| Washington Watch | Vital Signs | Issues Update |
By Stephanie Reed
Stephanie Reed is an associate director in the ANA’s Department of Federal Government Relations.
Several energizing developments have added impetus to the ANA’s agenda to push for legislation providing protections for nurses and their patients. Specifically, on May 8, Senator Harry Reid (D-NV) introduced Senate companion bills to two major ANA initiatives: the Patient Safety Act of 1998 (S 2055) and the Health Workers Protection Act of 1997 (S 2056). A prior bill was introduced in the House that would provide whistle-blower protections. In addition, legislation based on the Consumer Bill of Rights and Responsibilities brought forth by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry was introduced by Democratic leaders in the House and Senate in April 1998.
“I am proud of the strides nurses have made in working with our members of Congress to develop such significant protections for the profession and the patients for whom we care,” stated ANA President Beverly L. Malone, PhD, RN, FAAN, who along with state nurses association members Marta Prado, RN, and Mary Wakefield, PhD, RN, FAAN, served on the president’s commission. “This rising tide of legislation makes it clear that the time has come for us all to intensify our commitment to making quality and the interests of consumers the hallmarks of our health care system.”
Introduction of the companion bill to the Patient Safety Act in the Senate is the latest success in the ANA’s efforts to improve the quality of health care in institutions, which began four years ago with its “Every Patient Deserves a Nurse” campaign. As the Senate bill comes forward, the House bill (HR 1145), introduced in 1997 by Representative Maurice Hinchey (D-NY), is continuing to gain steam, garnering 45 cosponsors by mid-May. The provisions of HR 1165/S 2055 are drafted as conditions for participation in Medicare by a health care institution. The legislation requires that health care institutions
• make public specified information on staffing levels and mix, patient outcomes, and data relating to complaints filed about Medicare conditions of participation;
• protect “whistle-blowers” from retaliation; and
• report to the secretary of the Department of Health and Human Services information regarding the overall impact on the community of proposed hospital mergers or acquisitions.
The protections for nurses voicing concerns about quality and safety also take center stage in “stand-alone” whistle-blower protection legislation (HR 3342) introduced in the House by Representatives Mark Foley (R-FL) and Ron Klink (D-PA) in April. This bill, the Patient Safety and Health Care Whistleblower Protection Act of 1998, would prohibit retaliation or discrimination against any health care worker who in good faith discloses information, advocates on behalf of patients, or participates in investigations with respect to the care, services, or conditions of a health care entity.
Whistle-blower protections also appear in the Patients’ Bill of Rights Act of 1998 (S 1980/HR 3605). Health plans and institutions that are participating providers in health plans may not retaliate or discriminate against a protected health care professional for disclosing to managers of health plans or regulatory or accrediting bodies information relating to care, services, or conditions. The provision requires that health care professionals first follow reasonable internal procedures and that the procedures must be distributed or posted.
The legislation also includes provisions for choice of health plans for consumers, an adequate provider network, access to specialty care, referrals for chronic care, protections for women, protections for children, continuity of care, access to emergency services, coverage for routine services for participants in clinical trials, limitations on drug formularies, and patient nondiscrimination.
ANA Interim Executive Director Argene Carswell, JD, RN, participated in three press conferences in April and May to express the ANA’s support for the legislation. On April 29, she joined the American Medical Association, Consumers Union, and Families USA in welcoming the cosponsorship of HR 3605 by seven House Republicans, emphasizing the importance of bipartisan action on patient-protection legislation.
On May 13, Carswell joined Senators Tom Daschle, Edward Kennedy (D-MA), Richard J. Durbin (D-IL), and Barbara Boxer (D-CA) to urge passage of the legislation. Kennedy and Carswell called particular attention to another vulnerable sector of the U.S. patient population—women. In excoriating managed care plans for failing to meet women’s needs, Carswell cited as an example the requirements that women undergo mastectomies as outpatient procedures, calling such practices “unconscionable.”
“That practice is symptomatic of more pervasive dysfunctions in the health care system that impact women disproportionately and must be addressed by this Congress,” Carswell stated. “For the nurses at the bedside, the need for patient protection and patient advocacy is played out every day, and we urge speedy passage of this important legislation.”
The following day, Carswell and a number of Democratic members of the House of Representatives joined with the three nurses in Congress, Representatives Lois Capps (D-CA), Eddie Bernice Johnson (D-CA), and Carolyn McCarthy (D-NY), in a Capitol Hill press conference stressing the need for access to emergency services. Specifically, those present urged the Republican leadership of Congress to stop blocking managed care reform legislation. A key focus of their call to legislative action was the unmet needs of children.
Carswell said, “Some parents of families covered by managed care are afraid to call 911 for their children in the middle of the night, lest they be found in violation of their plans’ complex procedures. Meanwhile, the plans do little or nothing to promote pediatric wellness and injury prevention. Such situations and the outrages against women ... are the impetus behind policy makers’ push to remove the roadblocks and to pass managed care reform.”
The ANA worked with the Democratic leadership in the development of the Patients’ Bill of Rights, which generally conform to the president’s commission’s recommendations, and Nursing’s Principles for a Managed Care Environment, which was adopted by the ANA Board of Directors in 1997.
With this in mind, the Senate version (S 2056) of the Health Workers Protection Act (HR 2754) was introduced by Senator Reid in May. Introduced in the House by Representative Fortney “Pete” Stark (D-CA) last October, this bill would, first, ensure that safe medical devices are reviewed by the Food and Drug Administration for their efficacy and quickly made available to front-line health care workers; second, make the use of such safer devices a condition for participation in the Medicare program; and third, mandate an education campaign to inform health care workers about the risks associated with bloodborne pathogens and the benefits of safer needle devices.
Substantial progress has been made in educating members of Congress on the need for this legislation, and 68 members of the House of Representatives were listed as cosponsors by early May 1998. The introduction of the legislation in the Senate will create additional impetus for addressing this issue.