[Congressional Record (Bound Edition), Volume 145 (1999), Part 10]
[Senate]
[Pages 13954-13962]
[From the U.S. Government Publishing Office, www.gpo.gov]



          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. SCHUMER:
  S. 1267. A bill to require that health care providers inform their 
patients of certain referral fees upon the referral of the patients to 
clinical trials; to the Committee on Health, Education, Labor, and 
Pensions.


                 clinical trials disclosure act of 1999

  Mr. SCHUMER. Mr. President, I rise today to introduce the Clinical 
Trials Disclosure Act of 1999. As the Senate debates important health 
care issues such as Medicare, prescription drug access, and managed 
care reform, I want to call our attention to another important health 
care matter: doctors and other health care providers accepting payments 
from drug companies and their contractors to refer patients to clinical 
trials. Each of us understands that by providing a forum for medical 
research, clinical trials play a vital role in our health care system. 
Unfortunately, some providers are violating the patient-doctor 
relationship by not informing patients of the fees they receive for 
referrals to the clinical trials.
  Recent media reports have highlighted this growing trend that 
threatens the important relationship between doctor and patient. In one 
case in California, a doctor received over $1,600 to refer a patient to 
a prostate cancer drug trial despite the fact that the patient's 
prostate was healthy. Other drug companies offer bonuses to physicians 
who refer numbers over and above a certain quota. Providers benefit in 
other ways, too. A cooperative doctor may get his or her name attached 
to an academic study authored by a ghost writer based on the drug 
company's data. No matter how the doctor benefits, however, he or she 
is not compelled to inform the patient of his or her relationship with 
the drug company. This is why today I introduce the Clinical Trials 
Disclosure Act of 1999.
  This bill simply requires that if a health care provider receives 
payments or other compensation for referring a patient to a clinical 
trial, the provider must inform the patient both orally and in writing. 
The measure is not intended to discourage patient participation in 
important medical research. Instead, it will strengthen the 
relationship between doctor and patient and help ensure that clinical 
trials attract patients who will benefit from their important work.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1267

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Clinical Trials Disclosure 
     Act of 1999''.

     SEC. 2. REQUIRED DISCLOSURE OF REFERRAL FEES.

       (a) Through Contracts with Insurers.--
       (1) Amendment to erisa.--
       (A) In general.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following new section:

     ``SEC. 714. REQUIRED DISCLOSURE OF REFERRAL FEES.

       ``The provisions of any contract or agreement, or the 
     operation of any contract or agreement, between a group 
     health plan or health insurance issuer in relation to health 
     insurance coverage (including any partnership, association, 
     or other organization that enters into or administers such a 
     contract or agreement) and a health care provider (or group 
     of providers) shall require that, if the provider refers a 
     patient to a clinical trial, the provider shall disclose 
     (orally and in writing) to the patient (at the time of such 
     referral) any payments or other compensation that the 
     provider receives (or expects to receive) from any entity in 
     connection with such referral.''.
       (B) Clerical amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1001 note) is amended by inserting after the item 
     relating to section 713 the following new item:

``Sec. 714. Required disclosure of referral fees.''.

       (2) Amendments to phsa.--
       (A) Group market.--Subpart 2 of part A of title XXVII of 
     the Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
     amended by adding at the end the following new section:

     ``SEC. 2707. REQUIRED DISCLOSURE OF REFERRAL FEES.

       ``The provisions of any contract or agreement, or the 
     operation of any contract or

[[Page 13955]]

     agreement, between a group health plan or health insurance 
     issuer in relation to health insurance coverage (including 
     any partnership, association, or other organization that 
     enters into or administers such a contract or agreement) and 
     a health care provider (or group of providers) shall require 
     that, if the provider refers a patient to a clinical trial, 
     the provider shall disclose (orally and in writing) to the 
     patient (at the time of such referral) any payments or other 
     compensation that the provider receives (or expects to 
     receive) from any entity in connection with such referral.''.
       (B) Individual market.--Part B of title XXVII of the Public 
     Health Service Act (42 U.S.C. 300gg-41 et seq.) is amended--
       (1) by redesignating the first subpart 3 (relating to other 
     requirements) as subpart 2; and
       (2) by adding at the end of subpart 2 the following new 
     section:

     ``SEC. 2753. REQUIRED DISCLOSURE OF REFERRAL FEES.

       ``The provisions of section 2707 shall apply to health 
     insurance coverage offered by a health insurance issuer in 
     the individual market in the same manner as they apply to 
     health insurance coverage offered by a health insurance 
     issuer in connection with a group health plan in the small or 
     large group market.''.
       (b) Other Providers.--A health care provider who provides 
     services to beneficiaries under the medicare program under 
     title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.) shall, with respect to any patient that such provider 
     refers to a clinical trial, disclose (orally and in writing) 
     to the patient (at the time of such referral) any payments or 
     other compensation that the provider receives (or expects to 
     receive) from any entity in connection with such referral.
                                 ______
                                 
      By Mr. HARKIN (for himself, Mr. Frist, Mr. Kennedy, Mr. Chafee, 
        Mr. Reed, Mr. Mack, Ms. Mikulski, Mrs. Murray, Mr. Cleland, Mr. 
        Helms, Mr. Warner, Mr. Schumer, Mr. Cochran, Mr. Durbin, Mr. 
        Moynihan, Mrs. Boxer, Mr. Roberts, and Mr. Reid):
  S. 1268. A bill to amend the Public Health Service Act to provide 
support for the modernization and construction of biomedical and 
behavioral research facilities and laboratory instrumentation; to the 
Committee on Health, Education, Labor, and Pensions.


