[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.

                          ____________________