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Senator Debbie Stabenow and Tricia
Luker on the Patients' Bill of Rights
from CNN, June 26,
2001 (edited)
CNN MODERATOR: Thank you for joining us today, Senator Debbie
Stabenow and Tricia Luker, and welcome.
STABENOW: Hi, this is Senator Debbie Stabenow from Michigan,
and I'm proud to be one of the sponsors of the Patients' Bill
of Rights. I was also one of the sponsors when I was in the
House, before coming to the Senate in January.
LUKER: I'm Tricia Luker, also from Michigan, and I'm here as a
representative of all the families who are struggling with the
HMOs and with insurance companies.
CNN MODERATOR: What are the current criticisms of operations
of HMOs?
STABENOW: The concern right now is that families are paying
for insurance, or getting insurance from their employer and
trusting that health care will be available for their
families. In too many instances now, the care they need isn't
available. One example is access to emergency rooms. They
simply aren't available like they were. One example is a
family in Michigan, Sam and Susan Yamin. Sam and his wife live
in Birmingham, Michigan. He owned a tree trimming business. He
had a severe accident with a chain saw, and went to an ER in
Michigan, assuming he'd receive care. They took him to
surgery, and then were informed he was at the wrong emergency
room. They literally had to pack him up and take him across
Detroit to another ER. He didn't get the care he needed, and
he lost his business and is permanently disabled. There's no
accountability for the HMO who denied him care.
Another example is a case where a specialist is needed, or
your insurance changes from one company to an HMO, and you or
your children have been with a specialist for a long time, and
they're not part of the HMO, and you can't continue getting
treatment from that specialist. That's one of the things that
Tricia Luker is here to talk about, what happened to her
daughter Jessica, when her doctor of 12 years was not allowed
to continue treating her. She had a severe illness and seizure
disorder, and was not allowed to continue seeing that doctor
when they had to switch to an HMO.
CNN MODERATOR: Ms. Luker, can you tell us a little bit about
your experience?
LUKER: My daughter died in September of 1999. In March and
April of 1999, Jessica had 60 grand mal seizures. Her
neurologist felt it was important for her to have a surgery.
On May 11, she had a VMS implant. We got a letter dated May 7,
but postmarked May 12, which we received May 17. It told us
that retroactive to May 1st, she was enrolled in a different
HMO. So none of the care from May 1 on was covered, because we
didn't have prior authorization. Then, when we wanted to
continue with our neurologist, they said he wasn't part of the
network.
When we asked if he could continue being her primary care
physician, they refused. We called every doctor in the
catalogue that they finally sent to us in June (we didn't even
know who they were), and not one would take Jessica, because
of the severeness of her disabilities, and the time it would
take to care for her. We couldn't get follow-up care from her
surgery in May. We had no recourse whatsoever. There was
nothing we could do.
Families are vulnerable, individuals are vulnerable. The only
people protected are the HMOs. I work at the parent training
center in Michigan, and I had two calls this morning that were
so poignant. One was from Lisa Zarnacki, and her son has
Prader-Willie Syndrome. She's been fighting with her HMO to
get services for him. The HMO case manager said that they
wouldn't cover it, but that she could get it covered by having
her parental rights terminated, and then she could get
coverage through Medicaid. Jessica's neurologist-- I talked
with him this morning, and he expressed frustration that once
someone is referred to him through a primary care physician,
and he recommends a test, it has to go BACK through the
primary physician, and if they don't agree, then they don't
get the test. So why bother sending them to a specialist if we
can't get the care from them?
CHAT PARTICIPANT: Senator Stabenow, would you please contrast
the Edwards-McCain-Kennedy bill versus the Frist-Breaux-Jeffords
bill?
STABENOW: There are several differences, and first let me say
that in each difference, the McCain-Kennedy-Edwards bill comes
down on the side of patients and doctors and nurses and other
providers. So we have over 500 groups of consumers, patients,
families, care-providers that are supporting our bill, because
it comes down on the side of providing care. The Frist-Breaux-Jeffords
bill is more focused on the needs of the HMOs and insurance
companies. For example, there is a difference in terms of
accountability for HMOs.
It's interesting that there are only two groups of people in
our country who are not held accountable for their behavior or
decisions. One is exempted by the constitution, and that is
foreign diplomats. The other, through a loophole, is HMOs.
We're trying to correct that loophole, and want to keep it
consistent with the way doctors and nurses and other health
care providers are held accountable for health care decisions.