             21st century research laboratories act of 1999

  Mr. HARKIN. Mr. President, today I am pleased to introduce the 
Twenty-First Century Research Laboratories Act of 1999. I am joined in 
this effort by Senators Frist, Kennedy, Chafee, Reed of Rhode Island, 
Mack, Mikulski, Murray, Cleland, Helms, Warner, Sarbanes, Schumer, 
Cochran, Durbin, Moynihan, Boxer, Roberts, and Reid of Nevada. I want 
to thank my colleagues for cosponsoring this legislation.
  First though, let me say how pleased I was that we were able to 
provide the biggest increase ever for medical research last year. The 
Conference Agreement of the Fiscal 1999 Labor, Health and Human 
Services, Education and Related Agencies Appropriations Subcommittee, 
provided a $2 billion, or 15 percent, increase for the National 
Institutes of Health. And this year, I and Senator Specter will 
continue our work to make sure that Congress stays on course to double 
funding for the NIH over the next five years, a target that was agreed 
to by the Senate, 98 to 0, in 1997.
  However, as Congress embarks on this important investment in improved 
health, we must strengthen the totality of the biomedical research 
enterprise. While it is critical to focus on high quality, cutting edge 
basic and clinical research, we must also consider the quality of the 
laboratories and buildings where that research is being conducted.
  In fact, Mr. President, the infrastructure of research institutions, 
including the need for new physical facilities, is central to our 
nation's leadership in medical research. Despite the significant 
scientific advances produced by Federally-funded research, most of that 
research is currently being done in medical facilities built in the 
1950's and 1960's, a time when the Federal Government obligated from 
$30 million to $100 million a year for facility and equipment 
modernization. Since then, however, annual appropriations for 
modernization of our biomedical research infrastructure have 
dramatically declined, ranging from zero to $20 million annually over 
the past decade. As a result, many of our research facilities and 
laboratories are outdated and inadequate to meet the challenge of the 
next millennium.
  In order to realize major medical breakthroughs in Alzheimer's, 
diabetes, Parkinson's, cancer and other major illnesses, our Nation's 
top researchers must have top quality, state-of-the-art laboratories 
and equipment. Unfortunately, the status of our research infrastructure 
is woefully inadequate.
  A recent study by the National Science Foundation finds that academic 
institutions have deferred, due to lack of funds, nearly $11.4 billion 
in repair, renovation, and construction projects. Almost one quarter of 
all research space requires either major renovation or replacement and 
70% of medical schools report having inadequate space in which to 
perform biomedical research.
  A separate study by the National Science Foundation documents the 
laboratory equipment needs of researchers and found that 67 percent of 
research institutions reported an increased need for laboratory 
instruments. At the same time, the report found that spending for such 
instruments at colleges and universities actually declined in the early 
1990's.
  Several other prominent organizations have documented the need for 
increased funding for research infrastructure. A March 1998 report by 
the Association of American Medical Colleges stated that ``The 
government should reestablish and fund a National Institutes of Health 
construction authority. . . .'' A June 1998 report by the Federation of 
American Societies of Experimental Biology stated that ``Laboratories 
must be built and equipped for the science of the 21st century . . . 
Infrastructure investments should include renovation of existing space 
as well as new construction, where appropriate.''
  As we work to double funding for medical research over the next five 
years, the already serious shortfall in the modernization of our 
Nation's aging research facilities and labs will continue to worsen 
unless we take specific action. Future increases in NIH must be matched 
with increased funding for repair, renovation and construction of 
research facilities, as well as the purchase of modern laboratory 
equipment.
  Mr. President, the bill we are introducing today expands Federal 
funding for facilities construction and state-of-the-art laboratory 
equipment through the NIH by increasing the authorization for this 
account within the National Center for Research Resources to $250 
million in FY 2000 and $500 million in FY 2001. In addition, the bill 
authorizes a ``Shared Instrumentation Grant Program'' at NIH, to be 
administered by the Center. The program will provide grants for the 
purchase of shared-use, state-of-the-art laboratory equipment costing 
over $100,000. All grants awarded under these two programs will be 
peer-reviewed, as is the practice with all NIH grants and projects.
  We are entering a time of great promise in the field of biomedical 
research. We are on the verge of major breakthroughs which could end 
the ravages of cancer, heart disease, Parkinson's and the scores of 
illnesses and conditions which take the lives and health of millions of 
Americans. But to realize these breakthroughs, we must devote the 
necessary resources to our Nation's research enterprise.
  The Association of American Universities, the Association of American 
Medical Colleges and the Federation of American Societies of 
Experimental Biology have all expressed their support for this 
legislation.
  I hope the rest of my colleagues will soon sign on as cosponsors to 
this important effort to improve the research capacity of this country.
                                 ______
                                 
      By Mr. McCONNELL (for himself and Mr. Hatch):
  S. 1269. A bill to provide that the Federal Government and States 
shall be subject to the same procedures and substantive laws that would 
apply to persons on whose behalf certain civil actions may be brought, 
and for other

[[Page 13956]]

purposes; to the Committee on the Judiciary.


                        litigation fairness act

  Mr. McCONNELL. Mr. President, I rise today to introduce the 
Litigation Fairness Act of 1999. This common sense legislation says 
that whenever the government sues private-sector companies to recover 
costs, the government plaintiff gets no more rights than the ordinary 
plaintiff. If the law is good enough for the average citizen, then it's 
good enough for the government.
  This legislation to codify rules of fair play for government-
sponsored lawsuits is necessary for three reasons:
  First, the Litigation Fairness Act is necessary to prevent an 
avalanche of lawsuits against law-abiding companies. Let me say at the 
outset: this legislation is not about tobacco. Tobacco was just the 
beginning--the Model Act for hungry and enterprising trial lawyers.
  After tobacco, there was speculation that the government would sue 
the men and women who manufacture and sell guns in America. The 
speculation was right. And now that we've got government-sponsored 
lawsuits against gun companies, the speculation turns to other legal 
industries, such as automobile manufacturers, paint manufacturers, 
and--yes, even the fast food industry.
  Before some of you begin to shake your head about this widespread 
speculation, let me share some recent theories I've heard that verify 
that the theater of the absurd continues to move ever closer to legal 
reality. As reported recently by the Associated Press, a Yale professor 
is espousing a theory that, ``There is no difference between Ronald 
McDonald and Joe Camel.'' Both market products that are--and I quote 
this Professor from a recent seminar--``luring our children into killer 
habits'' ultimately increasing healthcare costs for the public--so the 
theory goes. And I promise that I'm not making this up. This Ivy League 
professor was in Washington just yesterday discussing this emerging 
theory.
  Second, this legislation ensures basic fairness for individual 
citizens. Under established principles of tort law, private plaintiffs 
are often barred from recovering damages based on a failure to prove 
direct causation. For example, if a person is injured in an automobile 
accident, but cannot prove that his or her injuries were caused by a 
defect of the automobile then that person cannot recover from the 
manufacturer. This legislation simply says that if the injured party 
couldn't recover from the auto manufacturer, then the government should 
not be able to sue the manufacturer to recover the health care expenses 
incurred by the government on behalf of the injured person.
  In short: Government plaintiffs should not have rights superior to 
those rights of private plaintiffs.
  Third, the Litigation Fairness Act is necessary to prevent taxation 
through litigation. The power to tax is a legislative function and 
those who raise taxes should be directly accountable to the voters. 
Fortunately, it is getting more and more difficult to raise taxes in 
the Congress and the State legislatures--so money-hungry trial lawyers 
and big-government public officials are bypassing legislatures to 
engage in taxation and regulation through litigation. The Litigation 
Fairness Act will discourage lawyer-driven tax increases being dressed 
up and passed off as government lawsuits.
  In closing, I want to point out some things that the Litigation 
Fairness Act does not do: it does not prohibit government lawsuits; it 
does not close the courthouse door to injured parties; it does not 
place caps on recoveries or limits on lawyer fees. Further, the 
Litigation Fairness Act cannot be construed to create or authorize any 
cause of action for any governmental entity.
  In fact, the Litigation Fairness Act does not even prohibit the 
unholy marriage between plaintiffs' lawyers and government officials--
although it admittedly makes such a marriage of money and convenience a 
bit less desirable. My legislation will simply ensure that the 
government plays by the same rules as its citizens.
  This bill has broad support. I ask unanimous consent that the Record 
include statements in support of the bill from the United States 
Chamber of Commerce, the American Tort Reform Association, and Citizens 
for a Sound Economy.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

        [From the U.S. Chamber of Commerce News, June 23, 1999]

     U.S. Chamber Endorses McConnell Bill to Stop Governments From 
                  Undermining Business Legal Defenses

