Oregon AFL-CIO files "Patients' Bill of Rights" initiative

By DON McINTOSH, Staff Reporter

For a patient, there's no negotiating with a health maintenance organization (HMO). HMOs set their own rules, which may dramatically limit the amount and quality of health care patients receive.

But if backers of a new Oregon ballot measure succeed, Oregon may be the first state to enact a multiple-item "Patients' Bill of Rights" that would change that equation.

Six separate versions of the measure are currently on file with the secretary of state's elections office, each of them with a slightly different mix of reform proposals that were floated, and sunk, in the 1999 Oregon Legislature.

Four elements appear in all six bills:

* The right to appeal denials of care to an independent external reviewer;

* The right to a standing referral to a specialist (rather than having to go to a "gatekeeper" each time access to the specialist is needed);

* The right to access a doctor outside the health plan if the plan's own network doesn't have enough doctors or the kind of doctor needed; and

* The right to keep seeing the same doctor until a course of treatment is completed.

Three other proposals are in at least one version of the measure, but not all:

* The right to sue HMOs if denial of care leads to injury or death;

* The right of access to drugs which are needed for a covered condition but which are not on the list of covered medications; and

* The establishment of minimum staffing levels at all health care facilities.

The issue of patients' rights is hot right now, say backers of the measure, owing to public frustrations with health care.

Wendy Van Elverdinghe of the Oregon Health Action Campaign said her organization gets calls from people enrolled in health plans who've had problems getting health care. One man, for example, had received from his health plan a booklet full of names of primary care physicians, but he couldn't find a single one that was accepting new patients.

In another case, a woman was having a problem breathing as she was exposed to field-burning smoke, and her health plan doctor was refusing to refer her to a specialist; desperate for treatment, her husband took her to an emergency room, a course of action which her plan later refused to pay for.

With public anger rising, the issue is percolating in state capitals around the country and in Washington, D.C. Oregon AFL-CIO President Tim Nesbitt said there's a possibility even the Republican-controlled U.S. Congress may adopt some watered-down reforms this year because it is an election year.

And one or more of the seven patient rights proposals filed in the various versions of the Oregon ballot initiative have already become law in Alabama, Arkansas, California, Colorado, Idaho, Minnesota, Montana, New Jersey, New York, Ohio and Texas.

In Oregon, all seven proposals were introduced as bills in the last session of the Legislature by State Senators Kate Brown, Frank Shields, Marylin Shannon and Tony Corcoran, but none got even a hearing in the Senate Human Resources Committee. That committee was headed by State Senator Bill Fisher, R-Roseburg, who received a 0 percent Committee on Political Education rating from the Oregon AFL-CIO for his voting record during the session. Fisher is a nursing home operator.

"The Legislature refused to take this on even though there's broad public support for it," said Amy Klare, a political consultant whose clients include the Oregon Federation of Nurses and Health Professionals, an affiliate of the American Federation of Teachers.

Consequently, backers of the reforms are taking their case directly to voters. The Patients' Bill of Rights is one of a handful of initiatives being prepared for the November 2000 ballot that the Oregon AFL-CIO is considering throwing its weight behind. Nesbitt said the federation is committed to backing at least two pro-active ballot measures such as this one. Not only are pro-active measures a way to win concrete reforms, Nesbitt said, but having them on the ballot increases voter turnout among union members, which could affect the outcome of the legislative races and change the composition of the next Legislature.

Whether the Patients' Bill of Rights will get the AFL-CIO's full backing will depend on a strategic assessment that takes into account the amount of commitment of other organizations to support the measure, the results of a soon-to-be-conducted public opinion poll, and feedback from an issues survey being mailed out to union activists and leaders.

That survey, devised by the national AFL-CIO, asks respondents to prioritize which issues the union federation should focus on; the 20,000 copies being sent out in Oregon contain an additional section with questions on Oregon issues. The survey results will be released at a statewide strategy-setting meeting Saturday, Feb. 26.

The other half of the strategic assessment is trying to second-guess which measures are likely to draw significant monied opposition. The Patients' Bill of Rights is likely to be opposed by insurance companies, HMOs, and Associated Industries of Oregon. However, a "Universal Health Care" ballot measure could draw away some of those opponents' resources. And at the same time, Nesbitt predicted, a campaign finance reform ballot measure could draw significant opposition from right-wing Shilo Inn owner Mark Hemstreet, while a measure to repeal video poker could preoccupy the Oregon Restaurant Association. If measures such as the latter two qualify for the ballot, the thinking goes, less big-business money would be available to target something like the Patients' Bill of Rights.

Even if the Patients' Bill of Rights measure doesn't make it to the ballot, the fact that it was filed with the secretary of state's office will already have been useful, Nesbitt said, for the press coverage it prompted about a set of reforms that had been ignored in Salem. If it fails at any stage, the reforms are sure to be reintroduced in the next Legislature.

If backers decide to go ahead with the initiative, Steve Novick, executive director of the Center for Constructive Citizen Action and an authority on the initiative process, said it will be at least mid-March before legal challenges to the ballot titles are resolved before the Oregon Supreme Court. Then signature-gatherers will have until July 5 to gather 67,000 signatures.