S. HRG. 112–911 ENSURING PATIENTS’ ACCESS TO CARE AND PRIVACY: ARE FEDERAL LAWS PROTECTING PATIENTS? FIELD HEARING OF THE COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS UNITED STATES SENATE ONE HUNDRED TWELFTH CONGRESS SECOND SESSION ON EXAMINING ENSURING PATIENT’S ACCESS TO CARE AND PRIVACY, FO- CUSING ON WHETHER OUR FEDERAL LAWS ARE DOING ENOUGH TO PROTECT PEOPLE WHEN THEY ARE MOST VULNERABLE, WHEN THEY ARE SICK AND IN NEED OF MEDIAL CARE MAY 30, 2012 (St. Paul, MN) Printed for the use of the Committee on Health, Education, Labor, and Pensions ( Available via the World Wide Web: http://www.gpo.gov/fdsys/ U.S. GOVERNMENT PRINTING OFFICE 91–572 PDF WASHINGTON : 2015 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001 COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS TOM HARKIN, Iowa, Chairman BARBARA A. MIKULSKI, Maryland MICHAEL B. ENZI, Wyoming JEFF BINGAMAN, New Mexico LAMAR ALEXANDER, Tennessee PATTY MURRAY, Washington RICHARD BURR, North Carolina BERNARD SANDERS (I), Vermont JOHNNY ISAKSON, Georgia ROBERT P. CASEY, JR., Pennsylvania RAND PAUL, Kentucky KAY R. HAGAN, North Carolina ORRIN G. HATCH, Utah JEFF MERKLEY, Oregon JOHN MCCAIN, Arizona AL FRANKEN, Minnesota PAT ROBERTS, Kansas MICHAEL F. BENNET, Colorado LISA MURKOWSKI, Alaska SHELDON WHITEHOUSE, Rhode Island MARK KIRK, Illinois RICHARD BLUMENTHAL, Connecticut DANIEL E. SMITH, Staff Director PAMELA SMITH, Deputy Staff Director FRANK MACCHIAROLA, Republican Staff Director and Chief Counsel (II) CONTENTS STATEMENTS WEDNESDAY, MAY 30, 2012 Page COMMITTEE MEMBER Franken, Hon. Al, a U.S. Senator from the State of Minnesota .......................... 1 WITNESSES—PANEL I Swanson, Lori, Attorney General, State of Minnesota, St. Paul, MN ................. 3 Prepared statement .......................................................................................... 6 Rothman, Michael, Commissioner of Commerce, State of Minnesota, St. Paul, MN ......................................................................................................................... 9 Prepared statement .......................................................................................... 11 WITNESSES—PANEL II Mooty, Charles, Chairman of the Board of Directors and Interim CEO, Fair- view Health Services, Minneapolis, MN ............................................................ 18 Prepared statement .......................................................................................... 19 Kazarian, Gregory, Senior Vice President, Accretive Health, Inc., Chicago, IL ........................................................................................................................... 20 Prepared statement .......................................................................................... 22 WITNESSES—PANEL III Deb Waldin, Former Fairview Patient, Edina, MN .............................................. 40 John Thomas ‘‘Tom’’ Fuller, Former Fairview Patient, New Brighton, MN ....... 42 WITNESSES—PANEL IV Ross, Jean, RN, Former Nurse at Fairview; Co-President, National Nurses Association; Member, Minnesota Nurses Association, St. Paul, MN ............... 44 Prepared statement .......................................................................................... 45 Goodwin, Michele, Everett Fraser Professor in Law, University of Minnesota, Minneapolis, MN .................................................................................................. 46 Prepared statement .......................................................................................... 48 Curtis, Jessica L., J.D., Director, Hospital Accountability Project, Community Catalyst, Boston, MA ........................................................................................... 52 Prepared statement .......................................................................................... 53 ADDITIONAL MATERIAL Statements, articles, publications, letters, etc.: Nina Bugbee, RN, President, Teamster Local Union 332, Flint, MI ........... 69 Laurence J. Massa, President, Minnesota Hospital Association, St. Paul, MN ................................................................................................................. 74 Letters to Senator Franken from: Greg Kazarian, Accretive Health ............................................................. 76 (III) IV Page Linda Hamilton, RN, BSN, President, Minnesota Nurses Association (MNA) ..................................................................................................... 76 Michele Manion, Executive Director, Primary Ciliary Dyskinesia (PCD) Foundation and Cynthia Le Mons, Executive Director, Na- tional Urea Cycle Disorders Foundation (NUCDF) ............................ 