http://www.nytimes.com/2001/08/19/business/yourmoney/19FIVE.html

 

August 19, 2001

FIVE QUESTIONS

Patients' Rights: What's at Stake?

By MILT FREUDENHEIM

After four years of trying, Congress may be close to passing patients' rights legislation. A conference committee will work to reconcile a Senate bill and a version that the House passed on Aug. 3 after the chief Republican sponsor, Representative Charlie Norwood of Georgia, reached an agreement with President Bush on the thorny issue of a patient's right to sue a health plan.

The Bush administration had said that such lawsuits should be brought only in federal courts, where damages are rigorously limited. Mr. Norwood's earlier bills and the Senate bill would have allowed suits in state courts with no limits on damages. Under the agreement with Mr. Norwood, the House voted to permit suits to overturn denial of medical care to be filed in state courts. But damages would be limited to $1.5 million for pain and suffering and and 1.5 million for punitive damages.

The Senate and House bills are similar on most other points. Both bills include guarantees of access to the nearest hospital emergency room, to gynecologists and other specialists and to prescription drugs, even those that are not on a health plan's preferred list or experimental drugs still undergoing tests.

Charles B. Inlander, president of the People's Medical Society, a consumer advocacy group that had supported the Senate bill, is a longtime observer of the issue. He spoke last week about the legislation.

 

Laura Pedrick for The New York Time

Charles B. Inlander with a patients' rights manual he wrote, at right.

 

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Q. Will the legislation on patients' rights really make a difference for consumers?

A. I don't think consumers are going to see a major difference. The issue has been lingering so long that most health plans have pretty much made all of the changes that any version of the patients' bill of rights will have in it. The major plans have dropped requiring prior permission to go to the emergency room and for a woman to see an obstetrician or gynecologist. Most plans have third-party, outside review for disputes over care decisions. The new law would mean uniformity for the managed care companies, but most people are not going to see much of an effect.

Q. Are you concerned that a federal law might weaken existing state protections for consumers?

A. I don't think it applies to 99 percent of the bills, but I am concerned in two areas — the lawsuit provision and the independent review of medical decisions. The House version does not allow room for stricter state laws on the issue of independent review. But because this is such a hot- button issue, it will be fixed in the conference committee or there will be no final legislation.

I think the issue of $1.5 million limits on damages for pain and suffering and for punitive damages will also be worked out in conference, because the administration has agreed to allow suits in state courts, which the Democrats demanded.

Q. How important is the right to sue a managed care company?

A. Very important. We should have a right to sue anyone who might harm us — for example, a health plan that does something that is harmful to our health. The American people believe in that; it's what the tort system is all about. If you can sue a doctor for making a bad medical decision, why shouldn't you be able to sue a plan if it makes a decision that is harmful for your health?

This issue is being used as a vehicle for those who want tort reform, ranging from a limit on damages for an 80-year-old tractor that falls apart or a cup of hot coffee that spills as you are going through the line at McDonald's.

The irony is that the American Medical Association strongly supports a consumer's right to sue a health plan but at the same time the A.M.A. is calling for tort reform, so you can't sue your doctor.

Q. Will patients' rights legislation do anything for the 43 million people who have no health insurance?

A. Nothing at all. This isn't a health care bill. It is about the business relationships between consumers and health plans. It doesn't mean that your doctors are going to be better, that your hospital room will be improved or that you will get better medicines. The bill has nothing to do with improving the quality of health care or lowering the cost and it offers absolutely nothing for the uninsured. The only time this bill kicks into play is if you are in a managed care plan. For many members of Congress, this is their way of appearing to deal with the big issue.

Q. Will the debate on patients' rights affect efforts to restructure Medicare and add a drug benefit?

A. I don't think it will have any bearing, unless a patients' bill of rights is not passed. The Democrats have said that if this doesn't get through, the administration will have a hard time getting any health care legislation through. The administration knows they could never get legislation through right now unless somebody can claim victory on the bill of rights. That is why the administration has been willing to be somewhat flexible on this issue.

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.