[Congressional Record (Bound Edition), Volume 147 (2001), Part 4]
[House]
[Pages 5464-5465]
[From the U.S. Government Publishing Office, www.gpo.gov]



         MANAGED CARE REFORM, PATIENT ACCESS TO SPECIALTY CARE

  The SPEAKER pro tempore (Mr. Graves). Under a previous order of the 
House, the gentleman from Texas (Mr. Green) is recognized for 5 
minutes.
  Mr. GREEN of Texas. Mr. Speaker, I rise today to continue what is a 
series of speeches or Special Orders on the need to reform our Nation's 
managed care industry. In the past I have discussed external and 
internal appeals processes, medical necessity, and the need for 
accountability. Today I would like to discuss patient access to 
specialty care.
  Specialists fill an invaluable role in our Nation's health care 
system. And many of us have sought the services of a specialist because 
of high blood pressure, a broken arm, or migraine headaches. But 
oftentimes, HMOs refuse patients access to specialists because they do 
not have such specialists in their network or they are across town or 
literally unavailable.
  Such is the case of Sarah Peterson from San Mateo, California. She 
was born with a brain tumor that required her to see a physician who 
specialized in brain tumors. But her HMO, which was obtained through 
her father's employer, told her mother that she would not be able to 
see a pediatric specialist. She was told, what difference does it make, 
cancer is cancer.
  Well, it does make a difference if you are the parent of a child with 
a potentially deadly tumor. While Sarah was fighting for her life, her 
parents were fighting an HMO to get her the quality health care they 
were paying for. This situation could have had dire consequences; but 
fortunately for Sarah, her parents changed plans during the middle of 
this medical crisis. Sarah is now 8 years old and is doing well. But 
she still has a tumor and will still need to see a specialist. 
Hopefully, her health insurance will let her continue to see that 
specialist.
  The prognosis is not as promising for young Kyle of Bakersfield, 
California. Kyle began having ear problems when he was 6 months old. 
After months of corrective measures, antibiotics, infections, and 
finally a ruptured eardrum, Kyle's HMO referred him to an ENT. The ENT 
performed surgery to put tubes in Kyle's ears which would allow for the 
drainage of the infected fluids, but that surgery was too little too 
late. After 10 days, Kyle's ears began to bleed. Had the HMO followed 
the advice of the ENT, they would have given Kyle a CAT scan to provide 
evidence of cholosteatoma, a severe infection that destroys the bone in 
the inner ear. But again, the HMO denied this vital test, and Kyle's 
ear problems continued along, undiagnosed.
  Finally, after losing all patience with the HMO, his parents changed 
plans

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and were advised that their son needed this exploratory surgery. It was 
then that they learned of the severe nature of the cholosteatoma and 
that Kyle would need another surgery. After all of the waiting, 
surgeons had to remove all of the bones in Kyle's middle ear. Because 
of the delay in specialty care, combined with the HMO's denial of a 
simple test, Kyle's doctors anticipate he will suffer significant 
hearing loss as he reaches his adolescence.
  A denial of specialty care was deadly for Glenn Neally, who lost his 
life because an HMO denied him direct access to specialty care. When 
Glenn's employer changed plans in March 1992, he made sure that the 
managed care plan would continue to cover treatment of his cardiac 
condition, unstable angina. His cardiologist had prescribed a strict 
regime of nitrates, calcium blockers, and beta blockers. He was assured 
that he would be able to see his cardiologist. But his HMO required him 
to obtain a referral for follow-up treatment by his cardiologist. 
Bureaucratic paperwork problems gave Glenn the run-around for 2 months, 
while he tried to get the proper ID cards, referrals and pharmacy 
cards. Even after obtaining all of this paperwork, his HMO formally 
denied his request that he receive follow-up visits with his previous 
cardiologist and instead was forced to see their participating 
cardiologist in May of that year.
  That turned out to be one day too late for Glenn. He died of a 
massive heart attack on May 18, leaving behind his wife and two sons.
  Mr. Speaker, I stand here today and tell story after story of the 
damage that occurs when people are denied access to specialty care. But 
what this really tells us, we need managed care reform on a national 
basis like the Bipartisan Patient Protection Act, H.R. 526.
  This legislation ensures that patients who need specialty care can 
reach that specialist. It would ensure that children like Kyle and 
Sarah have direct access to their pediatrician.
  This plan could have helped Glenn Neally because it would have 
ensured that plans cover specialists even outside the network. It 
ensures that patient care is continuous, and if provider networks 
change, a patient is not forced to change doctors in midstream.
  These provisions are not abstract, legal, or political. These are 
real protections that make a real difference in saving people's lives. 
I hope my colleagues will consider how vital specialist care is for 
those who do not have access and join me in supporting H.R. 526, the 
Bipartisan Patient Protection Act.

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