[Congressional Record Volume 150, Number 138 (Tuesday, December 7, 2004)]
[Senate]
[Pages S11888-S11890]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ELDER JUSTICE ACT
Mr. GRAHAM of Florida. Mr. President, I wish to commend Senator John
Breaux and his staff for their excellent work on the Elder Justice Act.
They have worked long and hard on this legislation, and I share their
strong desire to see it pass the Senate this year.
I would like to share the comments I received from two Florida
attorneys, Nick Cox and Mark Shalloway, who have extensive knowledge
and experience in elder justice issues.
Nick Cox is a professor at the Stetson University College of Law in
St. Petersburg, where he specializes in elder consumer protection
matters and works on a special Federal project within the Elder Law
Center. Mr. Cox, a former State prosecutor, worked for Attorneys
General Bob Butterworth and Charlie Crist as their acting central
Florida regional deputy and bureau chief of the Economic Crimes
Division, which is the Florida Attorney General's consumer protection
unit. Mr. Cox's comments are as follows:
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I feel very strongly about passage of this act from a
consumer protection standpoint. At this time I have been
researching criminal elder exploitation issues and have found
that there is a complete lacking in good support research.
Despite several attempts to get a statistical handle on how
bad criminal exploitation of the elderly is, the reports that
have been done have been consistently criticized or found to
be scientifically/statistically deficient. The Elder Justice
Act calls for such research to be done on a national level
and would provide the needed data that could assist those of
us in the field of identifying the primary issues and
hopefully some suggestions for solutions to the problem.
I also am very excited about the call in the Elder Justice
Act for nationwide centers of excellence for study into these
matters. We have already begun such work here at Stetson, but
we can only address it on a regional basis here given the
magnitude of our senior populations in Florida and throughout
the Southeast United States. However, the work we have done
so far has been very well received and applauded by those in
the aging network. I think the Elder Justice Act would also
give us some significant strides forward in that respect as
well.
I also, as a former prosecutor, appreciate the attention it
seems to give to increasing prosecutions. From the
exploitation standpoint, I have experienced the positive
outcome of criminally charging scam artists and the resulting
change in business practices in that area. My office
conducted undercover sting operations with the Florida
Department of Law Enforcement. Once we convinced a prosecutor
to charge a few of the salesmen and business owners who were
targeting and scaring seniors into buying unneeded and
overpriced equipment, there was an immediate change in the
manner in which other companies conducted business.
Anything we can do to encourage or mandate criminal
prosecutions will be a positive step. I think the Elder
Justice Act starts us in the right direction.
Mark Shalloway is a practicing attorney in West Palm Beach and has
extensive experience in elder abuse and exploitation. Mr. Shalloway's
comments are as follows:
Elder Law attorneys, including my Florida colleagues see a
great deal of elder abuse and financial exploitation on a
weekly to monthly basis in our offices. The National Academy
of Elder Law Attorneys (NAELA) is one of the five founding
members of the Elder Justice Coalition that has worked for
several years to get this piece of legislation passed.
Senator Breaux and other supporters, like yourself, deserve
much credit for keeping this bill on the front burner during
a year when few bills have been addressed.
The revised version of S. 333 that the Finance Committee
has marked up is not as comprehensive as the original bill,
but is a great starting point and should be passed by the
full Senate as soon as possible.
As a Long-Term Care Ombudsman in Florida, I am anecdotally
aware of the difficulties in identifying and prosecuting
crimes against the elderly. This Act should give greater
recognition to a silent but huge and growing problem.
I agree with the comments of Mr. Cox and Mr. Shalloway, and have thus
strongly supported passage of the Elder Justice Act.
During Finance Committee deliberations of the Elder Justice Act, I
added two critically important provisions to the bill. These amendments
strengthened the bill immensely, would have greatly improved patient
safety in long-term care facilities, and, in fact, would have saved
lives.
Therefore, I am greatly disappointed that my patient safety
provisions were the basis of an objection from Senator Gregg. That
objection resulted in the provisions being stripped from the Elder
Justice Act. The result? The legislation will do less on behalf of our
elderly Americans than it could have done, and the elderly will
continue to suffer from adverse events and death as a result of
medication errors. This disappoints me deeply.
I would like to briefly describe the two amendments I had hoped would
be part of the Elder Justice Act.
The first would have provided grants to long-term care facilities to
improve quality and prevent neglect by improving patient safety and
reducing health care complications and deaths resulting from medication
errors in long-term care settings.
