Congressional Record, Volume 151 Issue 27 (Wednesday, March 9, 2005)

[Congressional Record Volume 151, Number 27 (Wednesday, March 9, 2005)]
[House]
[Pages H1218-H1224]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

HEALTH CARE

The SPEAKER pro tempore (Mr. Inglis). Under the Speaker's announced
policy of January 4, 2005, the gentleman from Georgia (Mr. Gingrey) is
recognized for 60 minutes as the designee of the majority leader.
Mr. GINGREY. Mr. Speaker, tonight, as part of the Republican Health
Care Public Affairs Team, my co-chair, the gentleman from Pennsylvania
(Mr. Murphy), and I are here with a couple of our colleagues to talk
about, over the next hour, one of the most important things to the
people of this great country, and that is health care and our health
care system.
We have a great system, without question, probably the greatest
health care system on Earth. But we are not going to just stand up here
during this next hour or as we go forward with our Health Care Public
Affairs Team and on a monthly basis, talk about different health care
issues that are so important to this Nation and pat ourselves on the
back. We are not going to do that. We are going to talk about some
problems that exist.
Tonight, we are going to focus primarily on the civil justice system
and trying to solve a problem in regard to medical liability insurance
and the lack of access to care. But there are so many other issues that
we will be talking about as we go forward in this series of 1-hour
discussions with our colleagues, Mr. Speaker. Things like Medicaid.
Obviously, we have got a serious problem with Medicaid. We need to
reform that system, and the President talked about many of these things
in his State of the Union address. We addressed, of course, Medicare
modernization and the prescription drug act last year. In fact,
December of 2003 is when that bill was signed by President Bush.
But we will continue to focus on Medicare in realizing that it is not
a perfect system. It is a good system. It has served our people well,
but it is not perfect.
Then, of course, the issue of the uninsured, some 43 million in this
country. Many of them, Mr. Speaker, have jobs. They work. They are not
unemployed, but they are underemployed and, in many cases, are not
insured at all. They do not have the opportunity to purchase health
insurance. Maybe it is not even offered by their employer, or if it is,
they cannot afford to purchase that insurance. And my colleague, the
co-chairman of this Republican Health Care Public Affairs Team who is
with us tonight, will be speaking in just a few minutes. We will be
talking about, also, just the issue of electronic medical record
keeping and how important that is to reduce the number of errors,
medical errors that we know cause far too many injuries and, yes, in
some cases, loss of life in this country. The gentleman from
Pennsylvania (Mr. Murphy) will talk about that.
The main emphasis tonight, of course, as I stated, Mr. Speaker, will
be to talk about this issue of medical liability and why it is causing
such anguish in our country and resulting in the lack of timely and
necessary access to health care.
I am often asked, I am a physician Member, I think, Mr. Speaker, you
know that, and my colleagues are aware of that. I came to this body
after practicing OB-GYN medicine in my district, the 11th district of
Georgia, the City of Marietta, Cobb County of Georgia, where I
delivered over 5,200 babies. And it was tough to give up that practice.
But without question, I was beginning to feel a lot of stress, a lot of
anxiety, frustration in my medical practice as I watched those medical
liability insurance premiums just continue to skyrocket and get up to
the point where it was awfully difficult to be able to afford that.
So this is really what a lot of my colleagues are going through. I
have also had people back in the district say, now, I think you have a
lot of doctors and a lot of health care providers in the Congress now.
Did we not elect a few more? In fact, we did in this 109th Congress. We
grew our numbers a little bit, Mr. Speaker. We went from a grand total
of seven M.D.'s to ten in the House, and of course, we have a number of
other health care providers, be they nurses or dentists or pharmacists
or psychologists, but it is still a small number.
When we look at 435 Members, and maybe we have something less than 20
who have a background in health care, in the health care professions,
and on the Senate side, we increased our number over there by 100
percent this time. We went from one to two. And, of course, I am
speaking of the majority leader of the Senate, Dr. Frist, and also,
now, Senator Coburn from the great State of Oklahoma.
But we are determined to talk about this health care issue and make
sure the American people know that, while we might not be large in
numbers, we are going to discuss these issues. We are going to do it on
a regular basis.
The Republican hour tonight, of which we are managing, we are going
to get this issue in front of our colleagues, in front of the public
and let them know that we care about this. It is a tremendously
important issue, and it should not be partisan.
When you think about it, health care, when you have a patient, you
never ask them if they are a Republican or a Democrat. And believe you
me, they do not ask their doctor either. President Reagan joked about
that when he was shot and went to the hospital and looked up just
before they put him to sleep, looked up at the anesthesiologist and
said, I sure hope we got some good Republicans in here. But truly, we
have, as I say, there are ten M.D.'s in the House, three on the
Democratic side, seven on the Republican side. But we are not going to
let this be a partisan issue.
We are going to just talk to our colleagues and make sure that
everybody understands that we need to do this for the good of the
country and not for the good of a party or, in particular, not with our
vision, our focus on the next election.
The issue of medical liability and the crisis that we are in, Mr.
Speaker, I would like to call attention to this first slide that we
have that shows the United States of America and the number of States
that are either in crisis in regard to this issue or they are getting
darn close.
I know that my colleagues on the other side of the aisle do not like
the word crisis. And we are talking about another issue, of course, in
regard to that, but let us say a serious, a very serious problem. But I
think indeed a crisis.
In my State of Georgia, along with about 13 others depicted here in
red, indeed a State in crisis, and something like 25 other States
depicted in yellow, showing serious problems in regard to this issue.
In fact, there is just only a handful of States, maybe less than six or
eight, that are not either in crisis or near crisis. And what do I mean
by that?
If you think about the fact that, when people go to the emergency
room