So, in our bill, if a doctor overturns a medical decision, and
the HMO overrides the doctor, and there is a bad outcome, they
can be held accountable in state court, just like a physician.
They would be subject to state law and state liability laws
and so on. In the Frist-Breaux-Jeffords bill, all losses would
go to federal court, which is much more difficult for
consumers, for families.
There are huge backlogs in federal court, and it would be a
very long, drawn-out, expensive process. So, it discourages
families from being able to bring liability cases against the
HMOs, which is why the HMOs like this approach. I should
mention that we're not promoting a patient's bill of rights to
promote lawsuits, but we want better options. We want people
to have better ER care, not more lawsuits about ER care. We
don't want the Lukers to be able to sue for care, we want them
to receive good care. What we've found, in states that have
passed laws, including Texas, is that there have been no more
lawsuits, but better medical decisions.
CHAT PARTICIPANT: I am currently a medical student. As a
future physician, why should I support the Patients' Bill of
Rights?
STABENOW: We now, by the way, have the American Medical
Association, as well as 44 separate state medical associations
endorsing our bill, because it will give the ability for
doctors to truly practice medicine again. As a future
physician, I think you have a tremendous stake in the outcome
of this bill. I'm sure you've had conversations with
physicians who are frustrated at their inability to provide
patients with the kind of care they believe the patient needs,
because of an HMO or insurance company decision not to pay for
the treatment.
We have physicians who have told us about tests that they
can't give, prescription drugs that are needed, but aren't on
a list somewhere, so they can't provide it, even if it's best
for the patient. We certainly have specialists deeply
concerned about the inability to provide special care when
needed. Doctors are one of our strongest allies in this,
because it's really about putting doctors and nurses in ch
arge of medical decisions.
LUKER: I certainly agree with what Senator Stabenow has said.
Families and physicians should make the decisions, not
bean-counters in an ivory tower. They're not seeing first
hand, they're second guessing a physician. We should have more
respect for our physicians than that.
CHAT PARTICIPANT: Ms. Stabenow...Since health care costs will
go up under the Patients' Bill of Rights, how is this bill
good for the everyday working American?
STABENOW: Let me first say that health care has been going up,
it went up about 10 percent last year, without a Patients'
Bill of Rights. The main reason is because of the
uncontrollable increasing costs of prescription drugs. When I
talk to hospitals and businesses and individuals, it's clear
that we have to address that cost, which is the driving force
behind the increase in health care today. In terms of the cost
of our bill, the argument has been made that by holding HMOs
and insurance companies accountable for their decisions, we'll
dramatically increase health care costs. That hasn't happened
in the states that have a Patients' Bill of Rights. Secondly,
the non-partisan Congressional Budget Office has indicated
that the accountability provisions in the bill will increase
health care costs by about 23 cents per person per month, who
has health care. I think that's an extremely small price to
pay to see that the insurance you have will actually provide
the health care that you need.
LUKER: I think that when your child needs to see a
neurologist, but you have to see the primary care doctor each
time before I can see the neurologist, it's a double trip.
There were times that the HMO did not want to pay for
Jessica's medication, they wanted us to try other ones. After
those trials, then they'll allow the originally prescribed
medication. The situation causes more costs, because of the
duplication of services.
STABENOW: I would agree.
CNN MODERATOR: Do you have any final thoughts to share with
us?
STABENOW: I think that we have a number of different health
care challenges in our country, and certainly addressing the
uninsured is one, and the second is making sure that those
with health insurance actually get the care that they assume
they'll have available to them if they get sick. The Patients'
Bill of Rights is necessary to guarantee that health care will
be available for those who are paying for insurance. It's a
part of the overall health care picture.
LUKER: We're so grateful that there are senators that are
working for us, and trying to get this Patients' Bill of
Rights passed. It's difficult when someone you love is ill,
and you're at your most vulnerable and stressed, and you're
trying to deal with bureaucracy and red tape through HMOs.
We're so glad that some are stepping up to help. It's not just
some of us, it's most of us. I sent an email on a parent's
list, and said, "if you're having trouble with your HMO,
please contact me," and we got over 100 hits in less than 24
hours from this very small list. We're being forced to deal
with this when we're the most stressed, the most tired, the
most vulnerable.
CNN MODERATOR: Thank you for joining us today.
STABENOW: Thank you.
LUKER: Thank you.
Senator Debbie Stabenow and Tricia Luker joined the chat via
telephone from Washington, D.C. CNN provided a typist for
them. The above is an edited transcript of the interview on
Tuesday, June 26, 2001.
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