Section 108 of the Medicare Modernization Act gave authority to the
Secretary to make such grants available to physicians in order to
improve the quality of care and patient safety in physician offices. We
should strive for no less for our patients in long-term care
facilities.
According to the Institute of Medicine, medical errors cause up to
98,000 deaths in this country each year, in addition to otherwise
avoidable injuries, hospitalizations, and expenses.
Although technologies are available to reduce errors and save lives,
start-up costs and a lack of awareness have slowed the diffusion of
these technologies, and prevented our long-term care facilities and
elderly patients from reaping the benefits of these technologies.
The grant program would improve patient safety among the elderly by
reducing medication errors in long-term care facilities. Grant money
could be used by long-term care facilities to purchase proven
technologies; the adoption of computer physician order entry systems,
for example, is an essential component of any effective strategy to
reduce medication errors.
Purchase and deployment of such systems is a substantial investment.
Costs can delay the rapid introduction of new information technologies
into long-term care facilities that already are grappling with other
major financial challenges.
The grant program would have reduced this barrier by providing
financial incentives for long term care facilities to adopt the
resource intensive information technologies essential to system wide
strategies for reducing and eventually ending most medication errors.
We know how to improve patient safety. We know how to save lives. My
provision to create a grant program would have done just that, and I
deeply regret having to strike the provision because of Senator Gregg's
objection to it.
My second amendment would have required the Secretary of Health and
Human Services to develop a plan for adopting open standards to enable
improved electronic submission of clinical data by long term care
facilities and allowing electronic transmission of data using such
standards.
Although the Medicare Modernization Act requires the Secretary to
develop uniform standards relating to requirements for electronic
prescription drug programs, there is no provision for adopting uniform
standards for data not related to prescription drug programs and no
requirement that the Secretary allow long term care facilities to
submit data electronically to HHS using uniform open standards.
The use of open standards is critical to ensuring that systems are
able to communicate with each other and without human manipulation,
thus allowing information to be processed automatically and quickly.
Automatic, expedited processing of information will reduce neglect in
the form of medical errors and save lives.
Currently, data may only be transmitted electronically using
spreadsheets, PDFs, or SAS transport files. This form of submission
does not allow systems to communicate with each other, and slows the
processing of information.
I would like to explain the importance of this amendment to my
constituents back in Florida and to people throughout our country.
Flu season is approaching. Without timely and accurate information to
guide public health officials and physicians, seniors in my State and
throughout the country are at risk. But, the public health system
currently relies on a slow and unreliable methods of tracking outbreaks
such as postcards and phonecalls from physicians and other medical
professionals. If I want to get information on the health status of 290
million Americans, post cards and telephone calls simply aren't
adequate. We need to use electronic reporting based on some common
method of collecting that data to make public health safer.
Vioxx provides another example. Vioxx is a drug used for arthritis by
seniors throughout the world; it was withdrawn by its manufacturer this
fall. Vioxx was first sold in the United States 5 years ago and has
been marketed in more than 80 countries. Worldwide sales of Vioxx in
2003 were $2.5 billion. It is a major drug with broad use. But, the FDA
relies on slow and unreliable methods of tracking problems associated
with drugs that may only appear after they go into broad use. Although
prescriptions are one of the most thoroughly computerized areas in
medicine, the FDA relies on slow and unreliable methods to track
medical problems resulting from drug use. We need to use electronic
reporting based on common method of collecting that data to make drug
use safer.
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One last example: heart conditions are one of the leading diseases
affecting Medicare patients and heart attacks can result in deaths and
high costs. Many heart attack victims can be helped if they receive
drugs to assist their damaged heart while it recovers. CMS studies
indicate that many of the victims do not receive those medications.
But, CMS collects that data with great effort--relying on many health
professionals to extract data from clinical records and summarize the
data for analysis. By the time the data is available, the patient has
met their fate and the time for correcting a mistake, for getting them
a lifesaving drug, has passed. We need to use electronic reporting
based on a common method of collecting data to improve quality of care
and patient safety for those in long-term care facilities, and for all
Medicare patients.
I had hoped to see these measures pass in my final days in the Senate
and thus leave patients with a safer medical system. I am deeply
disappointed in the removal of the amendments from the Elder Justice
Act.
However because of my great desire to see the Elder Justice Act go
through, I removed my hold on the legislation on Wednesday, November
17. It is my understanding that the Elder Justice Act has not yet
cleared the Senate because of Republican objections to the substance of
the legislation.
I share Senator Breaux's desire to see the legislation enacted this
year, and fervently hope that may still be possible.
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