106th Congress

Text of HR 2723 | Patients' Bill of Rights Comparison

The Bipartisan Consensus Managed Care Improvement Act of 1999, HR 2723 Fact Sheet on the Patient Advocacy Provision

An important provision for nursing in the Bipartisan Consensus Managed Care Improvement Act of 1999, H.R. 2723, is Section 135, which protects from retaliation nurses and other health care professionals who advocate for their patients in institutional settings.

Patient advocacy is a cornerstone of the nursing profession, and protection of that obligation is a priority of every state nurses association, whether or not its members engage in collective bargaining. This protection is included in the same part of the bill as a provision to prohibit health plans from interfering with communication between health professionals and their patients. The intent and purpose of the two provisions are the same: it is crucial to patients that their health care providers be free to advocate for their patients' health and safety.

Unlike traditional Whistleblower laws, this language does not protect those who speak to the press or the public.

The provision would only protect professionals who act in good faith. It would also require that professionals first utilize the plan or institutional provider's internal procedures, unless the disclosure involves imminent danger, is part of an investigation by a regulatory agency or is part of disclosure procedures of an accreditation body.

The provision does not apply protections to unlicensed or uncertified health care workers. It specifically requires that the disclosure is made on the basis of personal knowledge, is consistent with that person's expertise, and evidences either a violation of a law, rule, or regulation of an applicable accreditation standard, or of a generally recognized professional or clinical standard or that a patient is in imminent hazard of loss of life or serious injury.

The provision does not duplicate Federal law. The laws that have been cited by some hospital groups are limited or cannot be used to advocate for patients in most health care situations. For example, the False Claims Act contains a Whistleblower provision, but it applies only in cases of fraud and only when the fraud involves federal funds. The Emergency Treatment and Labor Act (EMTALA) includes protection for patient advocacy but only for personnel working in the emergency department of a hospital. The Whistleblower Protection Act of 1989 only applies to federal employees.

Nothing in this provision would allow disclosures that would violate Federal or State law, including patient confidentiality laws.

For registered nurses, patient advocacy is at the heart of their professional commitment, and patients depend on nurses to ensure that they receive the proper care. The patient advocacy provision in Section 135 assures patients that nurses and other health care professionals, acting within the scope of their expertise, will be able to speak for them, through appropriate channels, without fear of retaliation.

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