       Washington, D.C.--The U.S. Chamber of Commerce today 
     endorsed legislation that would stop the growing trend of 
     governments stripping legitimate industries of their legal 
     defenses and rights and then suing them to raise revenue 
     outside the constraints of the political process.
       The ``Litigation Fairness Act,'' sponsored by Senator Mitch 
     McConnell (R-KY), would prevent governments at any level from 
     changing laws to retroactively strip businesses of their 
     traditional legal rights and defenses in order to sue them.
       ``The U.S. Chamber is greatly concerned this dangerous 
     trend of governments changing the laws to facilitate their 
     revenue-grabbing lawsuits,'' said Chamber Executive Vice 
     President Bruce Josten. ``This practice began in the state 
     lawsuits against the tobacco industry to recover Medicaid 
     funds and, just as the Chamber predicted, has now spread to 
     other industries. President Clinton's plan to use the Justice 
     Department to sue the tobacco industry is a prime example of 
     this problem.
       ``Unfortunately, these lawsuits are becoming all too 
     common,'' Josten added. ``If this trend continues, economic 
     and social decisions affecting all Americans will be made not 
     by the democratically elected legislatures, but instead by 
     trial lawyers.
       ``McConnell's legislation would help curtail this abusive 
     situation,'' Josten said, noting that the legislation does 
     not affect any individual's rights or ability to sue a 
     company that has caused them harm.
       The bill simply says that a government entity filing suite 
     to directly recover funds expended by that government on 
     behalf of a third-party (such as a Medicare or Medicaid 
     patient) would only be entitled to the same rights as an 
     individual suing that defendant. In addition, such a 
     government plaintiff would be subject to the same substantive 
     and procedural rules and defenses as any other individual 
     plaintiff. The legislation recognizes that an indirectly 
     injured party should not have any greater rights than a 
     directly injured person.
       ``This legislation will stop the erosion of the two hundred 
     years of tort law, while fairly protecting the rights of 
     American industries from the litigious trial lawyers 
     collaborating with federal, state and local governments,'' 
     Josten concluded.
       Josten's comments followed a day-long conference, ``The New 
     Business of Government Sponsored Litigation: State Attorneys 
     General and Big City Lawsuits,'' sponsored by the Institute 
     for Legal Reform, the Chamber's legal policy arm, The 
     Federalist Society and The Manhattan Institute. The 
     conference featured Oklahoma Gov. Frank Keating, Alabama Gov. 
     Don Siegelman, attorneys general from New York, Alabama, 
     Delaware and Texas, and noted plaintiff's lawyers such as 
     Richard Scruggs and John Coale. The event can still be viewed 
     on the Chamber's website, at www.uschamber.org.
                                  ____


      [From the Citizens for a Sound Economy News, June 23, 1999]

 Senator McConnell's Litigation Fairness Act Would Help End `Taxation 
                          Through Litigation'

       Washington.--J.V. Schwan, Deputy Director and Counsel for 
     Civil Justice Reform at Citizens for a Sound Economy (CSE), 
     made the following statement in support of Senator Mitch 
     McConnell's bill, The Litigation Fairness Act.
       ``Taxation through litigation is the latest scheme in 
     Washington. When the Administration can't accomplish their 
     goals through legislation, they sue. This is not what our 
     Founding Fathers intended. `The Litigation Fairness Act' 
     would help stop their `taxation through litigation scheme.'
       ``Specifically, the bill would assure that when governments 
     file lawsuits for economic losses allegedly incurred as a 
     result of harm to citizens, the government's legal rights 
     will not be greater than those injured citizens. The bill 
     would preserve and in some instances restore that equitable 
     rule of law.
       ``McConnell's bill does not bar suits by governments 
     against private defendants, place a cap on the recoveries 
     that may be obtained, or limit attorney fees. It simply 
     codifies a traditional tort law rule that has existed for 
     over 200 years.''
                                  ____


              [From the American Tort Reform Association]

                Government Litigation Against Industries

       Robert Reich recently wrote in USA Today that ``The era of 
     big government may be over, but the era of regulation through 
     litigation has just begun.'' He advocated that

[[Page 13957]]

     courts should be the regulators of society, deciding whether 
     certain products or services should be available and at what 
     price.
       Mr. Reich is referring to the new phenomenon of governments 
     entering into partnerships with private contingency fee 
     attorneys to bring lawsuits against entire industries. 
     Manufacturers of tobacco products and firearms have already 
     been targets of litigation at the State and local levels. At 
     the federal level, President Clinton announced in his 1999 
     State of the Union address that he has directed the 
     Department of Justice to prepare a litigation plan to sue 
     tobacco companies to recover federal funds allegedly paid out 
     under Medicare.
       Future targets of federal and/or state or local cost 
     recovery, or ``recoupment,'' litigations could include 
     producers of beer and wine and other adult beverages, and 
     manufacturers of pharmaceuticals, chemicals, and automobiles. 
     Even Internet providers, the gaming industry, the 
     entertainment industry, and fast food restaurants could be 
     targeted.


                  The Changes to Black-Letter Tort Law

       Under traditional tort law rules, third party payors (e.g., 
     employers, insurers, and governments) have long enjoyed 
     subrogation rights to recover costs for healthcare and other 
     expenses that they are obligated to pay on behalf of 
     individuals.
       For example, if a worker is injured in the workplace as a 
     result of a defective machine tool, tort law permits the 
     worker's employer to recover the cost of worker compensation 
     and other medical expenses paid on behalf of the employee. 
     Through the process of subrogation, the employer can join in 
     the employee's tort claim against the manufacturer of the 
     machine tool or put a lien on the employee's recovery, but 
     the employer cannot bring a direct action on its own.
       Governmental cost recovery actions seek to radically change 
     the traditional subrogation rule. In the State tobacco cases, 
     the attorneys general argued that the States could bring an 
     ``independent'' cause of action against the tobacco 
     companies. Furthermore, the attorneys general argued, because 
     the States' claims were ``independent'' of the claims of 
     individual smokers, the States were not subject to the 
     defenses that could be raised against individual plaintiffs, 
     especially with respect to assumption of risk.
       Despite the current unpopularity of the tobacco companies, 
     most courts have followed basic principles of law and 
     dismissed cost recovery claims against the tobacco companies. 
     One federal district court, however, bent the rules and 
     partially sustained a healthcare reimbursement suit in Texas 
     based on a unique expansion of the ``quasi-sovereign'' 
     doctrine. Before the Texas federal court's decision, the 
     quasi-sovereign doctrine had been limited to suits for 
     injunctive relief; it did not extend to suits seeking 
     monetary damages. Even the ``pro-plaintiff'' Minnesota 
     Supreme Court recognized this fact in a tobacco case. The 
     Texas decision produced an avalanche of claims that were 
     ultimately settled out of court.