[[Page H1219]]

with an injured child, and maybe it is a head injury, maybe that child
is unconscious, they at that point do not need a family practitioner.
They do not need an OB-GYN. They do not need an oral surgeon. They need
a neurosurgeon. They need someone who can immediately assess the
condition of that child and if there is a serious head injury. And
certainly, if the child is unconscious, that is very likely.
If there is no neurosurgeon there that can act in a very timely
manner and in some instances get that child to surgery, the damage that
can be done is irreparable damage and it cannot be undone.

{time} 1845

So we know that we have physicians like neurosurgeons, and I
mentioned my specialty, OB/GYN. Doctors who are involved in high-risk
specialties are the ones that are getting absolutely killed by runaway
medical liability premiums and that constant threat. They are willing,
through compassion and love of their profession and their patients, to
take on those tough cases, those high-risk obstetrical cases.
I will use the word ``toxemia.'' I am sure most of my colleagues, Mr.
Speaker, do not know what that is, but all of the OB/GYNs certainly
know what I am talking about, a life-threatening complication of
pregnancy. If a doctor is not available to treat that condition, these
people could not only lose their child but they could lose their lives.
So we have some real serious problems, and I think it is just time to
talk about it.
I am very thankful that my State, as I showed my colleagues on the
first slide, is one of the 13 or so that is in crisis, did during this
session of their General Assembly just pass a really good, a
significant piece of tort reform legislation that I think is going to
bring some relief. When I say bring some relief, I am not hardly even
talking about the doctor's income. I am talking about keeping them in
practice, keeping them performing those cases, seeing those patients
that are high risk, rather than hanging up that stethoscope and trading
it in for a fishing rod or whatever, because they just no longer can
stay in practice under that environment. So it is a huge, huge problem.
Let me just talk about why we at the Federal level, I said Georgia
passed tort reform, Florida did, Texas did, California of course gave
us the model of tort reform back in 1978, the bill called MICRA, which
stabilized malpractice insurance premiums so that doctors did not leave
California, did not stop their practices, continued to see those high-
risk patients, without these premiums going just totally through the
roof, and it worked and it worked because of one thing primarily and
that is a cap, a cap of $250,000 on noneconomic damages, so-called pain
and suffering.
It has nothing to do whatsoever with economic damages. It is just to
say that without a cap that number could be infinity. It could be tens
of millions of dollars, and that is wrong and that is what is driving
those rates up so high. That is the model that was passed in Georgia,
and that is basically what we are trying to do here in the Congress.
My colleagues might say, well, just let the States take care of it;
why worry about it at the Federal level. Well, many of the States, in
fact most of the States, have not taken care of this.
There are a lot of reasons why you may think that we cannot get tort
reform. The trial lawyer lobby is a very strong lobby. There is no
question about it. We have passed tort reform legislation, the Health
Act of 2003. We passed it again here in this body, Mr. Speaker, last
year in 2004; and now we have reintroduced it in the 109th in 2005, and
we will pass it again. We will pass it again in this body with
bipartisan support; but when it gets to the other Chamber, it has been
just almost impossible.
Again, I mean, it should not be a partisan issue, but for some reason
it always seems to be, and I continue to have hopes. I am not going to
give up on the other body. I think that, Mr. Speaker, we have got some
different faces over there this year, and I have always said to my
doctor friends that say, well, what can we do, and I say to them, if
you cannot change their minds, you need to change their faces.
Fortunately, Mr. Speaker, in this last election cycle we changed a few
faces, and indeed, we elected another doctor to the United States
Senate and I mentioned Dr. Coburn earlier.
So I continue, hope springs eternal, but we want to continue to make
sure that we tell our colleagues about this and make sure the American
people understand how serious a problem this is.
At the Federal level, and let me just frame it just for a minute, the
amount of money that is spent on health care, I just want to focus my
colleagues on this particular chart.
Nearly 45 percent of all mandatory spending is on health care. Let me
say that again: nearly 45 percent of all mandatory spending is spent on
health care. This pie chart, this part over here, 55 percent is
nonhealth care mandatory spending; but when you talk about those
numbers and I can just throw out a few, $176 billion, this is fiscal
year 2004, and these numbers continue to grow. Medicaid spending, $176
billion; State children's health insurance program, the CHIP program,
$5 billion; Social Security disability, $73 billion, that is 6 percent;
Medicare, $297 billion, 24 percent of mandatory Federal health care
spending. No small numbers.
The Federal outlay for health care continues to rise. Nearly one-
third of all Federal spending goes toward health care, nearly one-
third, and just look at this slide. I would like my colleagues to pay
close attention to this.
Starting in 1965 going forward to 2004, the percent of total Federal
outlays, this is total Federal outlays, not just mandatory but also
discretionary, 1965, Federal health care spending as a percent of our
budget, 2.6 percent; 2004, all the way to the right, 29 percent.
We have a problem, and we have to solve it at the Federal level.
I hope that my colleagues can appreciate the magnitude of this, and I
am very, very pleased to be, as I said at the outset, co-chairing the
Republican Health Care Public Affairs Committee as we bring these
issues, like the need for medical liability reform, before my
colleagues. My co-chairman on this committee is the gentleman from
Pennsylvania (Mr. Murphy).
We appreciate him being with us tonight, and at this time I would
like to turn it over to him and let us hear about some of those issues
of concern in regard to medical errors and what we can do about that.
Mr. MURPHY. Mr. Speaker, I thank the good doctor from Georgia for
yielding.
What I would like to do is lay out a couple of issues here and also
turn it over to a couple of other colleagues who are here tonight and
review some of these issues of why it is so important, and I thank the
gentleman for pointing out some of the issues of the Federal outlay of
health care.
The Federal spending for health care, it is so important to note that
it is growing immensely, that it has grown and continues to grow, that
the numbers out there, about 45 percent of mandatory spending, is in
the area of health care, and it is probably going to climb to 49. By
``mandatory'' we mean spending and these are not necessarily the things
we vote on and change every year but other outlays that take place.
I want to point out as we are going towards this that as we are
talking about such things that are brought up about liability, and tort
reform issues are so important, that part of what we also have to pay
attention to is patient safety.
I would like to bring up a couple of points, and one of these is the
issue, the Institute of Medicine in a landmark study in 1999 pointed
out, this study was called ``To Err is Human,'' stated that over 7,000
people die every year from medication errors alone with 44,000 to
98,000 deaths every year from medical errors in hospital practices.
Now, this touched off a great concern across the Nation. The government
and many efforts, President Bush and then-Secretary Tommy Thompson
started investigations to see what happened, why this was so. A great
deal of research and other efforts took place in hospitals and
physician offices and medical schools across the country to find out
what this is about.
What stood out, however, is even more alarming: that we really do not
know how many of these deaths occur every year because they typically
may not get reported. This has led to a situation where many health
care providers simply do not talk about the

