[Congressional Record (Bound Edition), Volume 147 (2001), Part 8]
[Senate]
[Pages 11141-11143]
[From the U.S. Government Publishing Office, www.gpo.gov]



                        PATIENTS' BILL OF RIGHTS

  Mr. REID. Mr. President, there has been a concerted effort since the 
first day of this week to stall, hinder, slow down--whatever term one 
can use--the movement of this legislation which is before the Senate, 
the Patients' Bill of Rights. This method to slow down legislation has 
come about because the managed care entities and the people who work 
with them, who make a lot of money, have said to the minority: Do not 
let this legislation move. And the minority is trying to live up to 
their request. Keep this legislation boxed up. Tie it up for as long as 
possible.
  I announce to everyone within the sound of my voice and I spread over 
the Record of the Senate that the ``as long as possible'' has come to 
an end. We are going to move this legislation. Five years is long 
enough. We are going to move this legislation now.
  In the morning, we are going to vote on a motion to proceed that 
should have taken place a long time ago. We should not even be having a 
vote on a motion to proceed, but that is the way they decided to slow 
it down, recognizing if they slow it down this week, then maybe next 
week we will not want to work very hard. We have the Fourth of July 
parades, our 10 days at home, and then they will wait until after the 
Fourth of July, and we will have appropriations bills and maybe there 
will not be a Patients' Bill of Rights for the sixth year.
  That is not going to happen. Tom Daschle--whom I have known since 
1982; I served with him in the House and I have the good fortune of 
serving with him in the Senate; we came here together--has said we are 
going to complete this legislation before the Senate recesses for the 
Fourth of July break.
  Tom Daschle is a man of his word. That is what is going to happen, 
and everyone should understand that.
  Why is this legislation called the Patients' Bill of Rights? It is 
called the Patients' Bill of Rights because it will create a law that 
gives patients the rights to which they are entitled, which they now do 
not have. In short, it will once again allow a doctor to care for his 
or her patient. That is the way it used to be.
  Just think, a doctor can prescribe medicine for his or her patient 
that will heal that patient in the mind of the doctor, relieve pain, 
prevent disease. The doctor can do that because that doctor thinks that 
is best for his or her patient.
  Imagine a doctor can refer a patient to a specialist if he believes 
it is appropriate. That is the way it used to be. That is the way it is 
going to be in the future.
  We have heard all kinds of excuses that if this legislation passes, 
the sky is going to fall. This is not the first time we have heard 
these statements.
  Senator Dorgan and I spoke today to a person who is a very successful 
businessman. He said: The reason I like Democrats, but the reason you 
cause businesspeople concern, is you want to change things: Social 
Security, Medicare. There are things you are trying to do differently. 
They work out well, but people don't like change.
  Just a few years ago, the Family Leave Act was talked about. The 
Democrats thought it would be a good idea if America was like most 
civilized countries. If a woman, for example, had a baby, she would not 
lose her job. It was called the Family Leave Act. We said: Employer, 
you don't even have to pay the woman, but she should be guaranteed her 
job when she finishes 6 weeks of maternity leave.
  We can't do that. It will drive us out of business. We cannot have 
temporary employees. It will be awful.
  I defy anyone to go home and have anybody raise the question that the 
Family and Medical Leave Act has hurt their business. Of course, it has 
not. It helps their business.
  The Patients' Bill of Rights is in the same category. It is going to 
help our society. In the long run, it will help businesses because it 
will make the employees feel better about the businesses. We are being 
told the Patients' Bill of Rights will be like the Family and Medical 
Leave Act; it will drive businesses into bankruptcy. This is not going 
to happen.
  Everything possible is being brought up about this legislation. What 
are