                      The Role of Outside Counsel

       Another characteristic of the new ``era of regulation 
     through litigation'' is the partnering of governmental 
     entities and private contingency fee attorneys. This new 
     partnership raises a number of serious ethical and ``good 
     government'' issues:
       Contingent fee retainers were designed to give less-
     affluent persons (who could generally ill-afford hourly rates 
     and up-front retainers) access to the courthouse. 
     Governmental entities have their own in-house legal staff; 
     taxpayers should not have to pay excessive fees for legal 
     work that could be done by the government itself.
       In the State tobacco litigation, it seemed that many of the 
     cases were awarded to private attorneys who had been former 
     law partners or campaign supporters of the elected official. 
     Furthermore, there appears to have been a lack of competitive 
     bidding in the attorney selection process. As a result, 
     experts estimate that some plaintiffs' attorneys were paid in 
     excess of $100,000 per hour.\1\
---------------------------------------------------------------------------
     \1\ Professor Lester Brickman, ``Want To Be a Billionaire? 
     Sue a Tobacco Company,'' The Wall Street Journal, December 
     30, 1998.
---------------------------------------------------------------------------
       Should the prosecutorial power of government be brought 
     against lawful, though controversial, industries? ``As the 
     Supreme Court cautioned more than 60 years ago in Berger v. 
     United States, an attorney for the state, `is the 
     representative not of an ordinary party to a controversy, but 
     of a sovereignty whose obligation to govern impartially is as 
     compelling as its obligation to govern at all'.'' \2\
---------------------------------------------------------------------------
     \2\ Robert A. Levy. ``The Great Tobacco Robbery. Hired Guns 
     Corral Contingent Fee Bonanza'' Legal Times, Week of February 
     1, 1999, 27.
---------------------------------------------------------------------------


             All Industries Could Be Targets of Litigation

       To date, recoupment lawsuits have been filed against 
     politically disfavored industries because plaintiff attorneys 
     know that if courts bend the rules for controversial 
     products, those precedents will apply equally to other 
     industries.
       In fact, some contingency fee lawyers have already publicly 
     stated that tobacco and firearms are just the first of many 
     industries likely to be sued in the new era of regulation by 
     litigation. As stated, future targets of litigation could 
     include producers of beer and wine and other adult beverages, 
     manufacturers of pharmaceuticals, chemicals, and automobiles, 
     Internet providers, the gaming industry, the entertainment 
     industry, and fast food restaurants.


                     Separation of Powers Violated

       Legislating public policy in the courtroom violates the 
     ``separation of powers doctrine''--the fundamental rule upon 
     which this country's entire system of government is based. 
     The job of legislatures is to legislate; the job of courts is 
     to interpret the law. This bedrock principle of government 
     should not be eroded for the sake of political expediency and 
     political theater.
                                  ____


    Statement by Victor E. Schwartz, Counsel, American Tort Reform 
                       Association, June 23, 1999


the principle of equal justice under law is preserved by the litigation 
                              fairness act

       The Litigation Fairness Act helps assure equal justice 
     under law; that is why the American Tort Reform Association 
     supports it. Liability law should be neutral. Its principles 
     should apply in the same way to all defendants. A basic 
     principle of system of justice is equal justice under law.
       Unfortunately, legal principles developed in a few tobacco 
     cases did not apply neutral principles. They gave power to 
     state governments under a fiction called the ``quasi-
     sovereign doctrine,'' greater power in the law than was 
     possessed by an injured individual. New cases filed by cities 
     against gun manufacturers also may create new principles of 
     law that give those cities greater rights than injured 
     persons. There is little doubt that an engine behind these 
     new principles is the unpopularity of those defendants.
       These principles may be limited to so-called ``outlaw 
     defendants''--people who make guns, tobacco, liquor, or other 
     products that significant segments of our society do not 
     like. On the other hand, the principles may apply equally to 
     others. If that is true, those principles can apply against 
     people who make fast foods, automobiles that can go over 100 
     mph, motorcycles, hunting knives, and even the entertainment 
     industry.
       The Litigation Fairness Act preserves the principle that an 
     injured person's right to sue is paramount over government 
     rights, where the government has suffered some indirect 
     economic loss because of that person's harm. It restores 
     equal justice under law and neutrality within our tort 
     system.
       For those reasons, the Americans Tort Reform Association 
     supports the Litigation Fairness Act.
                                 ______
                                 
      By Mr. FRIST:
  S. 1270. A bill to establish a partnership for education progress; to 
the Committee on Health, Education, Labor, and Pensions.


                       the education express act

  Mr. FRIST. Mr. President, I ask unanimous consent that a summary of 
the Education Express Act be printed in the Record.
  There being no objection, the summary was ordered to be printed in 
the Record, as follows:

                 The Education Express Act (Ed-Express)


                               objective

       Funds would reaffirm our national commitment to state and 
     local control of education. The purpose of this Act is to 
     infuse significant new dollars into the hands of parents, 
     communities, and state and local governments to improve the 
     education achievement of students. This legislation unties 
     the burdensome and expensive federal strings on education 
     dollars by sending more money straight back to the states and 
     classrooms.
       States may elect to receive elementary and secondary 
     education funding by ``Direct Check.'' Most importantly, it 
     requires that 98 percent of the funding be used directly at 
     the local level. Incentives such as replacing existing 
     burdensome federal categorical programs are provided to 
     encourage states to choose the Direct Check. However, states 
     may choose to remain in the categorical system.
       The legislation creates three local/state programs to 
     enhance educational excellence: Challenge Fund, Teacher 
     Quality Fund, and Academic Opportunity Fund. These programs 
     will result in a substantial increase in federal education 
     assistance--$36.5 billion over five years.


                              how it works

       Those states that opt for the ``Direct Check'' flexibility 
     will receive their educational funding upon the adoption of a 
     state plan written by the governor or the governor's designee 
     that outlines the goals and objectives for the funds--how the 
     state will improve student achievement and teacher quality, 
     and the criteria used to determine and measure achievement.
       Decisons on how funds will be used to meet state goals and 
     objectives will be made at the local level.


                                programs

       Challenge Fund ($17 billion over five years) to improve 
     education achievement. Direct

[[Page 13958]]

     Check states will receive an additional 10% of their 
     allotment.
       Teacher Quality Fund ($14 billion over five years) to 
     improve education achievement. Direct Check states will 
     receive an additional 10%.
       Academic Opportunity Fund ($6 billion over 5 years) to 
     reward student achievement, implement statewide reforms, and 
     reward schools and school districts meeting state goals and 
     objectives. Only Direct Check states will be eligible to 
     receive these funds. States may receive an additional 10% of 
     their allotment if they (1) devote 25% or more of their 
     Challenge Fund allotment for Special Education; (2) 
     demonstrate improved education performance among certain 
     disadvantaged populations; or (3) adopt or show improved 
     performance on state-level National Assessment of Education 
     Progress tests (NAEP).
                                 ______
                                 
      By Mr. GRASSLEY:
  S. 1271. A bill improve the drug certification procedures under 
section 490 of the Foreign Assistance Act of 1961, and for other 
purposes; to the Committee on Foreign Relations.


