[Congressional Record (Bound Edition), Volume 147 (2001), Part 10]
[Senate]
[Pages 14448-14450]
[From the U.S. Government Publishing Office, www.gpo.gov]



                      THE PATIENTS' BILL OF RIGHTS

  Mr. DORGAN. Mr. President, the Senate recently passed the Patients' 
Bill of Rights and we are anxiously awaiting action by the House. The 
Patient Protection Act, or the Patients' Bill of Rights, is something 
we have spent a great deal of time on in the Senate.
  As Senator Daschle indicated, it was one of our top priorities. We 
had a great deal of difficulty getting it through the Senate. It took 
us a good number of years to do that, but after 4 or 5 years of debate, 
we finally got a Patient Protection Act passed by the Senate. We are 
now waiting for the House to take similar action.
  The President says he will veto it. And that is the way the 
legislative process works. We have to do the best we can to advance 
public policies that we think strengthen this country. We have done 
that under the leadership of Senator Daschle, with the cooperation of 
my colleagues on both sides of the aisle. We passed a real Patient 
Protection Act or a real Patients' Bill of Rights. Let me describe why 
that is important and what it does.
  All of us have had lengthy debates about what is happening to health 
care in this country, as more and more Americans have been herded into 
these groups called managed care organizations. They were created, in 
some cases, for very good reasons, to try to reduce the cost of health 
care and control and contain the cost of health care.
  But in recent years, the for-profit organizations that have become 
part of

[[Page 14449]]