[[Page H1220]]

problem because they fear legal retribution. In other words, hospitals,
we should have them tracking all errors, all suspected errors, and in
every case, lead to a program within that hospital and with health care
practice in every level of that hospital to review what that was for.
Many times the concerns could be if those records were kept there or if
they were reviewed this will simply be another source of suits.
What we have to be moving for in this Nation is a goal of zero
medical errors, zero patient errors. Anything beyond that I believe is
too high. It is too high of a cost for our Nation's health care
facilities, and we should not embrace a goal of 1 percent or 2 percent
or 3 percent.

Imagine a situation here if a factory had a goal of perhaps reducing
their safety errors and injuries to their workers down to this 3
percent or 1 percent of the workers, how many injuries that would be,
how many lost work days, how many deaths that would be. Would you want
to go to a hospital that had a goal of perhaps only 98 percent or 99
percent success? Certainly, every one of us in the health care field
wants to aim towards 100 percent success, and given the chart that we
saw before about the great increases in health care spending in the
Federal Government, it is very important that we look at controlling
health care spending, Mr. Speaker, not just from the idea of accounting
moves to cut down on some of those rates but also making some major
changes in what we are paying for, not just who is paying.
Let me touch off on a couple of areas here before I turn it back
over. One is the Pittsburgh Regional Health Care Initiative reported
that the United States has the world's second highest methasone-
resistant staphylococcus rates with more than 50 percent of these
infections resistant to antibiotics. They also went on to say that the
Pittsburgh Regional Health Care Initiative reported that these
hospital-acquired infections affect 5 to 10 percent of all patients, or
about 2 million, per year who are admitted to acute care facilities at
a cost overall in this Nation of $4.5 billion. Many of these infections
could have been prevented by simply having physicians wash their hands,
using anti-bacterial scrubs; and I will use other techniques here to
make sure we had a system that was working better.
Now, the reason I bring these up, they seem almost too simple, but
there are a couple of areas we recognize as we are moving towards the
issue of medical liability reform. I want to make it clear here to our
colleagues, we are not just excluding that, not just saying this is not
just an issue of caps on punitive damages. This is not just a legal
issue. This is one that we need to recognize as a Congress and as a
Federal Government embracing truly changes in how we handle errors.
Many hospitals and doctors are concerned about this, but we also see
that there are recommendations for open and meaningful communication
with health professionals about medical errors. It should be open to
discussions of what takes place. I believe the Federal Government can
be a major factor in moving these forward; and as we continue on this
evening, I will be coming up with more examples.
At this point, I would like to turn it back to my colleague, the
gentleman from Georgia (Mr. Gingrey), to proceed as we go through this
evening and look at other ways that this liability crisis is affecting
our Nation and how patient safety needs to work hand in hand with
working to reduce some of these liability issues, and that will be
something that not only keeps more doctors practicing but quite frankly
will save a lot of money and save a lot of lives.
Mr. GINGREY. Mr. Speaker, I thank my colleague from Pennsylvania for
bringing those points to us, because what is important for our
colleagues to know is that while physicians in this country, health
care providers are in a crisis situation, as we said at the outset,
because of the need to practice defensive medicine, inability to pay
for liability premiums that have gone through the roof, what Dr.
Murphy, my co-chair, has brought to us is to say physician, health care
provider, heal thyself, heal thyself.