                 most favored rogue states act of 1999

  Mr. GRASSLEY. Mr. President, today I am introducing legislation to 
help clarify for the administration certain aspects of drug policy that 
seem to have caused confusion. The confusion seems to lie in how to 
think about our friends and enemies when it comes to drug policy. There 
seems to be a willingness to overlook the actions and activities of 
certain rogue states when it comes to their involvement in drug 
production and trafficking.
  The purpose of our international drug policy is to establish a 
framework for achieving results that sustain the national interest. As 
part of that, the goal is to identify countries that are major 
producers or transit zones for drugs. It is also to determine whether 
those countries are committed to cooperate with the United States, with 
other countries, or are taking steps on their own to stop illegal drug 
production and transit. This goal is clearly in the national interest.
  Most illegal drugs used in this country are produced overseas and 
smuggled to this country. In accomplishing this, international drug 
thugs violate our laws, international laws, and, in most cases, the 
laws in the source and transit countries. Those drugs kill and maim 
more Americans every year than have all international terrorists in the 
last 10 years. In addition, they have made many of our schools, 
workplaces, our streets and our homes unsafe and dangerous.
  There are few threats more direct, more immediate, and more telling 
in our everyday lives than drug use and the activities of those who 
push them on our young people. We pay the costs in our hospitals, in 
our jails, and in our families. It is a devastation that we share with 
other countries. And the problem overseas is growing worse. Not only is 
drug production up but so is use. The source and transit countries are 
now facing growing drug use problems. Thus, in addition to attacks on 
the underpinnings of decent government from criminal gangs, many 
countries now face epidemic drug use among young people.
  What other countries do or do not do to confront this threat is of 
interest to us. The nature of the drug trade, production as well as 
transit, is an interconnected enterprise with international reach. Many 
drug trafficking gangs have contacts with each other. They share 
markets, expertise, and facilities. In some cases, they can count on 
the complicity of foreign governments or of significant individuals in 
those governments. This means that a serious policy to get at the trade 
and its connections must be international, coherent, and integrated. It 
cannot be piecemeal, episodic, and disjointed. But that is what we have 
today.
  Congress has over the years repeatedly pushed for an integrated, 
coherent approach, often over the reluctance of administrations. 
Dealing with the drug issue is often messy and uncomfortable. It 
disturbs the pleasantries of diplomatic exchanges. Progress is hard to 
achieve and difficult to document. And sometimes taking drug policy 
serious upsets other plans.
  This seems to be the case in this administration's dealings with 
several major drug producing or transit countries. It seems the 
administration would rather not know what these countries are up to on 
drugs, lest knowing make it difficult to pursue other goals. In several 
of these cases, the countries involved are not friends of the United 
States. One, Iran, is a sworn enemy. It has used terrorism and other 
tactics to attack U.S. interests and to kill Americans. it is also a 
drug producing and transit country.
  For many years, the lack of cooperation or reliable information of 
Iranian counter drug efforts placed them squarely on the list of 
countries decertified by the United States. Last year, however, the 
administration removed Iran from the list. it did so on feeble 
pretexts, with limited information, and in a less than forthright 
manner. The administration used lawyerly interpretation of statute to 
drop Iran from the so-called Majors' List. Doing this meant the 
administration could then duck the question of whether to certify Iran 
as cooperating on drugs or not.
  To accomplish this little sleight of hand, the administration had to 
ignore the interconnectedness of drug trafficking, congressional 
intent, and the national interest. So far as I can determine, it did 
this in the vague hope that a unilateral gesture towards Iran on drugs 
would see a reciprocal gesture leading to detente. It is hard to 
account for the change otherwise. And even so it is hard to comprehend. 
Never mind Iran's continuing hostility, its past and current support of 
terrorism aimed at the U.S. and American citizens. Never mind the 
facts. Never mind drug production and transit. Never mind the national 
interest. This is another case of the triumph of hope over experience 
that seems to be the lodestar of this Administration's foreign policy.
  What makes the case even more disturbing is the apparent subterfuge 
the administration resorted to in order to evade explaining this major 
shift in policy. I say major because Iran had been on every drug list 
since its inception and Iran has been decertified for that whole 
history. I say subterfuge because of the pettifoggery the 
administration resorted to.
  Given the facts of Iran's past, what is reasonable to assume would be 
a responsible way of dealing with the issue? It is the clear intent of 
the law on these matters that the administration would consult with 
Congress before making a major change in policy. But what did it, in 
fact, do? Not only did the administration not consult, it nitpicked. 
The law requires the administration to submit the Majors List by 
November 1. Instead of complying with this known statutory requirement, 
the administration delayed by over a week the submission of the list, 
conveniently waiting until after Congress had adjourned. Mere 
coincidence? Well, the administration did precisely the same stalling 
routine the year before when Syria was similarly spirited off the list. 
Without any prior notice to Congress. Once is accidental, twice is 
beginning to look like a pattern.
  Weeks after this move, the administration finally provided an 
explanation. It deserves a full retelling to appreciate. First, some 
basic facts. Iran has a long history of drug production, most opium. It 
is a major transit country for opium and heroin from Afghanistan and 
Pakistan. Major Iranian criminal gangs have been involved in the drug 
trade for years.
  Since the Iranian revolution, it has been difficult for any outsiders 
to determine what, if anything, the Islamic Government is doing to stop 
this trade. It is also important to understand that Iran was on the 
Majors List as a producing country. The law requires that any country 
that grows more than 1,000 hectares of opium poppy be put on the list. 
Iran met this qualification. The standard for classifying a transit 
country is not so precise and it is this imprecision that the 
administration exploited.
  Here, in brief, is the administration's explanation for dropping Iran 
from the list: Iran no longer grows more than 1,000 hectares, and the 
transited heroin does not come to the United States, so it does not 
qualify for the list.
  This latter rationalization is based on the administration's own 
favored way of reading the law. In this reading,

[[Page 13959]]

