2. FINDINGS AND PURPOSES.
[(a) Findings.--Congress makes the following findings:
[(1) In 1999, the Institute of Medicine released a report
entitled To Err is Human that described medical errors as the
eighth leading cause of death in the United States, with as
many as 98,000 people dying as a result of medical errors
each year.
[(2) To address these deaths and injuries due to medical
errors, the health care system must identify and learn from
such errors so that systems of care can be improved.
[(3) In their report, the Institute of Medicine called on
Congress to provide legal protections with respect to
information reported for the purposes of quality improvement
and patient safety.
[(4) The Health, Education, Labor, and Pensions Committee
of the Senate held 4 hearings in the 106th Congress and 1
hearing in the 107th Congress on patient safety where experts
in the field supported the recommendation of the Institute of
Medicine for congressional action.
[(5) Myriad public and private patient safety initiatives
have begun. The Quality Interagency Coordination Taskforce
has recommended steps to improve patient safety that may be
taken by each Federal agency involved in health care and
activities relating to these steps are ongoing.
[(6) The research on patient safety unequivocally calls for
a learning environment, rather than a punitive environment,
in order to improve patient safety.
[(7) Voluntary data gathering systems are more supportive
than mandatory systems in creating the learning environment
referred to in paragraph (5) as stated in the Institute of
Medicine's report.
[(8) Promising patient safety reporting systems have been
established throughout the United States and the best ways to
structure and use these systems are currently being
determined, largely through projects funded by the Agency for
Healthcare Research and Quality.
[(9) The Department of Health and Human Services has
initiated several patient safety projects. The Joint
Commission on Accreditation of Healthcare Organizations
issued a patient safety standard that went into effect on
July 1, 2001, and the peer review organizations are
conducting ongoing studies of clinical performance
measurement of care delivered to beneficiaries under the
medicare program under title XVIII of the Social Security
Act.
[(10) Many organizations currently collecting patient
safety data have expressed a need for legal protections that
will allow them to review protected information so that they
may collaborate in the development and implementation of
patient safety improvement strategies. Currently, the State
peer review protections provide inadequate conditions to
allow the sharing of information to promote patient safety.
[(11) In 2001, the Institute of Medicine released a report
entitled Crossing the Quality Chasm that found that the
United States health care system does not consistently
deliver high quality care to patients.
[(b) Purposes.--It is the purpose of this Act to--
[(1) encourage a culture of safety and quality in the
United States health care system by providing for legal
protection of information reported voluntarily for the
purposes of quality improvement and patient safety; and
[(2) ensure accountability by raising standards and
expectations for continuous quality improvements in patient
safety through the actions of the Secretary of Health and
Human Services.
[SEC. 3. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.
[Title IX of the Public Health Service Act (42 U.S.C. 299
et seq.) is amended--
[(1) in section 912(c), by inserting ``, in accordance with
part C,'' after ``The Director shall'';
[(2) by redesignating part C as part D;
[(3) by redesignating sections 921 through 928, as sections
931 through 938, respectively;
[(4) in section 938(1) (as so redesignated), by striking
``921'' and inserting ``931''; and
[(5) by inserting after part B the following:
[``PART C--PATIENT SAFETY IMPROVEMENT
[``SEC. 921. DEFINITIONS.
[``In this part:
[``(1) Non-identifiable information.--The term `non-
identifiable information' means information that is presented
in a form and manner that prevents the identification of any
provider, patient, and the reporter of patient safety data.
[``(2) Patient safety data.--The term `patient safety data'
means--
[[Page S8628]]
[``(A) any data, reports, records, memoranda, analyses,
deliberative work, statements, root cause analyses, or
quality improvement processes that could result in improved
patient safety or health care quality, that are--
[``(i) collected or developed by a provider for the purpose
of reporting to a patient safety organization;
[``(ii) reported to a patient safety organization for
patient safety or quality improvement processes;
[``(iii) requested by a patient safety organization
(including the contents of such request);
[``(iv) reported to a provider by a patient safety
organization;
[``(v) collected or developed by a patient safety
organization; or
[``(vi) reported among patient safety organizations, after
obtaining authorization; or
[``(B) information related to corrective actions taken in
response to patient safety data;
for the purpose of improving patient safety, health care
quality, or health care outcomes.
[``(3) Patient safety organization.--The term `patient
safety organization' means a private or public organization
or component thereof that performs the following activities
(which are deemed to be necessary for the proper management
and administration of such organization or component
thereof):
[``(A) The conduct, as its primary activity, of efforts to
improve patient safety and the quality of health care
delivery.
[``(B) The collection and analysis of patient safety data
that are voluntarily submitted by a provider.
[``(C) The development and dissemination of information to
providers with respect to improving patient safety, such as
recommendations, protocols, or information regarding best
practices.
[``(D) The utilization of patient safety data to carry out
activities under this paragraph and for the purposes of
encouraging a culture of safety and of providing direct
feedback and assistance to providers to effectively minimize
patient risk.
[``(E) The maintenance of confidentiality with respect to
individually identifiable health information.
[``(F) The provision of appropriate security measures with
respect to patient safety data.
[``(G) The certification to the Agency that the patient
safety organization satisfies the criteria of this paragraph
for the period in which the organization is carrying out such
duties.
[``(4) Provider.--The term `provider' means--
[``(A) a provider of services (as defined in section
1861(u) of the Social Security Act) and a person furnishing
any medical or other health care services (as defined in
section 1861(s)(1) and (2) of such Act) through, or under the
authority of, such a provider of services;
[``(B) a physician (as defined in section 1861(r) of such
Act);
[``(C) any other person, including a pharmacist, who is
engaged in the delivery of medical or other health services
(as defined in section 1861(s)(1) and (2) of such Act) in a
State and who is required by State law or regulation to be
licensed or certified by the State to engage in the delivery
of such services in the State;
[``(D) a renal dialysis facility, ambulatory surgical
center, pharmacy, physician or health care practitioner's
office, long term care facility, behavioral health
residential treatment facility, or clinical laboratory; or
[``(E) any other person or entity specified in regulations
by the Secretary after public notice and comment.
[``SEC. 922. CONFIDENTIALITY AND PEER REVIEW PROTECTIONS.