the managed care industry have, from time to time, taken actions with 
respect to patient care that have much more to do with their bottom-
line profit than it has to do with patient care.
  So we had a debate about a Patient Protection Act that says the 
following:
  One, you ought to be able to know all of your medical options for 
treatment, not just the cheapest option for medical treatment. That 
ought to be a fundamental right for patients.
  Two, if you have an emergency, you ought to have a right to go to an 
emergency room. Sound simple? Yes, it is simple. But it is not always 
the case in this country that with an emergency, you are going to get 
reimbursement for emergency room treatment by a managed care 
organization.
  Three, you have a right to see a specialist when you need one for 
your medical condition. Does that sound simple and pretty 
straightforward? Sure, but it doesn't happen all the time.
  You have a right to clinical trials. You have a right to retain, for 
example, the relationship you have with your oncologist who has been 
treating you for breast cancer for 7 years. Even if your employer 
changes health care organizations, you have a right to continue to see 
the same oncologist who has been treating you for cancer for 7 years.
  Those are the kinds of provisions we put in the Patient Protection 
Act. Let me describe why we did it. We did it because in this country 
too often patients are discovering that what they believed they were 
covered for in their medical or health care plan was not in fact 
covered at all.
  I have told the story of the woman who went hiking in the 
Shenandoahs. She fell off a 50-foot cliff and sustained very serious 
injuries. She was unconscious. She had multiple broken bones and was in 
very serious condition. She was brought to an emergency room on a 
gurney unconscious. She survived after a long convalescence, only to 
find out that the managed care organization said they would not pay for 
her emergency room treatment because she had not had prior approval for 
emergency room care. This is a woman hauled into an emergency room 
unconscious, told that she should have gotten prior approval for 
emergency room care.
  Does that literally cry out and beg for some kind of legislative 
attention? Yes, it does. It is just one piece of the Patient Protection 
Act providing that, if you have an emergency, you have a right to 
emergency room treatment.
  There are so many other examples. For instance, the issue of what is 
medically necessary. I have held up pictures on the floor of young 
children born with terribly deformed facial features, being told that 
the correction of that radically deformed facial feature is not 
``medically necessary,'' and therefore the insurance they thought they 
had with the managed care organization would not cover it.
  I have told the story often of my colleague, Senator Reid of Nevada 
and I, holding a hearing in the State of Nevada on this subject, where 
we heard from a mother of a young boy named Christopher Roe who died at 
age 16. Christopher had cancer. This young boy fought cancer valiantly 
but lost his life on his 16th birthday. In the process of fighting 
cancer, they also had to fight in order to get the treatment he needed. 
He didn't get it in time. It is an unfair fight to ask a 16-year-old 
boy to fight cancer and have to fight the insurance company at the same 
time.
  His mother held up a picture of young Christopher, a big colored 
poster picture, and cried at the end of her testimony as she described 
her son looking up at her from the bedside asking: Mom, how can they do 
this to a kid? What he was asking was: How can they do this? How can 
they not provide the treatment I need to give me a chance to live? That 
boy died at age 16.
  I have told that story. I have told many other stories, including the 
story of Ethan Bedrick. Ethan had a very difficult birth and was born 
with very serious problems because the umbilical cord had shut off his 
oxygen. A doctor had decided, after evaluating him, that he had only a 
50-percent chance of being able to walk by age 5 if he got certain 
rehabilitative services. A 50- percent chance for this little boy to be 
able to walk by age 5 was ``insignificant,'' and, therefore, the 
services were denied.
  Does it sound bizarre? Does it sound like a system with which we are 
acquainted? Not to me. This all sounds just Byzantine, that decisions 
are made about health care on what is medically necessary, what is an 
emergency, what kind of treatment is available, what kind of treatment 
is necessary. Some decisions have been made with an eye toward the 
bottom line of the corporation providing the health care. And that is 
wrong because human health is not a function of someone's bottom line.
  We had a woman who suffered a very serious brain injury. She was 
still conscious. She was in an ambulance, and she asked the ambulance 
driver to take her to the furthest hospital. There was one closer. She 
wanted to go to the one that was a bit further away. This is someone in 
an ambulance with a brain injury. She survived and later was asked: Why 
did you not want the ambulance to drop you off at the nearest hospital? 
She said: Because I understood the reputation of that hospital. It was 
their bottom line, their profit; I did not want to be presented on a 
gurney with a brain injury and be looked at by a doctor who thought in 
terms of profit and loss. Doctors wouldn't do that, but a health care 
system determined by profit and loss, how much would this cost? I 
wanted someone to see me and determine they wanted to fight for my life 
regardless of cost.
  That is what people have been concerned about with respect to managed 
care. Not all managed care organizations have done this. Some are 
wonderful. Some have done a great job. Some have not. Some have taken a 
position that jeopardizes people's health. They have said to people: 
Here is your option for medical treatment, not giving them all the 
options that might be available to them, only describing the cheapest 
option that would be available to be delivered by the health care 
organization.
  Is that fair to people in this health care system? The answer clearly 
is no.
  So we have had a fight in the Senate the last 3, 4, 5 years. We have 
a managed care organization that is big, strong, well financed, and 
they very aggressively oppose what we are trying to do. On the other 
side are doctors, the American Medical Association. They want to 
practice medicine in the hospital room. They want to practice medicine 
in the clinic. They don't want to practice medicine only to find out 
that some young fellow 1,000 miles away, working as a junior accountant 
for an insurance company, who hasn't yet shaved twice a week, is making 
decisions about health care that the doctor is going to deliver in the 
hospital room.
  That is not the kind of health care they are dedicated to provide the 
American people. They didn't study in medical school for the purpose of 
having somebody 1,000 miles away, who knows very little about health 
care, tell them how they ought to treat a patient.
  So we have a battle between the managed care organization, that has 
spent a great deal of money, putting ads all over television to try to 
defeat it, and doctors, patients, and other health groups saying: We 
need this.
  It was long past the time to get this done, and we finally did it. We 
finally got it done. We got it through the Senate after a number of 
years. Now it waits in the House for action. We read day after day of 
reasons that somehow it is not quite getting done. The big industries 
that have something at stake are making all the efforts they can to try 
to defeat the legislation. And if we get it through the House of 
Representatives--and we should; there is no excuse for this Congress 
not passing this legislation--the President says he will veto it.
  He has a right to veto it. I must say, though, what we have enacted 
in the Senate is almost exactly what they have for law in the State of 
Texas. I know President Bush vetoed it first when he was Governor of 
Texas, but

[[Page 14450]]