a major transit country does not qualify for the list if current 
intelligence information does not show a direct flow to the United 
States. Since the underground nature and fungibility of the 
international drug trade is hard to quantify precisely, this leaves a 
lot of room for interpreting the facts to reach a politically correct 
conclusion. This, of course, leaves aside the question of whether such 
an exception was ever part of congressional intent or is consistent 
with the law or the national interest. The reasoning is shaky on both 
policy and information. It also ignores the nature of international 
drug trade and criminal organizations and what must be done to get at 
them. And it relies on how little we know about what goes on inside 
Iran.
  In reality, the administration's approach is a resort to 
technicalities and convenient interpretations to dodge the real issues. 
But as we have been instructed, it all depends upon what the meaning of 
``is'' is. But let's remind ourselves that what is being done here is 
to base a weighty policy decision involving serious issues of national 
security and well being on lawyerly gamesmanship. And this on the 
unanchored hope that the gesture, and that's all it is, might get a 
friendly reaction in Iran. What did Iran actually do in response? What 
you would expect. It thumbed its nose in our direction. But let me 
illustrate a little further the way facts have been employed.
  Recall that Iran used to be on the Majors List for producing over 
1,000 hectares of opium. Drop below this number, in the 
administration's reasoning, and you automatically fall off the list. In 
this very careful parsing of meaning, I would suppose that if a country 
produced 999 hectares, no matter what other facts applied, it wouldn't 
qualify. But is this the case in Iran? The administration's explanation 
is that they could not find opium production in Iran in 1998, ergo, 
they do not qualify on this criteria. But this so-called objective 
assessment needs a little closer look.
  In most cases, we base our estimates of illicit crop production on 
overhead imagery and photo interpretation. While we are pretty good at 
it, this is not a precise science, whether we're talking vegetables or 
missiles. And it is, by the way, even more difficult when it comes to 
counting vegetables. Good analysis is dependent of weather, adequate 
overhead coverage, information from corroborating sources, and a track 
record of surveying that builds up a reliable picture over time. What 
was the case in Iran? Before the so-called objective, imagery-based 
assessment in 1998, the last overhead coverage of Iran had been in the 
early 1990s.
  The 1998 decision was therefore based on a one-time shot after years 
of no informaiton. Corroborating information is also scant. But the 
situation is even more dubious.
  Based on the past estimates, Iran cultivated nearly 4,000 hectares of 
opium in various growing regions across the country. The 1998 survey 
concentrated in only one of those traditional growing areas. Although 
in the early 1990s it was the major one, it still only accounted for 
some 80 percent of total cultivation. The 1998 survey could find no 
significant growing areas in these areas. But if we are to believe 
Iranian authorities, they have specifically attacked this cultivation 
with vigorous eradication efforts. The imagery would seem to support 
this claim. But we also know that growers adjust to enforcement. It is 
not unreasonable, therefore, to assume that drug producers might shift 
the locus of cultivation to less accessible areas and resort to 
measures to disguise production. The 1998 survey did not examine other 
areas.
  We cannot, of course, prove a negative, but that should not lead us 
to jump to conclusions, especially when those conclusions are what we 
want. Let me illustrate the point. If 20 percent of Iranian opium 
production--a number based on earlier assessments--was in areas other 
than those checked, that figure alone gives us close to 800 hectares. 
Since those other areas--which cover an immense amount of countryside--
were not checked, we cannot know if there was any production for sure. 
But, it would only require a little effort on the part of growers to 
shift a small amount of production to get us to our 1,000 hectare 
threshold. Also remember that opium is an annual plant. In some areas 
it has more than one growing season. Thus, a region that only had 500 
hectares of opium at any one time but had two growing seasons, would 
have an actual total of 1,000 productive hectares per year. I do not 
know that this was the case in Iran, but neither does the 
administration. It doesn't know because it didn't look. It didn't look 
because it was not convenient.
  I would suggest, even if you agree with the assumptions the 
administration is making about the intent of the law, that there are 
enough uncertainties in estimating Iranian opium production to counsel 
caution in reinterpreting the data. And even more caution in using this 
to revise policy. All the more so, given the nature of Iran's past 
actions and attitudes towards the United States. But even if you buy 
all the rationalizations leading to a decision to drop Iran from the 
Majors List, we are left with this: Is it responsible or creditable to 
make such a major shift in policy without even the pretense of 
consultation with Congress? Without an effort to explain the decision 
and shift to the public?
  If there are grounds for reconsidering Iran's counter narcotics 
efforts, why was it necessary to resort to gimmicks? Is there something 
wrong with presenting the facts publicly and reaching a reasonable 
consensus consistent with the national interest? Not to mention that in 
this decision on Iran and the earlier one on Syria that we did not 
consult with Israel, our most consistent ally in the region? Was it 
necessary? Was it wise?
  Is this the way we conduct serious counter drug policy as part of our 
international efforts? But this is not the only disturbing case.
  I earlier alluded to a similar situation with regard to Syria. I will 
not review the details of that case. Suffice it to say, they are in 
keeping with what was done about Iran. The case I would like to look at 
more closely is that of North Korea. Here we have another rogue state 
and enemy of the United States that seems to get favored treatment when 
it comes to drugs.
  There is credible and mounting evidence that North Korea is a major 
producing country of opium and processor of heroin. Stories of these 
activities have circulated for years, including details provided by 
defectors. Information that is further supported by the arrests of 
North Korean diplomats in numerous countries for drug smuggling using 
the diplomatic pouch. Defectors have indicated that illegal opium 
production and heroin sales have been used to fund North Korea's 
overseas activities and its nuclear program.
  These reports also indicate that opium cultivation in North Korea far 
exceed the 1,000 hectare level, ranging from 3,000 to 7,000 hectares 
depending on the climate and growing conditions. In a country plagued 
by famine, precious arable land has been turned to illicit opium 
production by the government to fund terrorism and the development of 
nuclear weapons. Until this year, however, the administration did not 
report on these activities. It was not until Congress required such a 
report that we have even a hint of all of this in official reporting. 
When I asked the administration two years ago to supply data on opium 
cultivation in North Korea, it responded by saying they did not have 
any detailed information. Why? Because the administration was not 
looking for it. Under pressure, it is now beginning to look. While I 
welcome this, I am concerned that this search for information will be 
handled in the same manner as was used in the case of Iran. Information 
will be collected, but it will be carefully scripted and narrowly 
interpreted.
  I find it puzzling that we should be willing to cut such corners. 
What is it about nations that are declared enemies of this country and 
many of our allies that we look the other way when it comes to drugs? 
What do we gain from empty gestures? And why do we make these gestures 
on an issue as basic to the national interest and well

[[Page 13960]]

being of U.S. citizens as drug policy? I am at a loss to explain it. 
So, rather than trying to guess at motives, I am offering legislation 
to clarify the situation and to require more overt explanations. I 
therefore send to the desk the Most Favored Rogue States Act of 1999 
and ask my colleagues to join me in supporting it. It addresses a 
serious issue that needs our immediate attention.
                                 ______
                                 
      By Mr. NICKLES (for himself, Mr. Lieberman, Mr. Lott, Mr. 
        Abraham, Mr. Allard, Mr. Brownback, Mr. Coverdell, Mr. Enzi, 
        Mr. Hagel, Mr. Inhofe, Mr. Craig, and Mr. Sessions):
  S. 1272. A bill to amend the Controlled Substances Act to promote 
pain management and palliative care without permitting assisted suicide 
and euthanasia, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.