[``(a) In General.--Notwithstanding any other provision of
law, and subject to this section, patient safety data shall
be privileged and confidential.
[``(b) Scope of Privilege.--Subject to the provisions of
subsection (c), patient safety data to which subsection (a)
applies shall not be--
[``(1) subject to a civil, criminal, or administrative
subpoena;
[``(2) subject to discovery in connection with a civil,
criminal, or administrative proceeding;
[``(3) disclosed pursuant to section 552 of title 5, United
States Code (commonly known as the Freedom of Information
Act) or any other similar Federal or State law;
[``(4) admitted as evidence or otherwise disclosed in any
civil, criminal, or administrative proceeding; or
[``(5) utilized in an adverse employment action or in the
evaluation of decisions made in relation to accreditation,
certification, credentialing or licensing of an individual,
that is based on such individual's participation in the
development, collection, reporting, or storage of patient
safety data in accordance with this part.
[``(c) Disclosure Requirements.--Nothing in this section
shall be construed to prohibit one or more of the following
disclosures (which are deemed to be necessary for the proper
management and administration of the patient safety
organization):
[``(1) Disclosures by a provider in complying with
authorized requests for the provision of information to which
subsection (a) applies (such as a patient's medical record or
other relevant information) that is in the control of such a
provider and that has been developed, maintained, or exists
separately from the process by which the provider collects or
develops information for reporting to a patient safety
organization.
[``(2) Disclosures by a provider or patient safety
organization of patient safety data as part of a disciplinary
proceeding relating to a provider, or a criminal proceeding,
if such a disclosure of such patient safety data is--
[``(A) material to the proceeding;
[``(B) within the public interest; and
[``(C) not available from any other source.
[``(3) Disclosures by a provider or patient safety
organization of relevant information to the Food and Drug
Administration, or to a person that is subject to the
jurisdiction of such Administration, with respect to an
Administration-regulated product or activity for which that
entity has responsibility, for the purposes of activities
related to the quality, safety, or effectiveness of such
Administration-regulated product or activity, subject to
section 520(c) of the Federal Food, Drug, and Cosmetic Act.
[``(4) Disclosures by a provider or patient safety
organization of information to which subsection (a) applies
to carry out activities described in paragraph (2)(A) (i)
through (vi) or (3) of section 921.
[``(d) Transfer of Information.--The transfer of any
patient safety data by a provider to a patient safety
organization shall not be treated as a waiver of any
privilege or protection established under this part or
established under State law.
[``(e) Penalty.--Except as provided in subsection (c) and
as otherwise provided for in this section, it shall be
unlawful for any person to disclose any patient safety data
described in subsection (a). Any person violating the
provisions of this section shall, upon conviction, be fined
in accordance with section 934(d).
[``(f) No Limitation of Other Privileges.--Nothing in this
section shall be construed to limit other privileges that are
available under Federal or State laws that provide greater
peer review or confidentiality protections than the peer
review and confidentiality protections provided for in this
section.
[``(g) Rule of Construction.--Nothing in this section shall
be construed to alter or affect the implementation of any
provision of section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 (Public Law 104-
191; 110 Stat. 2033) or any regulation promulgated under such
section.
[``SEC. 923. NATIONAL DATABASE.
[``(a) Authority.--
[``(1) In general.--In conducting activities under this
part, the Secretary may provide for the establishment and
maintenance of a database to receive relevant non-
identifiable patient safety data, or may designate entities
to collect relevant non-identifiable patient safety data,
that is voluntarily reported by patient safety organizations
upon the request of the Secretary.
[``(2) Use of data.--Data reported to any database
established or designated under paragraph (1) shall be used
to analyze regional variations and national statistics
related to patient safety and health care quality. The
information resulting from such analyses may be included in
the annual quality reports prepared under section 913(b)(2).
[``(b) Standards.--In developing or designating a database
under subsection (a)(1), the Secretary may determine common
formats for the voluntary reporting of non-identifiable
patient safety data, including necessary data elements,
common and consistent definitions, and a standardized
computer interface for the processing of such data. To the
extent practicable, such standards shall be consistent with
the administrative simplification provisions of part C of
title XI of the Social Security Act.
[``(c) Confidentiality.--Any non-identifiable patient
safety data that is transferred to the database under this
section shall be privileged and confidential.
[``SEC. 924. TECHNICAL ASSISTANCE.
[``The Secretary, acting through the Director, may provide
technical assistance to patient safety organizations. Such
assistance shall include annual meetings for patient safety
organizations to discuss methodology, communication, data
collection, or privacy concerns.
[``SEC. 925. PROMOTING THE INTEGRATION OF HEALTH CARE
INFORMATION TECHNOLOGY SYSTEMS.
[``(a) Development.--Not later than 36 months after the
date of enactment of the Patient Safety and Quality
Improvement Act, the Secretary shall develop or adopt
voluntary national standards that promote the integration of
health care information technology systems.
[``(b) Updates.--The Secretary shall provide for the
ongoing review and periodic updating of the standards
developed under subsection (a).
[``(c) Dissemination.--The Secretary shall provide for the
dissemination of the standards developed and updated under
this section.
[``SEC. 926. AUTHORIZATION OF APPROPRIATIONS.
[``There is authorized to be appropriated such sums as may
be necessary to carry out this part.''.
[SEC. 4. STUDIES AND REPORTS.
[(a) Medical Technologies and Therapies.--
[(1) In general.--The Secretary of Health and Human
Services shall enter into a contract with an appropriate
research organization for the conduct of a study to assess
the impact of medical technologies and therapies on patient
safety, patient benefit, health
[[Page S8629]]
care quality, and the costs of care as well as productivity
growth. Such study shall determine--
[(A) the extent to which the current health care system's
use of labor versus the use of technology has contributed to
increases in the share of the gross domestic product that is
devoted to health care and the impact of medical technologies
and therapies on such increases;
[(B) the extent to which early and appropriate introduction
and integration of innovative medical technologies and
therapies may affect the overall productivity and quality of
the health care delivery systems of the United States; and
[(C) the relationship of such medical technologies and
therapies to patient safety, patient benefit, health care
quality, and cost of care.