later it became law without his signature in Texas. What we are trying 
to do for the country says essentially the same as exists in the State 
of Texas with respect to a patients' protection act.
  Again, let me say that we have a lot of issues in this country. We 
sink our teeth into a good number of them throughout the year in the 
Senate.
  This is a critically important issue for us to get done this year. 
This issue is very important. We have a responsibility to continue 
applying pressure in this circumstance to the House. I hope the 
American people will apply pressure to the House and say: Get this 
done. Do this bill. Bring it up for a vote, pass it, and send it to the 
President.
  The President says he will veto it. I don't know that that is the 
case. I hope when he looks at this bill, he will understand this is the 
right bill for the American people. It is the right thing to do.
  It is very interesting to me that as we look at all of the challenges 
we face in this country, we have had some great successes, and almost 
every step of the way we have had people who have said: Not me, help me 
out, this won't work. All of us come from towns and have friends who 
are there sitting around being crabby all day long, those who describe 
what won't work.
  I come from a town of 300 to 400 people. I spent most of my formative 
years there. Three or four people there were always crabby about 
things, and they said, ``This won't work,'' or, ``This will never do.'' 
But the rest of the town was out doing things. They paved our Main 
Street while others said it could not be done. It got done because the 
builders and the doers decided to make it happen.
  The same is true in the Senate. It doesn't matter what the issue is, 
it doesn't matter whether it is Social Security, workers rights, 
minimum wage, we have people in this body who have opposed everything 
for the first time, and it doesn't matter what it is. Those who 
progressively want to make changes strengthen this country. It is our 
burden to say, here are our ideas, here is what we must do to 
strengthen our country.
  We have done that. A Patient Protection Act is just one more step in 
a series of things that we know must be done to help the American 
people deal with a health care system that has increasingly moved 
toward managed care and has increasingly empowered the bigger interests 
and taken away from the American people and the individuals who need 
health care the opportunity to fight back. That is what the Patient 
Protection Act or Patients' Bill of Rights is about.
  Now we have passed that legislation. We have had good leadership in 
the Senate, and in the last couple of months we have passed legislation 
dealing with that Patients' Bill of Rights and a number of other things 
that have been welled up for a long while in the Senate. But now it is 
done. It is up to the House to do the same. I call on the President to 
join us. I urge the House to pass this bill, and then I urge the 
President to sign the bill. Let this bill work for the American people.
  I know the Senator from Nevada, who attended a hearing with me that I 
referenced recently, cares a great deal about this issue. I know that 
at the hearing in the State of Nevada I heard exactly what I had heard 
at hearings I held in New York, Minnesota, and elsewhere. I held 
hearings as chairman of the Democratic Policy Committee on this issue. 
It didn't matter where you were, you would hear the same story; that 
is, that patients in this country expect the kind of health treatment 
they were promised by their health care plan, when they get sick and 
need health care. Too often they discover that that kind of delivery of 
health care service is not available to them when they need it.
  We have, as I indicated, a number of challenges facing us this year. 
This is but one. I think it is one of the most important challenges. I 
hope in the not-too-distant future the House of Representatives will 
take action, as the Senate has already done, and we will see a Patient 
Protection Act become law in this country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nevada is recognized.
  Mr. REID. Mr. President, I have said before that the Senator from 
North Dakota has spent a great deal of time on the Patients' Bill of 
Rights, developing a foundation so that the legislation could pass. It 
was Senator Edwards' legislation, along with Senators Kennedy and 
McCain. But the real foundation for that legislation came as a result 
of the work that Senator Dorgan did around the country as the chairman 
of the policy committee, holding hearings all over America. He 
mentioned Las Vegas. There was a dramatic hearing held in Las Vegas, 
with people complaining about how they had been mistreated or not 
treated. Not only did we have patients coming in, we had physicians 
coming in and telling us how they could not render care that they, in 
their expertise, training, and experience, indicated needed to be done, 
and their managed care entity would not let them do it. There are cases 
where a doctor has been pulled off the case because his recommendations 
for treatment were not what the HMO or the managed care entity wanted.
  I have great respect and admiration for the Senator from North Dakota 
for helping us lay a foundation so that we could pass successful 
legislation. All eyes are now upon the House of Representatives, to 
make sure they pass legislation that is in keeping with what we did 
over here. They are trying to spin this, saying the legislation in the 
Senate is all about lawyers.
  The legislation that passed in the Senate of the United States had 
nothing to do with lawyers and everything to do with patients. Out of a 
bill that contains 100 percent substance, 2 percent dealt with lawyers 
and 98 percent dealt with patients.
  I look forward to the bill passing in the House. Also, I have such 
great admiration and respect for Dr. Norwood, who has been willing to 
step beyond the pale. He has been willing to go beyond what most of the 
time happens in partisan politics. Congressman Norwood, a Republican, 
has said he can't do what his leadership has asked him to do. He 
believes in a Patients' Bill of Rights, and he has been a leader. I 
have such great respect for him.
  I express my appreciation to the Senator from North Dakota.

                          ____________________