{time} 1900

And that is important. We cannot say that we are not going to do
things to try to make sure that there are less errors and less
accidents. People must know that we are determined to reduce those
medical errors that the gentleman from Pennsylvania was talking about.
I am very pleased to introduce the next Member, my colleague from
Georgia. We talked at the outset about the number of physicians in the
House and the fact that we picked up a few. While it was indeed, Mr.
Speaker, a great pleasure to me that one of those three new Members in
this body is not only a colleague from Georgia but also a colleague
from my own County of Cobb and represents the district that adjoins
mine. We both have a part, a significant part of Cobb County.
The gentleman from Georgia (Mr. Price), Representative Price,
Congressman Price is an orthopedic surgeon, one of my great mentors
when I was a member of the Georgia Assembly, so I am very proud to
introduce him tonight. He is going to talk about some of the unique
problems in regard to physician workforce in our great State of
Georgia.
Mr. PRICE of Georgia. Mr. Speaker, I thank my colleague, and it
really is a pleasure to join him and the gentleman from Pennsylvania
and others who are talking about something that is so incredibly
important to every single American, and that is their health.
I know we are talking about patient safety, but I want to put a
little different spin on patient safety. I want to put it in a little
different light. Because I know, as my colleagues do, that if you
cannot find a hospital that is open or if you cannot find a doctor's
office, then you cannot be safe in your health care. So I want to talk
a little bit about the access to health care and what is the dynamic
going on that is limiting drastically, drastically, the access that so
many individuals in our great State, but also our Nation as well, have
to health care.
I want to point out some of this information just to start: Georgia
is no different than the vast majority of States in this Nation, and
this report came recently from the Georgia Board of Physician
Workforce. What that workforce does is it reviews the entire State and
looks at where doctors are practicing, where hospitals are open, how
many beds they have and the like, and how capable they are of
delivering the care that is needed by our citizens.
What they found recently is that 11 Georgia hospitals have closed
since 1999. Eleven hospitals have closed. Ones does not think about
that happening. If it is in your community, though, it is an incredibly
important thing for not just the economic vitality of your community
but for the health and well-being of your citizens.
Four percent of Georgia physicians will leave the State or quit
medical practice in the coming year. This was asking, what is going to
happen to your practice over this next year? Four percent. A remarkable
number. And 11 percent of Georgia physicians will stop taking emergency
room coverage.
Now, I believe that the crux of the liability crisis that has been
talked about tonight and that, I think, is very real and incredibly
important, but it is not important because of the amount of money that
physicians have to pay for their malpractice insurance. It is important
because, when that cost goes up, this is the consequence: Hospitals
close; doctors quit doing certain procedures because they cannot afford
the insurance to cover that, or they simply close their office. And
when that happens, what is the real result? The real result is that
patients cannot have access to the kind of quality care that they need
and that they deserve.
So I want to touch on a few very specific issues that are certainly
true in our State, and I know them to be true around the Nation
because, as I mentioned, Georgia is not any different than any other
State.
We have a number of different specialties that are more at risk than
others, but any time you upset or kind of break that chain of quality
care that is being delivered to a patient, any time a patient cannot
get the specialists they need or the kind of doctor they need, then
that individual, that patient's health care is compromised. They are
not as safe in their health care. So I want to talk about a few
specialists that I know who are having significant problems, and I will
point out what they are no longer doing or are not

[[Page H1221]]