77 Response to questions of Senator Franken by: Lori Swanson ............................................................................................. 78 Michael Rothman ...................................................................................... 79 Charles Mooty ............................................................................................ 89 Gregory Kazarian ...................................................................................... 90 Jean Ross, RN ........................................................................................... 99 Michele Goodwin ....................................................................................... 100 Jessica L. Curtis, J.D. ............................................................................... 101 ENSURING PATIENTS’ ACCESS TO CARE AND PRIVACY: ARE FEDERAL LAWS PROTECTING PATIENTS? WEDNESDAY, MAY 30, 2012 U.S. SENATE, COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS, St. Paul, MN. The committee met, pursuant to notice, at 10 a.m. in Hearing Room 15, Minnesota State Capitol, Rev. Dr. Martin Luther King Jr. Blvd., Hon. Al Franken presiding. Present: Senator Franken. OPENING STATEMENT OF SENATOR FRANKEN Senator FRANKEN. This field hearing of the Senate Health, Edu- cation, Labor, and Pensions Committee will be called to order. This hearing will focus on whether our Federal laws are doing enough to protect people when they are at their most vulnerable, when they are sick and in need of medical care. Being in the hos- pital, even under the best of circumstances, is a stressful experi- ence. When you or someone you love is in urgent need of care, nothing else matters. I think everyone has had the experience of powerlessness and vulnerability when you’re in pain and you don’t know what’s wrong, or when your child or your parent or your spouse is hurting, and at that moment the last thing on your mind is your wallet. That’s why I found Attorney General Lori Swanson’s report about Accretive’s alleged activities at Fairview extremely dis- turbing. I would find it absolutely abhorrent if any patients had been badgered by debt collectors in the emergency room or if any patients had been given the impression that they wouldn’t be seen unless they pre-paid for their care. That type of activity is not ac- ceptable anywhere, and is certainly not acceptable here in Min- nesota. I’ve read that patients in extreme pain were asked for payment for health services in Fairview’s emergency room before they even knew what was wrong with them, and I’ve heard that parents of premature infants were approached about their bills while they were in the neonatal intensive care unit. I’ve even heard that off- site debt collectors had access to detailed protected health informa- tion about patients, including their mental health conditions and other diagnoses, which may be in violation of Federal privacy laws. And I’m worried. I’m worried that if patients know they’ll be asked for pre-payment of services, that they’ll stop going to the (1) 2 emergency room when they’re sick, which isn’t just dangerous for them but could result in the spread of disease and in entire com- munities getting sick. And I’m worried that if patients hear that their protected health information isn’t going to be kept private, that they won’t share important information with their doctors such as what medications they’re taking, and that could lead to even worse health problems and higher costs if doctors don’t have the information that they need. I’m worried that activities like the ones that have been alleged could bring down the quality of health care that Minnesotans re- ceive when they go to the hospital, and that would be a real trag- edy. Our State has always been a national leader in providing high-quality health care, and Fairview Health Services is a prime example. I visited Fairview Hospital many times and I’ve spoken at length with their doctors and their nurses. I’m convinced that they are among the best health care providers anywhere, and I think we’ll hear from people today who will bear that out. But I also know that there’s another part of the equation dealing with the administrative side of things, and so I look forward to working with Fairview and all of Minnesota’s health care leaders to make sure that patients are fully protected. It’s possible that the laws that protect consumers from debt col- lection and those that protect our privacy don’t go far enough, and although we’re still getting all the facts about the activities that may have taken place, I look forward to hearing from our experts about whether we need to strengthen