[(2) Report.--Not later than 18 months after the date of
enactment of this Act, the Secretary of Health and Human
Services shall prepare and submit to the appropriate
committees of Congress a report containing the results of the
study conducted under paragraph (1).
[(b) State Laws Relating to Patient Safety Peer Review
Systems.--
[(1) Survey.--The Attorney General shall conduct a survey
of State laws that relate to patient safety data peer review
systems, including laws that establish an evidentiary
privilege applicable to data developed by such systems, and
shall review the manner in which such laws have been
interpreted by the courts.
[(2) Report.--Not later than 9 months after the date of
enactment of this Act, the Attorney General shall prepare and
submit to the Committee on Health, Education, Labor, and
Pensions of the Senate and the Committee on Energy and
Commerce of the House of Representatives, a report concerning
the results of the survey conducted under paragraph (1).]
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patient Safety and Quality
Improvement Act of 2003''.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress makes the following findings:
(1) In 1999, the Institute of Medicine released a report
entitled To Err is Human that described medical errors as the
eighth leading cause of death in the United States, with as
many as 98,000 people dying as a result of medical errors
each year.
(2) To address these deaths and injuries due to medical
errors, the health care system must identify and learn from
such errors so that systems of care can be improved.
(3) In their report, the Institute of Medicine called on
Congress to provide legal protections with respect to
information reported for the purposes of quality improvement
and patient safety.
(4) The Health, Education, Labor, and Pensions Committee of
the Senate held 4 hearings in the 106th Congress and 1
hearing in the 107th Congress on patient safety where experts
in the field supported the recommendation of the Institute of
Medicine for congressional action.
(5) Myriad public and private patient safety initiatives
have begun. The Quality Interagency Coordination Taskforce
has recommended steps to improve patient safety that may be
taken by each Federal agency involved in health care and
activities relating to these steps are ongoing.
(6) The research on patient safety unequivocally calls for
a learning environment, rather than a punitive environment,
in order to improve patient safety.
(7) Voluntary data gathering systems are more supportive
than mandatory systems in creating the learning environment
referred to in paragraph (6) as stated in the Institute of
Medicine's report.
(8) Promising patient safety reporting systems have been
established throughout the United States and the best ways to
structure and use these systems are currently being
determined, largely through projects funded by the Agency for
Healthcare Research and Quality.
(9) Many organizations currently collecting patient safety
data have expressed a need for legal protections that will
allow them to review protected information and collaborate in
the development and implementation of patient safety
improvement strategies. Currently, the State peer review
protections are inadequate to allow the sharing of
information to promote patient safety.
(b) Purposes.--It is the purpose of this Act to--
(1) encourage a culture of safety and quality in the United
States health care system by providing for legal protection
of information reported voluntarily for the purposes of
quality improvement and patient safety; and
(2) ensure accountability by raising standards and
expectations for continuous quality improvements in patient
safety.
SEC. 3. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.
Title IX of the Public Health Service Act (42 U.S.C. 299 et
seq.) is amended--
(1) in section 912(c), by inserting ``, in accordance with
part C,'' after ``The Director shall'';
(2) by redesignating part C as part D;
(3) by redesignating sections 921 through 928, as sections
931 through 938, respectively;
(4) in 934(d) (as so redesignated), by striking the second
sentence and inserting the following: ``Penalties provided
for under this section shall be imposed and collected by the
Secretary using the administrative and procedural processes
used to impose and collect civil money penalties under
section 1128A of the Social Security Act (other than
subsections (a) and (b), the second sentence of subsection
(f), and subsections (i), (m), and (n)), unless the Secretary
determines that a modification of procedures would be more
suitable or reasonable to carry out this subsection and
provides for such modification by regulation.'';
(5) in section 938(1) (as so redesignated), by striking
``921'' and inserting ``931''; and
(6) by inserting after part B the following:
``PART C--PATIENT SAFETY IMPROVEMENT
``SEC. 921. DEFINITIONS.
``In this part:
``(1) Non-identifiable information.--
``(A) In general.--The term `non-identifiable information'
means information that is presented in a form and manner that
prevents the identification of a provider, a patient, or a
reporter of patient safety data.
``(B) Identifiability of patient.--For purposes of
subparagraph (A), the term `presented in a form and manner
that prevents the identification of a patient' means, with
respect to information that has been subject to rules
promulgated pursuant to section 264(c) of the Health
Insurance Portability and Accountability Act of 1996 (42
U.S.C. 1320d-2 note), that the information has been de-
identified so that it is no longer individually identifiable
health information as defined in such rules.
``(2) Patient safety data.--
``(A) In general.--The term `patient safety data' means--
``(i) any data, reports, records, memoranda, analyses (such
as root cause analyses), or statements that could result in
improved patient safety or health care quality or health care
outcomes, that are--
``(I) collected or developed by a provider for reporting to
a patient safety organization, provided that they are
reported to the patient safety organization within a
reasonable period of time;
``(II) requested by a patient safety organization
(including the contents of such request);
``(III) reported to a provider by a patient safety
organization; or
``(IV) collected from a provider or patient safety
organization or developed by a patient safety organization;
or
``(ii) any deliberative work or process or oral
communications with respect to any patient safety data
described in clause (i).
``(B) Limitation.--The term `patient safety data' shall not
include information (including a patient's medical record)
that is collected or developed separately from and that
exists separately from patient safety data. Such separate
information or a copy thereof submitted to a patient safety
organization shall not itself be considered as patient safety
data.
``(3) Patient safety organization.--The term `patient
safety organization' means a private or public organization
or component thereof that performs all of the following
activities (which are deemed to be necessary for the proper
management and administration of such organization or
component thereof), and that is currently listed by the
Secretary as a patient safety organization pursuant to
section 924(c):
``(A) The conduct, as its primary activity, of efforts to
improve patient safety and the quality of health care
delivery.
``(B) The collection and analysis of patient safety data
that are submitted by more than one provider.
``(C) The development and dissemination of information to
providers with respect to improving patient safety, such as
recommendations, protocols, or information regarding best
practices.
``(D) The utilization of patient safety data for the
purposes of encouraging a culture of safety and of providing
direct feedback and assistance to providers to effectively
minimize patient risk.