able to do because of the liability crisis.
For example, in our State, nearly 40 percent, nearly 40 percent of
the radiologists in our State are no longer performing high-risk
procedures. So you say, well, what is a high-risk procedure? Must be
something that endangers the patient's life; right, immediately? Well,
in fact, that is not the case. For radiologists, mammograms are high-
risk procedures. Mammograms are high-risk procedures. Something that is
a preventive health care measure is a high-risk procedure.
Now, why is that? The reason is that the technology that goes into
performing a mammogram and reading a mammogram is not perfect. There is
about a 10 percent error rate. If you get the best radiologist in the
world reading mammograms, that individual will only be correct in his
or her interpretation about 90 percent of the time, which means there
is about a 10 percent error rate because of the limitation of the test
itself.
Now, that means if a radiologist is performing 25 or 30 mammograms in
a given day, two or three of those interpretations is not going to be
correct. And so the radiologist, 40 percent of the radiologists nearly
in our State, and I know it is true around the Nation as well, have
said, look, I cannot expose my family to that liability, and the only
thing I can do from a personal standpoint is say, I am sorry, I cannot
do mammograms any longer.
Now, what does that mean? It does not necessarily limit that
individual's livelihood significantly, but what it does mean for that
community is that the women of that community no longer have access to
appropriate preventive health care in the form of a mammogram. And it
is not just true of radiologists, though I think you get the connection
between when the cost of insurance goes up, that the important thing is
not the cost of the insurance to the physician; the important thing is
that we are limiting access to quality care for patients.
A pathologist is another classic example. Pap smears that
pathologists interpret, many of them, it is approaching again that same
number, 30 to 40 percent of pathologists will no longer interpret Pap
smears. Because, again, that error rate, that inherent error rate
because of the limitation of the technology itself, does not allow them
to interpret that with the reliability that is appropriate or that does
not expose them to significant problems or significant liability.
So they say, well, the only option that I have is to no longer read
Pap smears. Again, what is the consequence of that? It is that women no
longer have somebody who is able to perform that preventive test for
them.
I know that neurosurgeons were mentioned earlier, and I want to talk
a bit about that because it is an extremely important issue. My
district is all northern suburban Atlanta. I have a number of hospitals
in my district. It is a grand place to live. It is a great place to
work and play, and it has wonderful health care provided to it, except
that there are hospitals within my district and very, very close to me
in the center of Atlanta or around the environs of Atlanta, who no
longer have the emergency room coverage 24 hours a day, 7 days a week
of a neurosurgeon. Now, the consequences of that is not that it hurts
the hospital; the consequence is that it harms patients.
I believe that the amount of safety for patients that is being
compromised because of the liability crisis that we have is not even
being measured because it is not recordable. I will use an example that
I know to be true.
There was a gentleman in his mid-40s who fell and hit his head. So he
went to the hospital. He drove himself to the emergency room. And when
he was in the emergency room, his clinical course or his health status
deteriorated, and he became unconscious. The hospital did not have a
neurosurgeon on call that night because of the liability crisis. So
what is the hospital to do? They have to put him in an ambulance and
move him to a hospital that has a neurosurgeon available.
The problem in this case is that that individual died on the way to
the hospital. On the way to that second hospital. Now, this is a
healthy gentleman who just had a fall. He had a significant injury,
obviously, but the treatment for that injury is what is called a burr
hole, which means you relieve the pressure on the brain where the
bleeding is. And the vast majority of individuals not only survive;
they recover 100 percent.
That individual's safety, health and life were compromised because of
the liability crisis that we have in this Nation. That death will never
be recorded as one that fits any of the statistics that people are
talking about because it will be attributed to a traumatic fall. It
will not be attributed to a liability crisis. Nowhere on that record
will you find that the original hospital did not have a neurosurgeon
available.
So these are the consequences of the incredible liability crisis that
we have right now. Again, the problem is not that doctors are having to
pay too much; the problem is that patients are losing their access to
quality care.
Let me just review a couple of these slides, and then I would look
forward to hearing some of the comments again from my colleagues. I
mentioned this Georgia Board of Physician Workforce study that they
did. This shows that 17.8 percent of Georgia physicians will stop
providing high-risk procedures. You know what a high-risk procedure is
for an OB doctor? Delivering a baby. Delivering a baby is a high-risk
procedure. And so 17.8 percent of Georgia physicians will stop that,
again, not because they forgot how to deliver a baby; not because they
forgot how to perform the procedure or to read the tests, but because
they cannot do it with the current liability crisis. We talked about
the issue of radiologists as well.

The consequence of that is that more than 10 percent of the
obstetricians in the State of Georgia, more than 10 percent, quit
delivering babies over the last 18 months. That is a huge, huge
consequence, which, again, is a decrease in the quality of care that is
available to patients all across our State and, frankly, all across our
Nation.
Let me close with just three very specific examples. A good friend of
mine, and my colleague from Georgia knows him as well, Frank Kelly, an
orthopedic surgeon who practiced for 25 years. He is in the prime of
his career. He ought to be able to practice for another 10 or 15 year.
A very, very highly-qualified orthopedic surgeon in the middle of our
State who quit practice. Quit practice.
The reason was not that he did not have a passion for it any more.
The reason was not that he had forgotten what he was supposed to do
when he came to office. The reason was the liability crisis in our
Nation.
Another example. Atlanta pediatric neurosurgeon, and we only have
eight in the State, left the State last March, left the State because
of the liability crisis.
Again, in Marietta, where my colleague and I, where we both share
adjacent districts, a 52-year-old general surgeon we both know well,
performed 80 surgeries a month. That is the level of his practice. That
is how qualified he was and how much the patients and citizens of our
districts love him. He, at 52 years old, again, this is somebody who
ought to be in the prime of his career and providing excellent high-
quality care to citizens in our districts, had to quit the practice of
medicine because of the incredible liability crisis. And that is an
individual who had no claims; had never been sued. But because of the
increasing liability crisis and the increase in cost, he was no longer
able to do that.
I simply want to close by just thanking the gentleman from
Pennsylvania (Mr. Murphy) and my colleague, the gentleman from Georgia
(Mr. Gingrey), for their wonderful leadership on this issue, the
patient safety issue, which encompasses so many things. I hope we
continue to talk about it and make certain that we work with our
colleagues and push them just as hard as we can on both sides of the
aisle and on both sides of the Capitol to solve this problem.
Mr. MURPHY. Mr. Speaker, I thank the doctor from Georgia for his
comments. It is very important, the point that he made, which is that
the issue of health care, when you do not have health care providers
practicing, is really something that leads to many problems and, quite
sadly, deaths.
One of the statistics that I quoted before from the Institute of
Medicine is a study done a few years ago that threw

[[Page H1222]]

out some broadbased numbers; somewhere between 44,000 and 100,000
people die a year from medical errors. This study has come under some
question, but it is one that is often quoted by attorneys when they
bring up the concern for why one needs to focus on lawsuits in order to
try and change these.
Some have said that no patient has ever been cured by a lawsuit. And
certainly, even if it is just one, that is too many, but I would like
to call upon our colleague now, the gentleman from Texas (Mr. Burgess),
who oftentimes refers to himself as a country doctor from Texas. He has
delivered many babies in his OB-GYN practice, and so I wonder if he, as
he begins to talk, whether he can talk about making sure we have more
accurate approaches to tracking and understanding errors as a means of
improving on patient safety.