                   Pain Relief Promotion Act of 1999

  Mr. NICKLES. Mr. President, end-of-life issues are some of the most 
complicated our society wrestles with today, as medical technology 
dramatically advances and life expectancies continue to increase. Many 
of us have relatives, or know someone, who has grappled with grave and 
terminal illnesses. Doctors, caregivers, and family members work 
together in such situations, not just in an effort to save a loved 
one's life, but to give them the comfort and palliative care they 
deserve. However, love and concern can often come up against a 
confusing and complicated set of Federal and state laws which govern 
and influence care and treatment decisions in such situations.
  Today I, along with Senators Lieberman, Lott, Abraham, Allard, 
Brownback, Coverdell, Enzi, Hagel, Helms, Inhofe, and Craig, introduce 
the Pain Relief Promotion Act of 1999. This comprehensive legislation 
will restore the uniform national standard of the Controlled Substances 
Act (CSA) to all 50 states. The Pain Relief Promotion Act will:
  Affirm and support aggressive pain management as a ``legitimate 
medical purpose'' for the use of federally-controlled substances--even 
in cases where such use may unintentionally hasten death as a side-
effect (``principle of double effect'').
  Encourage practitioners to dispense and distribute federally-
controlled substances as medically appropriate to relieve pain and 
other distressing symptoms, by clarifying that such conduct is 
consistent with the Controlled Substances Act.
  Provide that a state law authorizing or permitting assisted suicide 
or euthanasia does not change the federal government's responsibility 
to prevent misuse of federally-controlled, potentially dangerous, 
drugs. The Federal government's responsibility to prevent such misuse 
in states which have not legalized assisted suicide is already conceded 
by the Attorney General and would not change.
  Provide education and training to law enforcement officials and 
health professionals on medically accepted means for alleviating pain 
and other distressing symptoms for patients with advanced chronic 
disease or terminal illness, including the legitimate use of federally-
controlled substances.
  Establish a ``Program for Palliative Care Research and Quality'' 
within the Agency for Health Care Policy and Research (AHCPR) to 
develop and advance scientific understanding of palliative care, and 
collect, disseminate and make available information on pain management, 
especially for the terminally ill health professionals and the general 
public.
  Authorize $5 million for a grant program within the Health Resources 
and Services Administration (HRSA) to make grants and contracts for the 
development and implementation of programs to provide education and 
training in palliative care. It states that physicians entrusted by the 
federal government with the authority to prescribe and dispense 
federally-controlled substances may not abuse that authority by using 
them for assisted suicide; however, it strongly affirms that it is a 
``legitimate medical purpose'' to use these federally-controlled 
substances to treat patient's pain and end-of-life symptoms, even in 
light of the unfortunate and unintended side effect of possibly 
hastening a patient's death.
  Recognize that this policy promoting pain control does not authorize 
the use of federally-controlled substances for intentional assistance 
in suicide or euthanasia.
  Restore the uniform national standard that federally-controlled 
substances can not be used for the purpose of assisted suicide by 
applying the current law in 49 states to all 50 states. This bill does 
not create any new regulatory authority for the DEA.
  This is a straight-forward, very positive bill that would merely 
apply what is current law in 49 states to all 50 states, without 
increasing the federal regulatory authority of the Drug Enforcement 
Administration (DEA). The bill has been endorsed by organizations 
including the National Hospice Organization, American Society of 
Anesthesiologists, American Academy of Pain Management, and former 
Surgeon General Dr. C. Everett Koop. And, today I was informed that the 
House of Delegates of the American Medical Association voted to support 
the bill.
  A variety of provisions in this legislation is in direct response to 
the June 5, 1998, letter by the Attorney General, allowing Oregon to 
use federally-controlled substances for assisted suicide, a decision 
that was in direct opposition to an earlier policy determination by her 
own Drug Enforcement Administration.
  It is significant to remember that in 1984 Congress passed amendments 
to strengthen the Controlled Substances Act, due to specific concerns 
regarding the use of prescription drugs in lethal overdoses. Congress's 
view was that while the states are the first line of defense against 
misuse of prescription drugs, the federal government must enforce its 
own objective standard as to what constitutes such misuse--and it must 
have the authority to enforce that standard when a state cannot or will 
not do so.
  Again, Congress clearly spoke on the issue of assisted suicide when 
it passed the Assisted Suicide Federal Funding Restriction Act of 1997 
by a nearly unanimous vote. Signing the bill President Clinton said it 
``will allow the Federal Government to speak with a clear voice in 
opposing these practices,'' and warned that ``to endorse assisted 
suicide would set us on a disturbing and perhaps dangerous path.''
  It is time for Congress to speak again.
  Federal law is clearly intended to prevent use of these drugs for 
lethal overdoses, and contains no exception for deliberate overdoses 
approved by a physician. The DEA currently pursues cases where a 
physician's negligent use of controlled substances has led to the death 
of a patient, it was inappropriate for the Attorney General to allow 
for the intentional use of controlled substances to cause the death of 
a patient. The Pain Relief Promotion Act will clarify federal law, to 
affirm use of controlled substances to control pain and reject their 
deliberate use to kill patients.
  This legislation is overdue. Already physicians have used these 
federally controlled substances to cause the death of their patients. 
There is no role for the Federal government in providing assisted 
suicide.
  I urge my colleagues to support and enact this urgently needed 
bipartisan legislation.
  Mr. President, I ask unanimous consent that the text of the bill and 
letters, of support be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1272

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Pain Relief Promotion Act of 
     1999''.

[[Page 13961]]



 TITLE I--USE OF CONTROLLED SUBSTANCES CONSISTENT WITH THE CONTROLLED 
                             SUBSTANCES ACT

     SEC. 101. REINFORCING EXISTING STANDARD FOR LEGITIMATE USE OF 
                   CONTROLLED SUBSTANCES.

       Section 303 of the Controlled Substances Act (21 U.S.C. 
     823) is amended by adding at the end the following:
       ``(i)(1) For purposes of this Act and any regulations to 
     implement this Act, alleviating pain or discomfort in the 
     usual course of professional practice is a legitimate medical 
     purpose for the dispensing, distributing, or administering of 
     a controlled substance that is consistent with public health 
     and safety, even if the use of such a substance may increase 
     the risk of death. Nothing in this section authorizes 
     intentionally dispensing, distributing, or administering a 
     controlled substance for the purpose of causing death or 
     assisting another person in causing death.
       ``(2) Notwithstanding any other provision of this Act, in 
     determining whether a registration is consistent with the 
     public interest under this Act, the Attorney General shall 
     give no force and effect to State law authorizing or 
     permitting assisted suicide or euthanasia.
       ``(3) Paragraph (2) applies only to conduct occurring after 
     the date of enactment of this subsection.''.

     SEC. 102. EDUCATION AND TRAINING PROGRAMS.

       Section 502(a) of the Controlled Substances Act (21 U.S.C. 
     872(a)) is amended--
       (1) by striking ``and'' at the end of paragraph (5);
       (2) by striking the period at the end of paragraph (6) and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(7) educational and training programs for local, State, 
     and Federal personnel, incorporating recommendations by the 
     Secretary of Health and Human Services, on the necessary and 
     legitimate use of controlled substances in pain management 
     and palliative care, and means by which investigation and 
     enforcement actions by law enforcement personnel may 
     accommodate such use.''.

                  TITLE II--PROMOTING PALLIATIVE CARE

     SEC. 201. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND 
                   RESEARCH.

       Part A of title IX of the Public Health Service Act (42 
     U.S.C. 299 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 906. PROGRAM FOR PALLIATIVE CARE RESEARCH AND QUALITY.

       ``(a) In General.--The Administrator shall carry out a 
     program to accomplish the following:
       ``(1) Develop and advance scientific understanding of 
     palliative care.
       ``(2) Collect and disseminate protocols and evidence-based 
     practices regarding palliative care, with priority given to 
     pain management for terminally ill patients, and make such 
     information available to public and private health care 
     programs and providers, health professions schools, and 
     hospices, and to the general public.
       ``(b) Definition.--For purposes of this section, the term 
     `palliative care' means the active total care of patients 
     whose prognosis is limited due to progressive, far-advanced 
     disease. The purpose of such care is to alleviate pain and 
     other distressing symptoms and to enhance the quality of 
     life, not to hasten or postpone death.''.

     SEC. 202. ACTIVITIES OF HEALTH RESOURCES AND SERVICES 
                   ADMINISTRATION.

       (a) In General.--Part D of title VII of the Public Health 
     Service Act (42 U.S.C. 294 et seq.), as amended by section 
     103 of Public Law 105-392 (112 Stat. 3541), is amended--
       (1) by redesignating sections 754 through 757 as sections 
     755 through 758, respectively; and
       (2) by inserting after section 753 the following section:

     ``SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PALLIATIVE 
                   CARE.