``(E) The maintenance of a process to preserve
confidentiality with respect to the information that is not
non-identifiable.
``(F) The provision of appropriate security measures with
respect to patient safety data.
``(G) The submittal to the Secretary of a certification
pursuant to section 924.
``(4) Provider.--The term `provider' means--
``(A) a person licensed or otherwise authorized under State
law to provide health care services, including--
``(i) a hospital, nursing facility, comprehensive
outpatient rehabilitation facility, home health agency,
hospice program, renal dialysis facility, ambulatory surgical
center, pharmacy, physician or health care practitioner's
office, long term care facility, behavior health residential
treatment facility, clinical laboratory, or health center; or
``(ii) a physician, physician assistant, nurse
practitioner, clinical nurse specialist, certified registered
nurse anesthetist, certified nurse midwife, psychologist,
certified social worker, registered dietitian or nutrition
professional, physical or occupational therapist, pharmacist,
or other individual health care practitioner; or
``(B) any other person specified in regulations promulgated
by the Secretary.
``SEC. 922. PRIVILEGE AND CONFIDENTIALITY PROTECTIONS.
``(a) Privilege.--Notwithstanding any other provision of
Federal, State, or local law, patient safety data shall be
privileged and, subject to the provisions of subsection (c),
shall not be--
``(1) subject to a Federal, State, or local civil,
criminal, or administrative subpoena;
``(2) subject to discovery in connection with a Federal,
State, or local civil, criminal, or administrative
proceeding;
``(3) disclosed pursuant to section 552 of title 5, United
States Code (commonly known as the Freedom of Information
Act) or any other similar Federal, State, or local law;
``(4) admitted as evidence or otherwise disclosed in any
Federal, State, or local civil, criminal, or administrative
proceeding; or
``(5) utilized in a disciplinary proceeding against a
provider.
[[Page S8630]]
``(b) Confidentiality.--Notwithstanding any other provision
of Federal, State, or local law, and subject to the
provisions of subsections (c) and (d), patient safety data
shall be confidential and shall not be disclosed.
``(c) Exceptions to Privilege and Confidentiality.--Nothing
in this section shall be construed to prohibit one or more of
the following uses or disclosures:
``(1) Disclosure by a provider or patient safety
organization of relevant patient safety data for use in a
criminal proceeding only after a court makes an in camera
determination that such patient safety data contains evidence
of an intentional act to directly harm the patient.
``(2) Voluntary disclosure by a provider or patient safety
organization of information to the Food and Drug
Administration, or to a person that is subject to the
jurisdiction of the Food and Drug Administration, with
respect to a Food and Drug Administration-regulated product
or activity for which that entity has responsibility, for the
purposes of activities related to the quality, safety, or
effectiveness of a Food and Drug Administration-regulated
product or activity or a Food and Drug Administration
proceeding.
``(3) Voluntary disclosure of non-identifiable patient
safety data by a provider or a patient safety organization.
``(4) Voluntary disclosure by a provider of patient safety
data to the Centers for Disease Control and Prevention for
public health surveillance, investigation, or other public
health activities.
``(d) Protected Disclosure and Use of Information.--Nothing
in this section shall be construed to prohibit one or more of
the following uses or disclosures:
``(1) Disclosure by a provider or patient safety
organization of information to which subsections (a) or (b)
applies to carry out activities described in paragraph (2) or
(3) of section 921.
``(2) Use or disclosure by a provider or patient safety
organization of patient safety data in connection with
providing treatment, improving patient safety, health care
quality or administrative efficiency, or any other customary
activity of the provider or in obtaining payment.
``(3) Disclosure of patient safety data among patient
safety organizations.
``(4) Disclosure of patient safety data by a provider or
patient safety organization to grantees or contractors
carrying out patient safety research, evaluation, or
demonstration projects authorized by the Director.
``(5) Disclosure of patient safety data by a provider to an
accrediting body that accredits that provider.
``(e) Continued Protection of Information.--Patient safety
data used or disclosed in accordance with subsection (d)
shall continue to be privileged and confidential in
accordance with subsections (a) and (b) and shall not be
disclosed--
``(1) by an entity that possessed such information before
such use or disclosure; or
``(2) by an entity to which the information was disclosed;
unless such additional disclosure is permitted under
subsection (d).
``(f) Limitation on Actions.--
``(1) Patient safety organizations.--Except as provided in
subsection (c), no action may be brought or process served
against a patient safety organization to compel disclosure of
information collected or developed under this part whether or
not such information is patient safety data.
``(2) Providers.--An accrediting body shall not take an
accrediting action against a provider based on the good faith
participation of the provider in the collection, development,
reporting, or maintenance of patient safety data in
accordance with this part. An accrediting body may not
require a provider to reveal its communications with any
patient safety organization established in accordance with
this part.
``(g) Disclosure or Use of Information.--
``(1) In general.--Except with respect to the specific
patient safety data that is used or disclosed, the disclosure
or use of any patient safety data in accordance with
subsection (c) or (d) shall not be treated as a waiver of any
privilege or protection established under this part.
``(2) Inadvertent disclosure or use.--The inadvertent
disclosure or use of patient safety data shall not waive any
privilege or protection established under this part with
respect to such data.
``(h) Reporter Protection.--
``(1) In general.--A provider may not take an adverse
employment action, as described in paragraph (2), against an
individual based upon the fact that the individual in good
faith reported information--
``(A) to the provider with the intention of having the
information reported to a patient safety organization; or
``(B) directly to a patient safety organization.
``(2) Adverse employment action.--For purposes of this
subsection, an `adverse employment action' includes--
``(A) loss of employment, the failure to promote an
individual, or the failure to provide any other employment-
related benefit for which the individual would otherwise be
eligible; or
``(B) an adverse evaluation or decision made in relation to
accreditation, certification, credentialing, or licensing of
the individual.
``(i) Enforcement.--
``(1) Prohibition.--Except as provided in subsections (c)
and (d) and as otherwise provided for in this section, it
shall be unlawful for any person to negligently or
intentionally disclose any patient safety data described in
subsection (a) and any such person shall, upon adjudication,
be assessed in accordance with section 934(d).