[[Page 11142]]

some of the things I have heard this week? Kill the lawyers--they go 
back to biblical times. Kill all the lawyers. They have not said that, 
but that is what they mean. They even know how many people are going to 
be driven out of the insurance protection field because of this 
legislation. They say keep legislation in Federal court and not have 
any in State court; it is too expensive. One dollar a month is too much 
money? Or nothing happened in committee; we need to go back to 
committee and hold hearings.
  This legislation has been going on for 5 years. We have had days of 
debate on the floor. We have had numerous committee hearings all over 
the country. The best way to sum this up, with all the crying and 
whining and stalling from the other side, is with who favors their 
legislation. The managed care industry, HMOs, that is who favors their 
legislation. Who favors McCain-Edwards-Kennedy? Everybody else. Does 
that mean everybody else is dumb? Everybody else is being led around by 
the greedy lawyers? The greedy doctors? The greedy nurses? Or does it 
mean this legislation solves a problem in our country? Is this the 
reason that 85 percent of everybody--Democrat, Republican, 
Independent--supports this legislation? I repeat: Who does not support 
it? The managed care industry, HMOs.
  Our Patients' Bill of Rights is a bill that is authored by the very 
courageous John McCain. When we talk about John McCain, why do we add 
``courageous''? That is what he is. He is a war hero. But he is also 
legislatively courageous. He is joined by John Edwards, a person in 
this Senate of great intellect, and also Ted Kennedy, a man who has a 
lifetime of experience dealing with this issue. They have written a 
bill that is uncompromised. I will be surprised if this side offers 
amendments. This is a good piece of legislation. We will take it as it 
is. We know we will put up with a lot of frivolous stalling, 
mischievous amendments on this side.
  Last night, I ran into a journalist. He said to me: Senator Daschle 
thinks he is bluffing. I talked to a Republican Senator, and they think 
Senator Daschle is bluffing because it can't be done in that short a 
period of time.
  This legislation has been handled in a short period of time in the 
past under the Republican leadership. When this bill came up in 1999, 
it finished in 4 days. We had a time certain it would pass--4 days. The 
bill was introduced and placed on the calendar on July 8. We began 
consideration July 12. There were no committee hearings either. All 
amendments were limited to 100 minutes of debate; no more than one 
second-degree amendment in order per side per amendment. Just prior to 
the third reading, we agreed that the majority leader, then Senator 
Lott, could be recognized to offer a final amendment to which no 
second-degree amendment was in order. Final passage occurred on that 
bill. Of course they killed it in conference. Everybody knows that. 
Final passage was completed in 4 days. We had 17 amendments and 13 
rollcall votes. So we can do this in 4 days and complete it by next 
Thursday if people have the will to do so.
  If they don't have the will to do it Thursday night sometime, we will 
be here Friday, Saturday, Sunday. The Fourth of July is our first day 
off, a Wednesday, because we are going to work Friday, Saturday, 
Sunday, Monday, Tuesday, and take Wednesday off and come back on 
Thursday, the 5th, to complete this legislation. Everyone should know 
this. It has been done in the past in 4 days. We can do it again.
  This afternoon I received a letter. I have a friend in Nevada. He is 
one of my wife's physicians, a wonderful, kind, thoughtful, considerate 
man. His name is Frank Nemec. Frank Nemec is not some person who does 
medicine from the back seat of his car, the trunk of his car. Frank 
Nemec is an extremely well-known physician around the country. He is 
published and has written articles for medical journals. He had a 
Fulbright scholarship to the University of California at Berkeley, 
graduated with honors from the University of California at Berkeley, 
attended with a full scholarship the university of California at Los 
Angeles Medical School, and graduated with honors. He has been 
president of the State medical society, president of the Clark County 
Medical Society, Las Vegas, chief of staff of the largest hospital in 
Nevada, board certified in internal medicine, gastroenterology. This is 
a fine physician and not somebody out stirring up trouble. He is a man 
who has been involved in politics only because he believes his patients 
are being affected.
  Here is a letter to me from Frank Nemec:

       As you have heard from so many Nevadans over the past 
     several years, we need a mechanism where patients have 
     options when care is denied. The following case is a clear 
     illustration.
       On April 20th, 1999, Joseph Greuble died at the age of 47 
     from malnutrition. Joseph's malnutrition was a direct 
     complication of his lifelong battle with Crohn's Disease.