{time} 1915

Mr. BURGESS. Mr. Speaker, I am pleased to comment on that. For a
number of years, ever since the Institute of Medicine study came out,
and I bought the book and read through it, I felt that their study
methods were significantly flawed.
While I agree with their premise that if there is one death from
medical errors, that is too many, the book is worth reading if only to
look through the very tortured methods that they went through to come
up with the number at the end of 98,000 deaths a year. They look at two
hospital wards, one back in 1984, one in 1992; and from these two wards
extrapolated the data that they have.
In fact, there was a significant reduction in medical errors between
1984 and 1992, and that never got really much in the way of any
headlines, but they go through this very tortured analysis; and at the
end they say since we are not sure that we are underestimating the
figure, they doubled it. That gives Members some idea of the scientific
rigor with which they approached the task.
Again I agree one death is too many, and we need to be moving toward
a system that is a no-fault system. We strive for error-free medicine
in a world that is sometimes all too human.
But I also feel compelled to talk about the good news. We have heard
a lot of information and how serious the situation is across the
country, and it is serious. I do not mean to diminish that, but there
are some good news items out, and I would like to share them with this
House. I am especially thankful to the Georgia medical delegation that
has allowed me to appear on stage with them.
The State of Texas, which is so often a leader in so many areas
across the country, 18 months ago dealt with the crisis in medical
liability insurance by passing a State law that allowed for caps on
noneconomic damages in medical liability suits. It was patterned after
the Medical Injury Compensation Reform Act of 1975 done in California
that we have all talked about here as a standard that we should aspire
to. Our Texas law updated that for the 21st century.
There is a cap of $250,000 on the doctor for noneconomic damages, not
for real damages, but for noneconomic damages capped at $250,000. The
hospital is capped at $250,000, and a third health care entity, a
nursing home or hospital, is capped at $250,000. That is a significant
change from the California cap of only $250,000 that was passed back in
1975.
What have the results been in the State of Texas since this
constitutional amendment passed? The results are worthy of our study
here. The first thing is when I was running for Congress in 2002, we
had medical insurers fleeing the State. We went from 17 to two in a
very short period of time.
Just like the stories we heard earlier, as I was campaigning for this
office, a young woman who is about 40 came up to me and said, I have
lost my insurance coverage because my insurer left the State, and now I
cannot practice my specialty of radiology. I cannot get insurance
anywhere, so I am now a stay-at-home mom. What a travesty. She had gone
to a State school, so the citizens of Texas essentially paid for her
education. She came to her peak earning years, her peak power, and her
profession is taken away from her, and not because as the gentleman
from Georgia (Mr. Price) pointed out, not because she forgot how to
read a chest X-ray, but because she could not get insurance coverage.
This system has changed with the passage of the Texas liability
reform law. What the Texas Department of Insurance has seen since the
law was passed in September 2003 is that we have now reacquired I
believe it is up to 14 liability insurers. We have gone from 17 down to
two, we are back up to 14, but the most important thing is those
insurers have come back into the State without the type of rate
increases that have occurred in neighboring States. Insurers have come
back into the State of Texas, but they did not up their premiums like
they did in Oklahoma, and that is a terribly significant event.
The other thing that we have seen is Texas Medical Liability Trust,
my old insurer of record, immediately cut its rates by 12 percent after
the constitutional amendment passed. There was some discussion as to
whether or not this rate reduction would hold, but in fact this year
they have put on top of that an additional 5 percent rate reduction for
a total of 17 percent in rate reductions. Again, remember what we are
talking about here is not cheaper insurance for doctors; what we are
talking about is permitting doctors to stay in the practice of medicine
because, after all, patients cannot have access to a health care system
if they do not have access to a physician somewhere along the line.
The other unintended benefit from passing caps in the State of Texas
has been what hospitals who self-insure, the benefits they have seen.
The Christus health care system down in South Texas reported in the
Dallas Morning News almost a year ago, so very shortly after these caps
went into effect, that they had achieved savings of $22 million in the
6 months after this law, this constitutional amendment was first
passed. That means $22 million going into nurses' salaries, capital
expansion. The types of things you want your community hospital to be
doing, they were allowed to participate in, again, because of the
savings brought about by simply instituting a series of caps on
noneconomic damages, those awards that are for pain and suffering in
medical liability suits.
The other thing that has happened which is pretty good news for Texas
doctors is the number of suits have plummeted. That has been truly a
significant breathing spell for the past 18 months for physicians of a
State who were significantly beleaguered.
I am frequently asked, if Texas has done such a good job of solving
the problem, why do you care about doing something on a national scale.
I do care because it is important. As a Member of Congress, I have been
privileged to travel around the country. Two years ago with the
Committee on Transportation and the Infrastructure, I visited the
Alaskan National Wildlife Refuge. On the way home, we stopped in Nome,
Alaska. We had a chamber of commerce lunch there. When they found out
there was a doctor who was a Congressman, all of the medical staff at
their local hospital came out to talk with me.

