[Congressional Record (Bound Edition), Volume 150 (2004), Part 12]
[Senate]
[Pages 16092-16094]
[From the U.S. Government Publishing Office, www.gpo.gov]




               PATIENT SAFETY AND QUALITY IMPROVEMENT ACT

  Mr. ENZI. Mr. President, I rise today to talk about patient safety. 
There is bipartisan legislation pending in the Senate that is 
absolutely critical to reducing health care errors and increasing 
health care quality. It is S. 720, the Patient Safety and Quality 
Improvement Act.
  The HELP Committee reported this bill to the Senate in November of 
last year. It was approved in committee by a unanimous vote. It is past 
time for the Senate to vote on and pass this important legislation.
  This patient safety legislation is an important step toward building 
a culture of safety and quality in health care. The Patient Safety and 
Quality Improvement Act would create a framework through which 
hospitals, doctors, and other health care providers can work to improve 
the health care quality in a protected legal environment.
  The bill grants privilege and confidentiality protections to health 
care providers to allow them to report health care errors and near-
misses to patient safety organizations.
  The bill also allows these patient safety organizations to collect 
and analyze the data confidentially. After analyzing the data, patient 
safety organizations would report on trends in health care errors and 
offer guidance to providers on how to eliminate or minimize these 
errors.
  Some of this takes place today, but much more information could be 
collected and analyzed if providers felt confident that reporting these 
errors did not increase the likelihood that they or their colleagues 
would be sued for honest mistakes.
  This legislation would not permit anyone to hide information about a 
medical mistake. Under the bill, the lawyers still can access medical 
records or other information that would normally be recoverable in 
legal proceedings. However, the bill would ensure that the analysis of 
that information by patient safety organizations would take place on a 
separate track than in a protected legal environment.
  Health care providers would be much more likely to share information 
about honest mistakes and how to prevent them if they have some 
assurance the analysis of their information will not result in a tidy 
package of information a personal injury lawyer could use against them 
in court.
  Errors in medical treatment take place far too often today. 
Unfortunately, providers live in fear of our unpredictable and unfair 
medical litigation system, and this legal fear inhibits efforts to 
address the root causes of health care errors. Without appropriate 
protections for the collection and analysis of patient safety data, 
providers are unwilling to report mistakes and errors, which is one of 
the reasons health care quality today is not what it could be.
  Litigation does nothing to improve quality or safety. The constant 
threat