  I am familiar with Crohn's disease, Mr. President. There are two of 
what are called digestive bowel diseases, Crohn's disease and 
gastroenteritis. They are both bad, but the worst is Crohn's. My wife 
is fortunate not to have such a dread disease as that; she has 
gastroenteritis. She has spent many months of her life in hospitals.
  So I know something about Crohn's disease. The letter continues:

       Joseph's gastrointestinal problem was quite complex. His 
     disease was complicated by ulcerations, fistulae, bleeding, 
     obstruction, electrolyte disturbances, seizures, and chronic 
     pain, and Joseph required multiple operations. Continuity of 
     care is most important when dealing with an incurable, 
     chronic, debilitating disease. In Joseph's case, the system's 
     failure to provide continuity of care proved tragic and 
     fatal.
       I served as Joseph's personal physician for 11 years. As 
     Joseph's condition worsened he was no longer able to live 
     independently, and he moved into his mother's small apartment 
     in Las Vegas. His mother would accompany him to my office for 
     all of Joseph's visits and as a result, I came to know his 
     mother Marion quite well.
       For over a decade, I performed needed physician 
     examinations, arranged for appropriate diagnostic studies, 
     wrote Joseph's prescriptions, and attended to him in the 
     hospital whenever he required admission due to complications 
     of his disease. One of Joseph's most pressing needs was for 
     nutritional support. Joseph had become malnourished as a 
     complication of his Crohn's Disease, and required TPN 
     (intravenous nutrition).

  I am also familiar with that, Mr. President.

     Joseph's weight had fallen to just over 110 pounds, and at 5' 
     10" tall Joseph needed the TPN to maintain his weight and 
     prevent death due to malnutrition.

       In January of 1999, Joseph was told by his HMO that I could 
     no longer treat him. Appeals by both myself and Joseph to 
     have this decision reversed were denied. My offer to see 
     Joseph free of charge was rejected by the HMO, as I still 
     would not have been permitted to write his prescriptions, 
     direct his nutritional support, order any diagnostic testing, 
     or request needed consultations.
       While I do not have any of the medical records of Joseph's 
     treatment for the three months after he left my care, 
     Joseph's mother informs me that his TPN had been 
     discontinued, that his malnutrition worsened, his weight 
     dropping to less than 100 pounds. Joseph, malnourished and 
     unable to fight off infection, subsequently developed 
     pneumonia, sepsis, and died.
       I have received permission from Mrs. Greuble to share this 
     story. Marion hopes that sharing her son's story will help 
     achieve the needed legislation to prevent this from happening 
     in the future. Holding health plans accountable when they 
     harm patients is not about suing insurance companies and 
     driving up the cost of health care, it is about stopping 
     abuses and bringing compassion back to medicine. Until the 
     health plans are accountable, people like Joseph and his 
     family will continue to suffer.
       Again, thank you for all the hard work on this important 
     issue.
           Sincerely,
                                              Frank J. Nemec, M.D.

  Doesn't this say it all? Why are we here? Are we here to talk about 
people dropped from insurance rolls? Are we here to talk about some 
lawyer fighting a lawsuit that doesn't exist?
  Zell Miller was on the floor today. Georgia has a Patients' Bill of 
Rights. Not one single solitary lawsuit has been filed. In the State of 
Texas they have a Patients' Bill of Rights that the President of the 
United States vetoed on two separate occasions. They have a Patients' 
Bill of Rights there. In over 4 years they have had 17 lawsuits, one 
every quarter. It doesn't sound too overwhelming to me. I don't think 
it is going to drive the HMOs out of business. So let's get real.

[[Page 11143]]

  This is about money. It is about the Frank Nemecs of the world who 
went to medical school to take care of his patients and he is told he 
can't take care of his patients. He said: I'll do it for nothing. They 
said: No, you might write a prescription we don't like.
  I don't know, this man might have died soon anyway, but he would not 
have died as soon as he did. I guess the HMO decided his life wasn't 
worth anything anyway--he's going to die. He's 5 foot 10, weighs 110 
pounds. Let's just terminate it more quickly.
  We are going to finish this legislation. We are going to finish this 
legislation and send it over to the House. They can play whatever games 
they want with it, but I think the games will end over there because we 
have very courageous Republicans on that side of this institution, led 
by Charlie Norwood from the State of Georgia, who have said they have 
taken all they can.
  I almost cried when I read this letter. Maybe if I were not here in 
front of the world I might admit when I read it in my office I shed a 
tear.
  This is sad. If you knew Frank Nemec, this gentle, big man, you would 
know how sincere he is.
  So why is this taking place? It is taking place because of money. It 
is taking place because the HMOs want to hang on as long as they can to 
keep those stock prices up and make as much money as they can in 
salaries. They are still going to do just fine after we pass this 
legislation, but they are not going to do as fine as they have been. 
They are not going to be able to terminate the care of someone such as 
Mr. Greuble.
  Yesterday I read into the Record those organizations with names 
starting with the letter A that support this legislation. I am going to 
read for a while tonight. I am not going to read them all. This is a 
partial list. But I want this spread across the Record of this Senate 
that this legislation is supported by America. It is supported by 
Minnesota, the people in Minnesota and the people of Nevada.
  The B's start with Baker Victory Services in Lackawanna, NY. This is 
a list of organizations that support the Bipartisan Patients' Bill of 
Rights:

       Baptist Children's Home of NC, Barium Springs Home for 
     Children in Barium Springs, NC, Bazelon Center for Mental 
     Health Law, Berea Children's Home and Family in OH, Bethany 
     for Children and Families, Bethesda Children's Home/Luthera 
     of Meadsville, PA, Board of Child Care in Baltimore, MD, Boys 
     & Girls Country of Houston Inc., TX, Boys & Girls Homes of 
     North Carolina, Boys and Girls Harbor, Inc. in TX, Boys and 
     Girls Home and Family Service, Boy's Village, Inc. of 
     Smithville, OH.
       Boysville of Michigan, Inc., Brain Injury Association, 
     Brazoria County Youth Homes in TX, Brighter Horizons 
     Behavioral Health in Edinboro, PA, Buckner Children and 
     Family Service in TX, Butterfield Youth Services, Cal 
     Farley's Boys Ranch and Affiliates, California Access to 
     Speciality Care Coalition, Catholic Family Center of 
     Rochester, NY, Catholic Family Counseling in St. Louis, MO, 
     Catholic Social Services of Wayne County in IN, Center for 
     Child and Family Services in VA.
       Center for Families and Children in OH, Center for Family 
     Services, Inc. in Camden, NJ, Center for Patient Advocacy, 
     Center on Disability and Health, Chaddock, Charity Works, 
     Inc., Child and Family Guidance Center in TX, Child and 
     Family Service of Hawaii, Child and Family Services in TN, 
     Child and Family Services of Buffalo, NY, Child and Family 
     Services, Inc., in VA, Child Care Association of Illinois.
       Child Welfare League of America, Children & Families First, 
     Children & Family Services Association, Children and Adults 
     with Attention Deficit/Hyperactivity Disorder, Children's Aid 
     and Family Service in Paramus, NJ, Children's Aid Society of 
     Mercer, PA, Children's Alliance, Children's Board of 
     Hillsborough, Children's Choice, Inc., in Philadelphia PA, 
     Children's Defense Fund, Children's Home & Aid Society of 
     Chicago, Children's Home Association of Illinois.
       Children's Home of Cromwell, Children's Home of Easton in 
     Easton, PA, Children's Home of Northern Kentucky, Children's 
     Home of Poughkeepsie, NY, Children's Home of Reading, PA, 
     Children's Home of Wyoming Conference, Children's Village, 
     Inc., ChildServ, Christian Home Association-Child, Clinical 
     Social Work Federation, Colon Cancer Alliance, Colorectal 
     Cancer Network.
       Committee of Ten Thousand, Community Agencies Corporation 
     of New Jersey, Community Counseling Center in Portland, ME, 
     Community Service Society of New York, Community Services of 
     Stark County in OH, Community Solutions Association of 
     Warren, OH, Compass of Carolina in SC, Congress of 
     Neurological Surgeons, Connecticut Council of Family Service, 
     Consortium for Citizens with Disabilities, Consuelo 
     Foundation, Consumers Union.
       Cornerstones of Care in Kansas City, MO, Corporation for 
     the Advancement of Psychiatry, Council of Family and Child 
     Caring Agencies in NY, Counseling and Family Services of 
     Peoria, Court House, Inc., Covenant Children's Home and 
     Families, Crittenton Family Services in Columbus, OH, 
     Crossroads for Youth, Cystic Fibrosis Foundation.

  Mr. President, we are through the C's. Before this is all over, there 
will be a partial list in the Record. I haven't been able to get them 
all. There are over 500. I have read in the Record a few hundred and I 
will continue to do so.

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