``(2) Relation to hipaa.--The penalty provided for under
paragraph (1) shall not apply if the defendant would
otherwise be subject to a penalty under the regulations
promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2
note) or under section 1176 of the Social Security Act (42
U.S.C. 1320d-5) for the same disclosure.
``(3) Equitable relief.--Without limiting remedies
available to other parties, a civil action may be brought by
any aggrieved individual to enjoin any act or practice that
violates subsection (h) and to obtain other appropriate
equitable relief (including reinstatement, back pay, and
restoration of benefits) to redress such violation.
``(4) Actions against state employees.--Notwithstanding
subsection (a), with respect to a State employer, the
privilege described in such subsection shall not apply to
such employer unless the employer consents, in advance, to be
subject to a civil action under paragraph (3).
``(j) Rule of Construction.--Nothing in this section shall
be construed to--
``(1) limit other privileges that are available under
Federal, State, or local laws that provide greater
confidentiality protections or privileges than the privilege
and confidentiality protections provided for in this section;
``(2) limit, alter, or affect the requirements of Federal,
State, or local law pertaining to patient-related data that
is not privileged or confidential under this section;
``(3) alter or affect the implementation of any provision
of section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191; 110 Stat.
2033), section 1176 of the Social Security Act (42 U.S.C.
1320d-5), or any regulation promulgated under such sections;
``(4) limit the authority of any provider, patient safety
organization, or other person to enter into a contract
requiring greater confidentiality or delegating authority to
make a disclosure or use in accordance with subsection (c) or
(d); and
``(5) prohibit a provider from reporting crime to law
enforcement authorities.
``SEC. 923. PATIENT SAFETY NETWORK OF DATABASES.
``(a) In General.--The Secretary shall maintain a patient
safety network of databases that provides an interactive
evidence-based management resource for providers, patient
safety organizations, and other persons. The network of
databases shall have the capacity to accept, aggregate, and
analyze nonidentifiable patient safety data voluntarily
reported by patient safety organizations, providers, or other
persons.
``(b) Network of Database Standards.--The Secretary may
determine common formats for the reporting to the patient
safety network of databases maintained under subsection (a)
of nonidentifiable patient safety data, including necessary
data elements, common and consistent definitions, and a
standardized computer interface for the processing of such
data. To the extent practicable, such standards shall be
consistent with the administrative simplification provisions
of part C of title XI of the Social Security Act.
``SEC. 924. PATIENT SAFETY ORGANIZATION CERTIFICATION AND
LISTING.
``(a) Certification.--
``(1) Initial certification.--Except as provided in
paragraph (2), an entity that seeks to be a patient safety
organization shall submit an initial certification to the
Secretary that the entity intends to perform the activities
described in subparagraphs (A) through (F) of section
921(3).
``(2) Delayed certification of collection from more than
one provider.--An entity that seeks to be a patient safety
organization may--
``(A) submit an initial certification that it intends to
perform the activities described in subparagraph (A) through
(F) of section 921(3) other than the activities described in
subparagraph (B) of such section; and
``(B) within 2 years of submitting the initial
certification under subparagraph (A), submit a supplemental
certification that it performs the activities described in
section 921(3)(B).
``(3) Expiration and renewal.--
``(A) Expiration.--An initial certification under paragraph
(1) or (2)(A) shall expire on the date that is 3 years after
it is submitted.
``(B) Renewal.--
``(i) In general.--An entity that seeks to remain a patient
safety organization after the expiration of an initial
certification under paragraph (1) or (2)(A) shall, within the
3-year period described in subparagraph (A), submit a renewal
certification to the Secretary that the entity satisfies the
criteria described in subparagraph (A) through (F) of section
921(3).
``(ii) Term of renewal.--A renewal certification under
clause (i) shall expire on the date that is 3 years after
that date on which it is submitted, and may be renewed in the
same manner as an initial certification.
``(b) Acceptance of Certification.--Upon the submission by
an organization of an initial certification pursuant to
subsection (a)(1) or (a)(2)(A), a supplemental certification
pursuant to subsection (a)(2)(B), or a renewal certification
pursuant to subsection (a)(3)(B), the Secretary shall review
such certification and--
``(1) if such certification meets the requirements of
subsection (a)(1) or (a)(2)(A), (a)(2)(B), or (a)(3)(B), as
applicable, the Secretary shall notify the organization that
such certification is accepted; or
``(2) if such certification does not meet such
requirements, as applicable, the Secretary shall notify the
organization that such certification is not accepted and the
reasons therefore.
``(c) Listing.--
``(1) In general.--Except as otherwise provided in this
subsection, the Secretary shall compile and maintain a
current listing of patient safety organizations with respect
to which the Secretary has accepted a certification pursuant
to subsection (b).
[[Page S8631]]
``(2) Removal from listing.--The Secretary shall remove
from the listing under paragraph (1)--
``(A) an entity with respect to which the Secretary has
accepted an initial certification pursuant to subsection
(a)(2)(A) and which does not submit a supplemental
certification pursuant to subsection (a)(2)(B) that is
accepted by the Secretary;
``(B) an entity whose certification expires and which does
not submit a renewal application that is accepted by the
Secretary; and
``(C) an entity with respect to which the Secretary revokes
the Secretary's acceptance of the entity's certification,
pursuant to subsection (d).
``(d) Revocation of Acceptance.--
``(1) In general.--Except as provided in paragraph (2), if
the Secretary determines that a patient safety organization
does not perform any activity described in subparagraph (A)
through (F) of section 921(3), the Secretary may, after
notice and an opportunity for a hearing, revoke the
Secretary's acceptance of the certification of such
organization.
``(2) Delayed certification of collection from more than
one provider.--A revocation under paragraph (1) may not be
based on a determination that the organization does not
perform the activity described in section 921(3)(B) if--
``(A) the listing of the organization is based on its
submittal of an initial certification under subsection
(a)(2)(A);
``(B) the organization has not submitted a supplemental
certification under subsection (a)(2)(B); and
``(C) the 2-year period described in subsection (a)(2)(B)
has not expired.
``(e) Notification of Revocation or Removal From Listing.--
``(1) Supplying confirmation of notification to
providers.--Within 15 days of a revocation under subsection
(d)(1), a patient safety organization shall submit to the
Secretary a confirmation that the organization has taken all
reasonable actions to notify each provider whose patient
safety data is collected or analyzed by the organization of
such revocation.