What they wanted to talk about is are you going to be able to do
anything about medical liability rates, because we cannot afford the
insurance rates for an anesthesiologist at our hospital. I said, My
gosh, how do you practice without an anesthesiologist?
And they said, We do the best we can.
I asked what kind of doctor he is, and the doctor said, I am an OB/
GYN just like you.
I said, Wait a minute, how do you practice obstetrics without an
anesthesiologist? What do you do for a C-section?
He said, We arrange for an airplane and get the mother transferred to
Anchorage.
Mr. Speaker, that is an hour and a half by air, assuming the weather
is okay; and they sometimes have bad weather in Nome, Alaska. I fail to
see how we are advancing the cause of patient safety by allowing this
situation to continue.
The gentleman from Georgia (Mr. Gingrey) eloquently pointed out how
much of our Federal budget goes for health care, and this is a key
point on why we need to involve ourselves with a national solution to
this problem.
A 1996 study done out in Stanford, California, estimated that the
cost of defensive medicine within the Medicare system is in excess of
$30 billion a year.

[[Page H1223]]

That is in 1996, almost 10 years ago. I bet those numbers are higher
today if someone were to rerun those numbers. That is the crux of the
problem. We are talking about an amount of money that would almost pay
for our prescription drug benefit that we are squandering on the
practice of defensive medicine because our doctors are afraid that they
are going to be pulled into court and they want to be sure their cases
look good when presented on the stand. That is why this is so critical
for us on a national level.
Mr. Speaker, I thank the doctors for putting this together. I
certainly want to thank Georgia for their indulgence in allowing a non-
Georgia physician to appear out here tonight. It has been a pleasure to
be here. I thank you for doing this.
Mr. GINGREY. Mr. Speaker, we thank the gentleman from Texas (Mr.
Burgess) for the doctor's timely remarks, and appreciate the gentleman
being here with us.
Again, I point out the fact that even though they have some relief in
Texas and now we have a little relief, good legislation in Georgia, why
are we so concerned. He said it so well, and that is as I had pointed
out earlier in the hour that the total percentage of nonmandatory
spending in this country that goes to health care, Federal dollars is
like 45 percent.
I remember during the most recent Presidential campaign, I do not
know which one of the three debates, I think maybe the last one, the
President talked about this, talked about the issue of needing to do
something about medical liability insurance rates and his opponent,
Senator Kerry, said the insurance premiums for physicians so they can
continue to practice is a minuscule amount. President Bush was so
correct when he said, yes, that is a big cost per individual physician;
but in the overall picture it is not a big cost, but the cost, of
course, as the gentleman from Texas pointed out, is all of the tests
and procedures, the defensive medicine that is being practiced. That is
why we cannot sustain that and we need to do something about it. It is
not just the cost, as my co-chair talked about during his time, and I
want to have further discussion about that. It is a safety issue. It is
very definitely a safety issue.
Mr. Speaker, I would like to ask the gentleman from Pennsylvania (Mr.
Murphy) if he would continue to discuss that with us a little bit.
Mr. MURPHY. Mr. Speaker, I thank the gentleman from Georgia (Mr.
Gingrey) for continuing to bring up these points. I want to talk about
a couple of things and have you comment as a member of the medical
profession.
First, I want to point out that this is an issue that the Federal
Government should be driving. The Federal Government is the largest
purchaser of health care in our Nation, even among very large companies
that may have hundreds of thousands of employees and retirees spending
billions of dollars on health care. Looking at our chart again, 45
percent of mandatory spending that the Federal Government spent on
health care, it is expected to climb to 49 percent, and this chart here
shows the Federal outlays are climbing over time.
That being the case, if we are dealing with liability issues, it is
inseparable from patient safety. There are a couple of issues that
President Bush has offered to be moving forward, and they are ones
which I am hoping all of us can embrace. The President has included
$125 million in this year's budget to help meet the goal of ensuring
that most Americans have electronic medical records within the next 10
years.
Patient records are usually kept on record on paper. I know when I
worked in hospitals, if we needed to call upon a patient's file,
sometimes that would take a good deal of time. Whether it was half an
hour or hours, that could have an effect on some of the decisions. I
ask the gentleman to describe the cumbersome system in terms of what we
are trying to move away from.
Mr. GINGREY. Mr. Speaker, the gentleman is so correct. I would hope,
and I think that some of my colleagues probably did a little bit better
job in keeping accurate records and neat charts, even though I learned
to write and my penmanship was developed by the Catholic nuns at a very
strict parochial school, but what the gentleman from Pennsylvania (Mr.
Murphy) is talking about is you have a chart, it is in the office. The
doctor sees a patient maybe a couple of times a year over a long period
of time. The chart gets thicker and thicker. Sheets are put in, not
tabbed, they are out of order. The doctor may not know even when the
patient was last seen if they are not a good historian.