       ``(a) In General.--The Secretary, in consultation with the 
     Administrator for Health Care Policy and Research, may make 
     awards of grants, cooperative agreements, and contracts to 
     health professions schools, hospices, and other public and 
     private entities for the development and implementation of 
     programs to provide education and training to health care 
     professionals in palliative care.
       ``(b) Priorities.--In making awards under subsection (a), 
     the Secretary shall give priority to awards for the 
     implementation of programs under such subsection.
       ``(c) Certain Topics.--An award may be made under 
     subsection (a) only if the applicant for the award agrees 
     that the program carried out with the award will include 
     information and education on--
       ``(1) means for alleviating pain and discomfort of 
     patients, especially terminally ill patients, including the 
     medically appropriate use of controlled substances;
       ``(2) applicable laws on controlled substances, including 
     laws permitting health care professionals to dispense or 
     administer controlled substances as needed to relieve pain 
     even in cases where such efforts may unintentionally increase 
     the risk of death; and
       ``(3) recent findings, developments, and improvements in 
     the provision of palliative care.
       ``(d) Program Sites.--Education and training under 
     subsection (a) may be provided at or through health 
     professions schools, residency training programs and other 
     graduate programs in the health professions, entities that 
     provide continuing medical education, hospices, and such 
     other programs or sites as the Secretary determines to be 
     appropriate.
       ``(e) Evaluation of Programs.--The Secretary shall 
     (directly or through grants or contracts) provide for the 
     evaluation of programs implemented under subsection (a) in 
     order to determine the effect of such programs on knowledge 
     and practice regarding palliative care.
       ``(f) Peer Review Groups.--In carrying out section 799(f) 
     with respect to this section, the Secretary shall ensure that 
     the membership of each peer review group involved includes 
     one or more individuals with expertise and experience in 
     palliative care.
       ``(g) Definition.--For purposes of this section, the term 
     `palliative care' means the active total care of patients 
     whose prognosis is limited due to progressive, far-advanced 
     disease. The purpose of such care is to alleviate pain and 
     other distressing symptoms and to enhance the quality of 
     life, not to hasten or postpone death.''.
       (b) Authorization of Appropriations; Allocation.--
       (1) In general.--Section 758 of the Public Health Service 
     Act (as redesignated by subsection (a)(1) of this section) is 
     amended in subsection (b)(1)(C) by striking ``sections 753, 
     754, and 755'' and inserting ``section 753, 754, 755, and 
     756''.
       (2) Amount.--With respect to section 758 of the Public 
     Health Service Act (as redesignated by subsection (a)(1) of 
     this section), the dollar amount specified in subsection 
     (b)(1)(C) of such section is deemed to be increased by 
     $5,000,000.

     SEC. 203. EFFECTIVE DATE.

       The amendments made by this title take effect October 1, 
     1999, or on the date of the enactment of this Act, whichever 
     occurs later.
                                  ____



                                National Hospice Organization,

                                     Arlington, VA, June 11, 1999.
     Hon. Don Nickles,
     U.S. Senate,
     Washington, DC.
       Dear Senator Nickles: The National Hospice Organization has 
     recently endorsed your bill, ``The Pain Relief Promotion Act 
     of 1999.''
       Your legislation would provide a mechanism for health care 
     professionals to collect, review and disseminate vital 
     practice protocols and effective pain management techniques 
     within the health care community and the public. In addition, 
     increased educational efforts focused within the health 
     professions community about the nature and practice of 
     palliative care are important components of your initiative.
       Our 2,000 member hospices provide what Americans say they 
     want if they were confronted with a terminal illness--to die 
     in their home, free of pain, and with emotional support for 
     themselves and their loved ones. For over 20 years, hospices 
     have been in the forefront of managing the complex medical 
     and emotional needs of the terminally ill. It is unfortunate 
     that we continue to see individuals living and dying in 
     unnecessary pain when the clinical and medical resources 
     exist but widespread education is lacking.
       Your legislation is a step toward a better awareness of 
     effective pain management techniques and should ultimately 
     change behavior to better serve the needs of terminally ill 
     patients and their families.
           Sincerely,
                                                   Karen A. Davie,
     President.
                                  ____

                                                  American Academy


                                           of Pain Management,

                                        Sonora, CA, June 15, 1999.
     Senator Donald Nickles,
     Washington, DC.
       Dear Senator Nickles: The American Academy of Pain 
     Management, America's largest multidisciplinary pain 
     organization, applauds your efforts to end the pain and 
     suffering for Americans. The Board of Directors of the 
     American Academy of Pain Management supports The Pain Relief 
     Promotion Act of 1999. We share your belief that opioid 
     analgesics should be available for those unfortunately 
     suffering from the pain associated with terminal illnesses. 
     The alternatives to assisted suicide and euthanasia are 
     compassionate and appropriate methods for prescribers to 
     relieve pain without fear of regulatory discipline.
       The Pain Relief Promotion Act of 1999 provides for law 
     enforcement education, the development and dissemination of 
     practice guidelines, increased funding for palliative care 
     research, and safeguards for unlawful prescribers of 
     controlled substances. This bill appropriately reflects the 
     changing philosophy about pain control as a significant 
     priority in the care of those facing terminal illnesses.
       The American Academy of Pain Management thanks you for your 
     effort to improve the quality of life for Americans.
           Sincerely,
                                         Richard S. Weiner, Ph.D.,
                                               Executive Director.

[[Page 13962]]

     
                                  ____
                                                  American Society


                                         of Anesthesiologists,

                                    Washington, DC, June 16, 1999.
     Hon. Don Nickles,
     Assistant Majority Leader, U.S. Senate, Washington, DC.
       Dear Senator Nickles: In my capacity as President of the 
     American Society of Anesthesiologists, a national medical 
     association comprised of 34,000 physicians and other 
     scientists engaged or especially interested in the practice 
     of anesthesiology, I am pleased to offer our endorsement of 
     the Pain Relief Promotion Act of 1999, which I understand you 
     will introduce this week.
       Many ASA members engage in a pain management practice, and 
     such a practice regularly includes the treatment of 
     intractable pain, experienced by terminally or severely ill 
     patients, through the prescription of controlled substances. 
     As you are aware, a major concern among these practitioners 
     has involved the possible that aggressive treatment of 
     intractable pain involving increased risk of death--however 
     medically necessary to provide the patient with the best 
     possible quality of life--could be the subject of criminal 
     prosecution as involving alleged intent to cause death.
       ASA's House of Delegates has formally expressed the 
     Society's opposition to physician assisted suicide as 
     incompatible with the role of the physician. At the same 
     time, the Society believes anesthesiologists ``should always 
     strive to relieve suffering, address the psychological and 
     spiritual needs of patients at the end of life, add value to 
     a patient's remaining life and allow patients to die with 
     dignity''.
       We find your bill to be fully consistent with these 
     principles, in that (1) it denies support in federal law for 
     intentional use of a controlled substance for the purpose of 
     causing death or assisting another person in causing death, 
     but (2) it includes in federal law recognition that 
     alleviating pain in the usual course of professional practice 
     is a legitimate medical purpose for dispensing a controlled 
     substance that is consistent with public health and safety, 
     even if the use of such a substance may increase the risk of 
     death.
       ASA believes that the bill articulates an appropriate 
     standard for distinguishing between assisted suicide and 
     medically-appropriate aggressive treatment of severe pain. 
     Although we have some continuing concern whether law 
     enforcement officers will regularly recognize and honor this 
     critical distinction, we believe much can be accomplished 
     through the education and training programs contemplated by 
     section 102 of the bill. We look forward to the opportunity, 
     during congressional consideration of the bill, to work with 
     you and your staff to strengthen this provision to assure 
     that the these programs include input from medical 
     practitioners regularly engaged in a pain management 
     practice.
       If we can be of further assistance, please ask your staff 
     to contact Michael Scott in our Washington office, at the 
     address and telephone number listed above.
           Sincerely,
                                         John B. Neeld, Jr., M.D.,
     President.

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