``(2) Publication.--Upon the revocation of an acceptance of
an organization's certification under subsection (d)(1), or
upon the removal of an organization from the listing under
subsection (c)(2), the Secretary shall publish notice of the
revocation or removal in the Federal Register.
``(f) Status of Data After Removal From Listing.--
``(1) New data.--With respect to the privilege and
confidentiality protections described in section 922, data
submitted to an organization within 30 days after the
organization is removed from the listing under subsection
(c)(2) shall have the same status as data submitted while the
organization was still listed.
``(2) Protection to continue to apply.--If the privilege
and confidentiality protections described in section 922
applied to data while an organization was listed, or during
the 30-day period described in paragraph (1), such
protections shall continue to apply to such data after the
organization is removed from the listing under subsection
(c)(2).
``(g) Disposition of Data.--If the Secretary revokes the
acceptance of an organization's certification under
subsection (d)(1) and removes the organization from the
listing as provided for in subsection (c)(2), with respect to
the patient safety data that the organization received from
providers, the organization shall--
``(1) with the approval of the provider and another patient
safety organization, transfer such data to such other
organization;
``(2) return such data to the provider of that patient
safety data; or
``(3) if returning such data to the provider is not
practicable, destroy such data.
``SEC. 925. TECHNICAL ASSISTANCE.
``The Secretary, acting through the Director, may provide
technical assistance to patient safety organizations,
including annual meetings for patient safety organizations to
discuss methodology, communication, data collection, or
privacy concerns.
``SEC. 926. PROMOTING THE INTEROPERABILITY OF HEALTH CARE
INFORMATION TECHNOLOGY SYSTEMS.
``(a) Development.--Not later than 36 months after the date
of enactment of the Patient Safety and Quality Improvement
Act of 2003, the Secretary shall develop or adopt voluntary
national standards that promote the electronic exchange of
health care information.
``(b) Updates.--The Secretary shall provide for the ongoing
review and periodic updating of the standards developed under
subsection (a).
``(c) Dissemination.--The Secretary shall provide for the
dissemination of the standards developed and updated under
this section.
``SEC. 927. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated such sums as may
be necessary to carry out this part.''.
SEC. 4. STUDIES AND REPORTS.
(a) In General.--The Secretary of Health and Human Services
shall enter into a contract (based upon a competitive
contracting process) with an appropriate research
organization for the conduct of a study to assess the impact
of medical technologies and therapies on patient safety,
patient benefit, health care quality, and the costs of care
as well as productivity growth. Such study shall examine--
(1) the extent to which factors, such as the use of labor
and technological advances, have contributed to increases in
the share of the gross domestic product that is devoted to
health care and the impact of medical technologies and
therapies on such increases;
(2) the extent to which early and appropriate introduction
and integration of innovative medical technologies and
therapies may affect the overall productivity and quality of
the health care delivery systems of the United States; and
(3) the relationship of such medical technologies and
therapies to patient safety, patient benefit, health care
quality, and cost of care.
(b) Report.--Not later than 18 months after the date of
enactment of this Act, the Secretary of Health and Human
Services shall prepare and submit to the appropriate
committees of Congress a report containing the results of the
study conducted under subsection (a).
Mr. KENNEDY. Mr. President, I commend Senator Gregg, Senator
Jeffords, Senator Dodd, Senator Frist, Senator Sessions, and all of the
other Democratic and Republican members of our Health committee who
have devoted extraordinary energy and skill to finding bipartisan
consensus on the complex issue of medical errors and improving patient
safety.
For even one American to die from an avoidable medical error is a
tragedy. That thousands die every year is a national disgrace--and an
urgent call to action.
More than 4 years ago, the Institute of Medicine reported that
medical errors cause 98,000 deaths every year. The IOM recommended that
health care professionals should be encouraged to report medical
errors, without fearing that their reports will be used against them.
Our legislation implements this sensible recommendation by establishing
patient safety organizations to analyze medical errors and recommend
ways to avoid them in future. The legislation also creates a legal
privilege for material reported to these safety organizations, while
seeing that original records, such as a patient's chart, remain
accessible to patients.
Drawing the boundaries of this privilege requires a careful balance.
The legislation is designed to create a culture in which medical
professionals feel secure in reporting errors without fear of
punishment, and it is right to do so. But we must be careful that in
doing so, we do not actually shield those who have negligently or
intentionally caused harm to patients. We must also make sure not to
interfere with existing State laws on reporting.
The proposal that the Senate considers today has made substantial and
welcome progress on these and other important issues, and I look
forward to making further progress in conference with our colleagues in
the House. I will do all I can to see that we continue the bipartisan
cooperation that has allowed today's important action. I look forward
to working with our colleagues in the House to produce a conference
report that includes the best features of the Senate and House
proposals. I believe that several features of the bipartisan House
legislation are worth close consideration by the conference, including
the strong protections against conflict of interest.
I hope that this legislation is the beginning of our action on
patient safety--not the conclusion. Other steps are also necessary. The
Federal Government should play a leading role in the quest for
improving quality and safety for patients. Indeed, the very title of
one of IOM's most important reports, ``Leadership by Example,''
highlights the central role that the Federal Government must play in
transforming the quality of health care.
I thank all my colleagues from both sides of the aisle, who came
together and put their differences aside to bring this legislation to
the floor. This legislation sends a promising message that every
patient in America will receive effective, high quality health care.
Mr. JEFFORDS. Mr. President, I am very pleased that today the Senate
will pass a measure that many have worked on for many years. The
Patient Safety and Quality Improvement Act, and similar companion
legislation, have been the focus of considerable efforts by many of our
colleagues since 1999. I must thank Senator Gregg, Senator Kennedy and
our other colleagues for all their hard work in bringing S. 720 before
the Senate today.
In 1999, Americans were shocked by the findings of the landmark
Institute of Medicine study on medical errors. As we all know, that
study reported that the number of deaths associated with medical errors
could be as high 98,000 each year.
Most importantly, the report noted that more than half of these
deaths resulted from preventable errors--needless deaths that could
have been prevented if we only had a system in place that would help
providers learn from each other's mistakes.