{time} 1930

The gentleman from Pennsylvania talked about this earlier, about
medical errors. The gentleman from Texas mentioned it, and I think the
gentleman from Georgia, too; that the Institute of Medicine statistics,
hopefully they are not accurate, because that is an astronomical number
of deaths and injuries that they say occur each year because of medical
errors. But as the gentleman pointed out, even one is too many. A lot
of it is because of this sloppy medical recordkeeping. So, yes, it is
definitely a problem and needs some immediate attention.
Mr. MURPHY. What the President has proposed here is to make some
changes to entice hospitals throughout the Nation and from medical
practice to go towards electronic medical records. Let me try and
describe that for our colleagues. This is a system which could be kept
in place within the hospital itself, so that, any time a physician
needed to access, or any medical provider within that hospital network,
needed to access the patient's file, they could call upon this. Think
about all the times you have been to see the doctor and you have to
fill in the history sheet all over again and your address. You hope you
remember all the places you have gone and all of the medication you
have been on and all the illnesses you have had, but chances are, for
the most part, a person cannot. In fact, some studies have looked at
that, just looking at some of the paper charts that occur, that there
are omissions and doctors acknowledge that because there are omissions
in there, if they had further information, they would have made some
different recommendations for tests, for diagnoses and that, in turns,
saves money. Electronic medical records are a way of keeping this. Some
have even proposed having either on a card or a patient may have some
other device which could be plugged into a computer when they go to
visit the doctor or the hospital, they can update those records. But
the whole thing is really keeping these secure and confidential.
I know the University of Pittsburgh Medical Center, for example, is
investing literally hundreds of millions of dollars in this.
Information Weekly magazine rated them as the top medical center in the
Nation in terms of making this move into electronic medical records. I
am not sure if the gentleman from Georgia has seen one of these at
work, but I am wondering perhaps if he could describe what happens and
changing from that paper-dependent system which is very time consuming,
requires a great deal of time for the doctor to keep track of what is
in there as well as research those, what happens when you move towards
an electronic medical records system and what that does for patient
safety.
Mr. GINGREY. The point of all of that is that you know with that
electronic medical recordkeeping, you can be anywhere in the world
literally, a patient, if we have a way with a swipe card or maybe a
radio frequency identification card which would look very much like a
typical credit card, about the same size and thickness, but an
individual would have a particular code that was unique to him or her
and would have access through a very secure fire wall system to their
medical records anywhere in the world, so that if you were in another
country, on vacation, and this happens a lot, far too often, when a
person gets sick, has a heart attack, in an automobile accident, in a
remote place, the language is not the same, the communication is poor
and the treatment is just not adequate. So when we get to that point,
and we are there. I know the gentleman has talked about some systems. I
have talked to a lot of people who are developing these cards. The
President has talked about the need to go to a system like that. We
have talked tonight about medical liability reform and needing to give
our healthcare providers some relief so they can continue to practice
medicine and our patients

[[Page H1224]]

have access to that great health care system, but we have also spent a
good bit of time tonight saying that we understand that, as I pointed
out earlier in my statement, physician, heal thyself. We know there are
some problems. I think one of the biggest problems in regard to the
error rate is this issue, as the gentleman from Pennsylvania points
out, of poor medical recordkeeping, the traditional system, the 20th
century recordkeeping, if you will. It is time to make these changes.
The technology is there. We need to incentivize. My colleague from
Pennsylvania asked the question, what can we do in our individual
office, how can we get doctors, either individuals or groups, to go to
that kind of a system? It is going to be costly. That is going to be a
disincentive, I think, for a lot of them to do that. But we need to
move toward a system of reimbursement, maybe under the Medicare or
Medicaid program, Federal match and 100 percent pay on Medicare. We
need to be able to incentivize individual doctors and groups to go to
this system.
Mr. MURPHY. The gentleman also well knows that doing these kinds of
things saves money. The Center For Information Technology leadership
estimated that, if we move towards electronic health records, it could
save about $78 billion a year, or 5 percent of the Nation's total
annual healthcare cost. And in a time when so many businesses have seen
their health care costs climbing, sometimes up into the double-digit
amounts per year, it can do a great deal.
I know we only have a few minutes left, but one other thing just to
whet the appetite with which we will need to come back to at another
time is electronic prescribing. No offense to the good doctor, but very
often, it is tough for someone to read a physician's handwriting. This
can also lead to errors. Pharmacists estimate about 140 million times a
year they will have to call back the physician because they may not
understand the medication; they may question the dose. The pharmacist
may be aware of other medication that patient is on, but the physician
may not be aware. They may be aware of other allergies or reactions.
Electronic prescribing, however, is another tool where doctors, at the
moment they write the prescription, they can access that prescribing
information. I wonder if the gentleman could comment on the importance
of that.
Mr. GINGREY. There is no question about how important that is,
because, as the gentleman from Pennsylvania pointed out, when you
cannot even read the prescription, it is bad enough, but in many
instances, a doctor is not going to know. Maybe the particular patient
is sick in the emergency room, high fever, not at their best mentally,
they are not going to be able to relate that information. That is why
these cards are going to be so important so that, when you write that
prescription, even if your penmanship is absolutely perfect, you need
to make sure that you are not giving them a medication that would react
with maybe two or three other things that they are on and could cause a
serious problem.
Tonight, as we wrap up, and I am so thankful to be doing this with my
cochair, the gentleman from Pennsylvania, and we will continue to bring
subjects, healthcare issues, probably do an hour like this on a monthly
basis, this team of Members, Republican Members, who are either
healthcare providers or extremely interested in this issue for the good
of the Nation.
In closing, I want to make sure that my colleagues understand that
most healthcare providers, if a patient is injured because of someone
practicing below the standard of care, then we want them to recover. It
is not about taking away anybody's right to a redress of grievances. I
look forward to the discussion with my colleagues next month.

____________________