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of litigation indeed stifles honest analysis of why health errors 
happen. This is one more reason why we need wholesale reform of our 
medical litigation system. We need to foster alternatives that restore 
trust between patients and providers and result in fair and reliable 
outcomes for both parties. We need to scrap the present system, not 
just cap it. Until we do so, we should take whatever steps we can to 
create an environment that protects the collection and analysis of 
patient safety data so providers can learn from their mistakes and the 
mistakes of others and prevent them from happening in the future.
  The Patient Safety and Quality Improvement Act is one of these steps. 
Last week, our committee chairman, Senator Gregg, asked for unanimous 
consent that we move to consideration of this legislation in the 
Senate. This is the third time since November he has done so. Each time 
he has been blocked by our colleagues in the minority, even though the 
committee of jurisdiction was unanimous--you cannot get more bipartisan 
than that--in support for the bill.
  My colleagues in the minority keep talking about problems with health 
care quality, as they keep on talking about the loss of American jobs. 
However, talk is cheap when their actions don't match their words.
  If they are really so concerned about improving health care in our 
Nation, why would they object to a bill that would reduce errors and 
improve patient safety, particularly a bipartisan bill with unanimous 
committee support? If they are really so concerned about American 
workers and jobs, why won't they let a bill improving the Nation's job 
training system go to conference?
  Another example of what is happening or not happening in the Senate: 
We have a bill, a bipartisan bill, that will help workers get back to 
work or find better jobs. This bill will equip our workforce with 
skills necessary for America to compete and succeed in the global 
economy. It reauthorizes and improves the Nation's job training that 
was created under the Workforce Investment Act. The Workforce 
Investment Act provides job training and employment services to more 
than 900,000 unemployed workers each year. Just like the patient safety 
legislation, this bipartisan bill passed out of the Health, Education, 
Labor, and Pensions Committee unanimously. We passed it on the Senate 
floor by unanimous consent last November. Remember, that is as 
bipartisan as you can get.
  Where is the bill now? Well, it passed in the House, too. The House 
has a somewhat different version. When there is a different version 
between the House and the Senate, you normally would have a conference 
committee, and the conference committee would work out the differences 
so that both Houses could pass it again as a unified bill that would 
then go to the President to be signed. It has to be one bill that goes 
to the President, not two bills that go to the President. You have a 
conference committee to work those bills out.
  Now, the House appointed a conference committee. It is a very simple 
task. You just figure out how many Members are going to be in the 
conference committee, and Members are chosen from both sides of the 
aisle in both Chambers to meet together to talk about the differences, 
to propose alternatives, to vote on those alternatives, and to come up 
with a compromise bill. Sometimes the compromise is taking all of one 
Chamber's bill and eliminating the other one. Usually it is somewhere 
in between.
  The first excuse I heard on this Workforce Investment Act, which will 
train 900,000 people to do jobs they do not have now or definitely to 
have better jobs than what they might have now, with a particular 
emphasis on moving women into higher paying jobs was how bad the 
outsourcing is in this country. Yes, because we do not have trained 
workers to take those jobs at the present time. We hear about the wages 
in this country. Yes, because the people do not have the higher skills 
for which you get paid higher wages.
  This bill would provide training for jobs we are having to send 
overseas right now or better paying jobs for American workers. We 
passed it unanimously. The House passed it. The House appointed a 
conference committee. We are not even allowed to appoint a conference 
committee, to get together and talk about it with the House. That is 
nothing final. It would have to be voted on again before it could be 
passed. There is an opportunity for a filibuster at that final point. 
Instead what we are getting is a filibuster at this point, a very 
subtle filibuster but nevertheless a filibuster.
  If jobs are important, why aren't we doing this JOBS bill that was 
unanimously passed out of committee and unanimously passed on the floor 
of the Senate? A lot of opportunity, and it is passing by. I guess 
because there is a Presidential election, and it might help President 
Bush if there were more jobs. Actually, the only ones it would help, if 
there are more jobs, is the people getting those jobs. None of us ought 
to be stopping people from getting jobs or getting better jobs. We 
recognize that. That is why we passed it unanimously.
  So where is that bill now? We can't get a conference committee 
appointed to resolve the differences with the House. There was enough 
trust in what I did in committee that it passed unanimously. There was 
enough trust when it came to the Senate floor that we passed the bill 
unanimously. The only thing I can see that has happened in the meantime 
is that we have gotten closer to an election. That should not happen in 
America. We teach people bad things about elections when we hold up 
important things such as workforce investment for jobs. If we really 
want to take care of jobs and workers in this country, we should 
appoint conferees for the Workforce Investment Act legislation.
  I could run through a few more excuses that I have heard on this 
bill. One of the excuses was that we might put something in that would 
allow faith-based groups to participate in job training and, under that 
scenario, put in something that would allow them to not hire people who 
are averse to their religion.
  Members may be surprised to find out that we already have statutes 
that do provide that churches, when they are involved in government 
work, can't discriminate, except they don't have to hire people who are 
averse to their religion. That would be a very small change if it made 
it in there at all, but we are not even allowed to get together and 
discuss whether that would make it in there for fear that maybe it 
would. Again, that is just an excuse for not passing the bill, an 
excuse to keep jobs from being created which would make the economy 
better and which would improve the President's chances of getting 
reelected. That is not how politics is supposed to work.
  I have to say there is a difference between Republicans and Democrats 
on most of the big issues facing our Nation. If my colleagues in the 
minority want to bottle up legislation with which they disagree, that 
is their prerogative. But that is not what I am talking about. I am not 
talking about bottling up issues with which they disagree. We have 
members of the minority party holding up bipartisan bills that received 
unanimous approval in committee--that is where the patients safety bill 
is--and holding up conferences on a bill that received unanimous 
support on the Senate floor. That is where the workforce bill is.
  The only logical conclusion I could draw to these roadblocks is based 
on politics, not policy, and that is a shame.
  Right now, the Senate floor reminds me of the airspace above a busy 
airport. We have a number of bipartisan bills lined up for final 
approach, but our colleagues in the minority are holding those bills up 
and won't allow them to land. The tactics of my colleagues in the 
minority give new meaning to the term ``holding pattern.'' That should 
not happen. There is going to be a crash.
  It is time for our Democratic colleagues to break this holding 
pattern so we can pass bipartisan bills such as the Patient Safety Act 
and the reauthorization of the Workforce Investment Act. These are not 
only bipartisan bills, they received unanimous

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committee support. Let's set election politics aside for a moment. 
These are bipartisan bills, so no one party can claim credit for their 
passage.
  The Patient Safety Act was introduced by the distinguished Senator 
from Vermont, Mr. Jeffords, who is the lone independent in the Senate. 
This bill is more than bipartisan. My distinguished Senator from 
Nevada, Mr. Reid, suggested last week that we should approve the House-
passed patient safety bill. He suggested we should take up the House 
bill rather than pass the Senate bill because Members of the House are 
the true experts on such complex legislation.
  I wonder if my colleague's opinion would be the same on medical 
liability reform. After all, the expert legislators in the House have 
sent us some excellent legislation to reform our medical litigation 
system. Perhaps we should stop working on this in the Senate and 
approve the House bill, as he is suggesting we should do with patient 
safety.
  I mentioned the Workforce Investment Act. The House passed that one. 
Their version is considerably more difficult, perhaps more conservative 
than the version I worked through with unanimous consent on this side, 
but if we are going to consider them the experts on patient safety, why 
don't we consider them the experts on workforce investment and take 
their version of the bill? We didn't do that on that bill.
  No, the right way to do it is to pass the patient safety bill, 
hopefully, by unanimous consent over here because there is no 
dissension on it. The dissension is with what they are doing over on 
the House side. So we would go ahead and pass it, and then we have a 
conference committee, a conference committee in the old-fashioned 
style. Not this ``let's preconference and give somebody on the minority 
side a veto right over anything that is done.'' That is a brandnew 
twist around here. What we have always done is appointed the conference 
committee, recognizing that there are majorities and minorities even on 
the conference committee, but that the point is to get the agreement 
between the House and the Senate. We will get that agreement between 
the House and the Senate, and will have better patient safety.
  I hope our colleagues in the minority will agree to take 2 hours of 
their time to debate and vote on the bipartisan safety act. Two hours 
is not a lot of time. It is the least we can do on such an important 
piece of legislation. We have spent hour upon hour working on this bill 
in committee and crafting a bill that received unanimous bipartisan 
support. Let's spend 2 more hours on the Patient Safety Act so that we 
can improve the quality and safety of health care in America. I don't 
think that is too much to ask.

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