The bill starts with a simple premise. Let's set up a system that
helps our health
[[Page S8632]]
care providers learn from each other. Let's set up a system that
promotes the reporting and analysis of medical errors. Let's set up a
system that engenders the trust of providers and the patients they
serve.
Of course, we also live in a complex society, one in which medical
errors that may have harmed a patient might also be the basis for
litigation. It is a right under our laws to seek a remedy when harmed,
and we need to preserve access to certain information for this redress
of grievances.
However, an unfortunate consequence of living in a litigious society
is that hospitals and providers often feel that it's not in their best
interests to share information openly and honestly. We know, in fact,
that their attorneys and risk managers often advise them not to do so.
So, in order for our system to work, it needs to balance these
sometimes competing demands.
The bill we are considering strikes this balance. It calls for the
creation of new entities we call Patient Safety Organizations that
would collect voluntarily reported patient safety data. This bill
provides the protections of confidentiality and privilege to that
patient safety data, but the bill also sets definite limitations on
what can be considered confidential and privileged.
This legislation does nothing to reduce or affect other Federal,
State or local legal requirements pertaining to health related
information. Nor does this bill alter any existing rights or remedies
available to injured patients. The bottom line is that this legislation
neither strengthens nor weakens the existing system of tort and
liability law.
Instead, the legislation before us creates a new, parallel system of
information collection and analysis, designed to educate our doctors
and protect patients' safety everywhere. This bill reflects difficult
negotiations and many compromises over almost 5 years of consideration.
Through the contributions of Members on both sides of the aisle, this
legislation has been greatly strengthened since I first introduced it
back in the 106th Congress. I have appended these remarks with an
article I wrote that provides a more detailed description of the
efforts that have been made to reduce medical errors and I ask
unanimous consent that it will be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
First, Do No Harm
With the publication of the Institute of Medicine IOM
study, To Err is Human 1999, we were all reminded that
Hippocrates' maxim to ``first, do no harm'' is as relevant to
the practice of medicine today as it was in 400 B.C. The IOM
report was among the first to galvanize national attention on
the issue of patient safety when it reported that medical
errors contribute to approximately 100,000 patient deaths a
year. This startling and troubling statistic has been
verified in subsequent studies and cited in peer reviewed
articles in the leading journals of biomedical research,
including the Journal of the American Medical Association,
the Lancet, and the New England Journal of Medicine.
When I was Chairman of the Senate Committee on Health,
Education, Labor, and Pensions in 1999, I undertook several
hearings--five in all--to examine this issue and discuss the
recommendations of the To Err is Human report. The testimony
overwhelmingly agreed with several of the original Institute
of Medicine recommendations.
Perhaps the most important of these recommendations stress
that improving patient safety requires a learning environment
rather than a punitive environment; voluntary data gathering
systems as opposed to mandatory systems; and appropriate
legal protections--including confidentiality and privilege
from discovery--that allow for the review and analysis of
medical error information.
In response to this focused attention, a myriad of public
and private patient safety initiatives have begun. The
Department of Health and Human Services has initiated several
patient safety projects, including project grants funded by
the Agency for Healthcare Research and Quality AHRQ. The work
of the Veteran's Administration in developing and
implementing innovative patient safety systems--especially in
the area of medication management--has drawn attention from
throughout the country. In addition, the Quality Interagency
Coordination Taskforce has recommended steps to improve
patient safety that can be taken by each Federal agency
involved in health care, and agency activities to implement
these steps are ongoing.
In addition, several non-governmental organizations and
professional societies have ``stepped up to the plate'' of
patient safety. The Joint Commission on Accreditation of
Healthcare Organizations, the U.S. Pharmacopoeia, the
American Medical Association, and other health care providers
including the American Federation of Hospitals and American
Hospital Association have launched innovative efforts
dedicated to improving patient safety. However, many of the
organizations currently collecting patient safety data have
expressed the need for legal protections that will allow them
to review protected information so that they may collaborate
in the development and implementation of patient safety
improvement strategies.
The work of Lucien Leape, a member of the IOM panel and
adjunct professor of health policy at Harvard University, has
supported this view. Dr. Leape has argued persuasively that
we as a society will continue to have difficulty in reducing
medical errors and improving patient safety because our
institutions are ``still locked into a blame and punish
approach to errors and a focus on individual culpability,''
and that ``the fear of malpractice litigation thus becomes a
major barrier to openly discussing and reporting errors.''
I have introduced legislation with my colleagues, Senators
Bill Frist, John Breaux, and Judd Gregg, which seeks to
address these concerns. The legislation raises expectations
for higher standards for continuous patient safety
improvement and it encourages a new and needed culture of
patient safety among health care providers and American
hospitals. The bill accomplishes these goals by establishing
appropriate legal protections for patient safety information
voluntarily shared among patient safety organizations and
providers. Our legislation reflects the belief that a culture
of patient safety can flourish only in an environment where
information, data, process, and recommendations enjoy legal
protection and privilege.
Because it appropriately addresses an obvious need and
concern, the Jeffords Patient Safety and Quality Improvement
Act has enjoyed widespread endorsement by hospital, patient,
doctor, and consumer advocacy organizations. This degree of
support underscores the broad appeal and essential nature of
this proposed legislation.
In the time since the release of To Err is Human, the
Congress has been unable to enact sensible legislation to
reduce medical errors and increase patient safety. However I
believe we can accomplish that goal this year. The House of
Representatives has already passed its version of patient
safety legislation and we are working to pass the Patient
Safety and Quality Improvement Act in the Senate. I am
hopeful that we can reconcile disagreements that have
previously stopped this legislation from moving forward and I
am committed to seeing that happen.
It has been three years since the release of the IOM
report. That means, based on the IOM's statistics, that an
additional 300,000 deaths and an untold number of injuries
have occurred from medical errors. We need to apply
Hippocrates' admonition to ``first, do no harm'' beyond the
medical community to the legislative community. We need to
pass legislation now that will help the health care community
stop the needless injury caused by unintentional medical
errors.
Mr. JEFFORDS. I offer my appreciation to the many contributions from
Chairman Gregg, Ranking Member Kennedy, and Senators Frist, Breaux,
Enzi, Sessions, Dodd, and Bingaman.
