Mr. Chairman:

It is a pleasure to be here today, and I appreciate the opportunity to speak before the committee on behalf of the American Nurses Association, the members of our 53 state and territorial associations, and the patients served by the more than two million registered nurses across the nation.

Nurses are on the front lines of health care, in virtually every health care setting, and the cornerstone of the nursing profession is patient advocacy. It is from that perspective as patient advocate that I speak today, and it is from that perspective that ANA has endorsed S. 6, the Patients' Bill of Rights, as the legislative vehicle that best meets the need for strong, comprehensive, enforceable legislation to protect consumers called for by the President's Commission on Consumer Protection and Quality in the Health Care Industry.

I am pleased to have the opportunity to join with several of my fellow commissioners in discussing the need for patients protections and for improvements in health care quality. It is important that we not lose sight of the first principle for the Consumer Bill of Rights and Responsibilities adopted by the Commission: All consumers are created equal. The Commission was clear that its work must apply to all consumers, regardless of the type of plan they have — or where they live. S.326, the Republican Patients' Bill of Rights proposal, misses this point entirely. It is not acceptable to establish a national standard and then leave millions of Americans to the vagaries of state legislation. If the states should choose to strengthen the standard to fit their particular needs, that is all to the good. But the goal for this legislation is basic protections, not Cadillac standards.

The Committee had asked that this testimony include the priorities for my association — and I am happy to address some issues of particular interest to nursing. But I do want to make it clear that ANA strongly supports a comprehensive bill. We are concerned that narrowing the focus of this legislation to avert controversy could result in legislation that would not meet that basic criterion of the Commission's report — that all consumers should have equal protections and that there is a set of protections that should be in place.

Specifically, ANA believes that it is crucial that any patient protection legislation contain protections from retaliation for health care professionals who advocate for their patients. The language in S.6 is carefully drafted to protect nurses and other professional health care providers from retaliation for meeting their professional commitment and obligation to advocate for their patients' health and safety. 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.

The bill should contain language prohibiting discrimination against health care professionals solely on the basis of type of licensure. Anti-competitive behavior of this sort limits a consumer's access to care and choice of practitioner. The language of the Commission's report is consistent in recognizing that health care is much broader than medicine and it is important that legislation not permit inappropriate restriction of health care practice to the medical profession.

At the same time we strongly oppose language which inappropriately specifies access to "physicians." For instance, ANA supports the concept of making sure that women and children have direct access to ob-gyn and pediatric services. However, ANA is strongly opposed to language that would designate only physicians as primary care providers in those circumstances. Pediatric nurse practitioners and certified nurse midwives are primary care providers, with their scope of practice determined by state law. The goal must be to provide more choices to the consumer, not fewer. The emphasis of any such language should be on the provision of services — not on the type of license a practitioner might hold.

With respect to the related issue of access to specialists, in general, the definition of specialist also should refer to "health care professionals." For instance, in the field of mental health, there are several disciplines in which referrals to non-physician practitioners would be appropriate.

Finally, ANA believes that consumers must have access to a full range of information about health plans and providers. A market system can only work if consumers — whether large purchasers or individuals — have the information required to make informed decisions. Specifically, one type of information that must be available is staffing: studies are showing that there is a direct relationship between staffing levels and quality of care. However, hospitals and other health care institutions are not required to make staffing information available, a problem that not only denies the information to consumers but also hampers research on that relationship.

Mr. Chairman, the American Nurses Association believes that we must have a bill that is not a sham with titles that sound good, such as access to emergency care, but then defines that access in a way that can make it meaningless in a true emergency. We cannot accept legislation that leaves a large segment of the population unprotected.

For the nurses at the bedside, the need for patient protection and patient advocacy is played out every day, and ANA will be steadfast in its support for genuine, comprehensive reform.

Thank you. I will be happy to address any questions Senators may have.

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