We legislate many essential issues in the Congress, but rarely can we
say that what we do is a matter of life and death. This, however, is
one of those issues. The time to act is long overdue. This is an area
where delay will lead to deaths that can be prevented. I urge all of my
colleagues to vote in support of this bill.
Mr. FRIST. I ask unanimous consent that the amendment at the desk be
agreed to, the committee amendment as amended be agreed to, the bill as
amended be read a third time, and the HELP Committee be discharged from
further consideration of H.R. 663, and the Senate proceed to its
consideration; provided that all after the enacting clause be stricken
and the text of S. 720, as amended, be inserted in lieu thereof;
provided further that the bill, as amended, be read a third time and
passed, the Senate insist upon its amendment and request a conference
with the House of Representatives on the disagreeing votes of the two
Houses, and the Chair be authorized to appoint conferees with a ratio
of 4 to 3.
Finally, I ask unanimous consent that S. 720 be returned to the
Calendar.
The PRESIDING OFFICER. Is there objection?
Mr. REID. Mr. President, reserving the right to object, I was on the
Senate floor a few weeks ago with the distinguished chairman of the
HELP Committee. At that time there was an attempt to move the bill.
I said at that time this bill could be done. There were ways we could
accomplish it. This is an extremely important piece of legislation.
Through the Chair to the distinguished majority leader, he knows better
than I. He is a
[[Page S8633]]
physician. But from what I know of patient safety, this is an extremely
important piece of legislation, and we have been able to do it. We are
going to be able to go to conference. There has been agreement between
the Chair and the ranking member. I think this is an important step
forward.
I would say, through the Chair to my friend who is not here, the
distinguished chairman of the HELP Committee, I am glad he brought this
to the Senate's attention. I am glad we did not agree to what his
unanimous consent request was at that time. But we were able to get it
done, and I am very happy for that.
I have no objection. This is an important piece of legislation. I now
wish the conferees well.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 3568) was agreed to.
(The amendment is printed in today's Record under ``Text of
Amendments.'')
The committee amendment in the nature of a substitute, as amended,
was agreed to.
The bill (H.R. 663), as amended, was read the third time and passed.
(The bill will be printed in a future edition of the Record.)
The Presiding Officer (Mr. Enzi) appointed Mr. Gregg, Mr. Frist, Mr.
Enzi, Mr. Alexander, Mr. Kennedy, Mr. Dodd, and Mr. Jeffords conferees
on the part of the Senate.
Mr. FRIST. Mr. President, I do want to congratulate Senator Gregg,
chairman of the HELP Committee, and ranking member, Senator Kennedy.
This is a piece of legislation that people can trace. Several years
ago, the Institute of Medicine did an outstanding report. We rely on
the Institute of Medicine again and again to objectively, in a
nonpartisan way, look at a whole range of issues, from the financing of
health care, health care delivery, preventive health care, acute
treatment, chronic treatment. They really respond very much to outside
bodies like the Senate and do studies.
One great study they did--people have argued their numbers aren't
exactly right, too high, too low--but it was that about 100,000 people
die every year from systems' lapses, medical errors. Those are, for the
most part, preventable deaths, if you improve the systems. This bill
goes right at the heart of improving the systems and does so in a way
that relies on individuals who may observe something that didn't work
out, sharing that data with their peers in a way that they do not have
to fear lawsuits.
Obviously, if there is wrongdoing, lawsuits would be appropriate.
But, if it is an error, minor error, or even a more serious error, it
can be addressed upfront in a way that you do not have to be afraid
somebody is going to come in and crush you from the outside.
I say that because it is a bipartisan bill. It went through the
Health, Education, Labor and Pension Committee. I think the fundamental
structure of the bill went through the committee unanimously. It shows
tremendous leadership.
There were disagreements on a few items that have been worked out,
with Senator Gregg's leadership, working with Senator Kennedy. With
that, we have a very good bill, a strong bill that will change systems
of health care in a positive way, and clinics and hospitals and
physicians offices such that we can eliminate or greatly reduce the
number of unnecessary medical errors that occur in large part through
systems approaches.
Just an example would be if somebody is on 10 different medicines and
somebody prescribes a new medicine. You don't know the interaction of
those medicines. You need a system to identify that. That sort of
organized, commonsense approach to improve systems is made possible by
this bill.
Mr. ENZI. Mr. President, the Senate this evening has taken a major
step toward better and safer health care for all Americans.
Tonight, we approved the Patient Safety and Quality Improvement Act.
The goal of this legislation is to allow health care providers some
freedom from legal fear so they can do what we all strive to do every
day--learn from our mistakes.
This bill would create a framework through which hospitals, doctors,
and other health care providers can work to improve health care quality
in a protected legal environment. It would accomplish this by granting
privilege and confidentiality protections to health care providers to
allow them to report health care errors and ``near misses'' to patient
safety organizations.
This bill would not permit anyone to hide information about a medical
mistake. Lawyers would still have access to medical records and other
information that would normally be discoverable in a legal proceeding.
However, the bill would ensure that the analysis of that information by
patient safety organizations would take place on a separate track in a
protected legal environment.
Under the bill, patient safety organizations would have the freedom
to collect and analyze data on health care errors in confidence, and
then report their findings to the health care community. These findings
would help health care providers understand how mistakes happen in our
health care system, and how to prevent them.
If we can reach an agreement in conference in the House and send this
bill to the President, health care providers will be much more likely
to share information about honest mistakes, because they will have some
assurance that the analysis of their information won't result in a tidy
package of information that a personal injury lawyer could use against
them in court.
I express my appreciation for the hard work that the members of the
Committee on Health, Education, Labor, and Pensions put into this bill,
particularly Chairman Gregg, Majority Leader Frist, the lead sponsor
Senator Jeffords, and Senators Sessions and Kennedy.
I also thank the staff who worked so diligently over the course of
this Congress to craft this legislation, particularly Vince
Ventimiglia, Peggy Carlson, David Fisher, Dean Rosen, Jim Hippe, Sean
Donohue, Megan Clarke, David Nexon, David Bowen, and of course Stephen
Northrup with my office.
Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. FRIST. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________