even $100. See for example Knickbocker Hospital v. Downing, 317 NYS 2d 688 (1971), and Society of New York Hospital v. Mogensen, 165 NYLJ20 (#4, 1971).3 The statute (§ 1902 (a) (3) ; 42 U.S.C. § 1396a (a) (3)) and regulations applicable to Medicaid recipients provide for a hearing in accordance with standards established in Goldberg v. Kelly, 397 US 254 (1970), for "any recipient who is aggrieved by any agency action resulting in suspensions, reduction, discontinuance or terminations of assistance," (45 CFR § 205.10 (a) (5)). Cases which have held that this provision includes level-of-care determinnation (like those PSROS will make) are Bell v. Heim, (No. 1989 D.N.M. Oct. 21, 1971, CCH Pov. L. Reporter § 14,406) and Martinez v. Richardson, 472E2d 112 (10th Cir. 1973). In using language which essentially follows the Medicare hearings process, the statute does not adequately recognize the rights of the different groups of government beneficiaries over which the PSRO program will have jurisdiction. Poor people who are weakened by illness manifest the "brutal need" for benefits to which they have established their eligibility. To deny them those benefits through an adverse determination by a PSRO without affording meaningful hearings rights, is truly to push the recipient against the wall. Sniadach v. Family Finance Corp. of Bay View, 395 US 337, (1969). Mr. MICHAEL STERN, GUSTE, BARNETT & COLOMB, Staff Director, Senate Finance Committee, Dirksen Senate Office Building, Washington, D.C. DEAR MR. STERN: It was a pleasure to be one of the witnesses at the Hearing of the Health Subcommittee on PSRO representing the Council of Medical Staffs yesterday on May 9, 1974. One of the questions asked by Senator Bennett included the issue as to whether CMS was representing the views of a "minority" position. In view of the limitations of time this could not be properly addressed. American CMS would like to have this Statement enclosed as a written statement in addition to the verbal testimony as per the ruling that witness statements should be mailed by May 12, 1974 for inclusion in the record. We hereby submit the following additional statement: Statement from American CMS (in addition to the verbal hearing): A question was asked during our oral testimony May 9th as to whether CMS represented the position of a minority. CMS believes that ours is a consensus position, as follows: (1) The position of the Medical Professions of those States represented by those Senators present at the time of the CMS hearing were in a majority for Repeal of PSRO, as follows: (a) The Hon. Senator Long from the State of Louisiana: the Louisiana State Medical Society has thoroughly debated the PSRO issue and unanimous'y voted on May 5, 1974 for the Repeal of PSRO by deletion of the entire amendment not by partial amendment. The entire Resolution #709 is, as follows, to be printed as part of this statement: (Resolution #709 attached.) (b) The Chairman of the Subcommittee on Health, Hon. Senator Talmadge, represents the State of Georgia. The Medical Association of Georgia voted for the Repeal of PSRO, as follows: "Our officers, counselors, and Executive Committee should be instructed to work for repeal and inform the AMA and all other state medical associations of our decision. (b) In addition, we should: (1) Urge the membership to work in a united way toward this end. (2) Notify our representatives in Congress of our position and request their help. (3) Ask the AMA for financial support and ask AMA to work with the Congress. (4) Communicate with those in health related 3 CCH Medicare and Medicaid Guide, ¶26,237. organizations and ask for support. (5) Encourage the membership to inform its patients about the disadvantages of the law and mount a letter campaign to Congress asking for repeal of the law. It voted a statewide public information program for the Repeal of PSRO, and held a rally in Atlanta on April 7, 1974 for Repeal of PSRO. The Georgia Legislature adopted a Resolution urging Repeal, as follows: (attached). (c) The Hon. Senator Curtis, representing the State of Nebraska: The Nebraska Medical Society is on record for Repeal of PSRO. Of the four senators who heard the CMS presentation, three had clear mandates from their respective states for the complete Repeal of PSRO. Only the Hon. Senator Bennett had support from his State Medical Society. (d) The State of Indiana Medical Society and Legislature are on record for Repeal of PSRO. Senator Vance Hartke represents the State of Indiana in the Finance Committee. (2) The list of State Medical Societies which have gone on record for Repeal of PSRO in 1973 and 1974 are, as follows: Oklahoma, Louisiana, Texas, Nebraska, Kentucky, Michigan, North Dakota, Virginia, Indiana, Tennessee, California, Illinois, Arizona, Missouri, Georgia. (3) The State Legislatures of the following states have gone on record for Repeal of PSRO and have thus memoralized the United States Congress: Tennessee, Indiana, Illinois (Precertification Regulations), Kentucky, Georgia. (4) The American Medical Association House of Delegates, the opinion-making body of organized medicine, is on record that the Repeal of PSRO is in the public interest. It is only the position of the Board of Trustees-which is not the policymaking body of the AMA-that they will accept "Repeal by substitution" of amendments. (5) Civic organizations have gone on record in Louisiana, as follows: New Orleans: (a) YMBC. The Resolution of the YMBC is hereby enclosed, to be printed on the record as part of this statement. This resolution of the 1300 member YMBC of New Orleans was written and voted by the assembly after six months of deliberations and open hearings. Representatives included the Regional HEW Director in Dallas, Texas, Dr. Kenneth Schneider, Honorable Congressman Rarick from Louisiana and Dr. James Mongan (representing Honorable Senator Long). Open hearings which were carried on extensively before the unanimous vote for the Repeal of PSRO. (b) The American Association of Retired People, New Orleans Chapter; Slidell: (a) The American Association of Retired People, Slidell Chapter; (b) The Resolution of the Slidell City Council signed by Mayor Cusimano; (c) Veterans of Foreign Wars; (d) Priscilla Club. (6) Enclosed for the Testimony is the editorial of the TIMES-PICAYUNE, April 20, 1974, called "Iron Fist" and the editorial of the ST. LOUIS GLOBE DISPATCH, April 23, 1974, and the editorial from the WALL STREET JOURNAL, December 6, 1973, are printed as examples of national press and opinion that PSRO Repeal should be considered. (7) In November 28, 1973, 39 Congressmen signed this letter (attached) urging Repeal of PSRO as addressed to the American Medical Association Convention in Anaheim. (8) At the time of writing, 67 Congressmen have introduced at least 20 bills for Repeal. (9) Orther Louisiana Delegations. The following Congressmen from Louisiana are on record for repeal: F. Edward Hebert, Lindy Boggs, David C. Treen, Joe D. Waggonner, Jr., John R. Rarick, John B. Breaux and Senator J. Bennett Johnston, Jr. (10) The Louisiana Medical Association (representing the black doctors of Louisiana) are also on record for Repeal of PSRO. (11) The Association of American Physicians and Surgeons is on record for Repeal. They have filed a suit to the Federal District Court in the State of Illinois. Repeal of PSRO, in toto, has overwhelming support from major segments of not only the medical profession, but also the State Legislatures, City Councils and Civic Organizations. In addition, American CMS has received thousands of letters from patients urging Repeal of PSRO which they have also sent to their Congressmen. We respectfully submit that if Congress is to reflect the voice of the people the members of the Senate Committee on Finance would indeed vote for the Repeal of PSRO. Respectfully submitted, ROY F. GUSTE, Legal Counsel, American CMS. RESOLUTION No. 709 Introduced by: Shreveport Medical Society Subject: To request the Congress of the United States to repeal Professional Standards Review, section 249F of Public Law 92-603 Whereas, Professional Standards Review, section 249F of Public Law 92-603, is detrimental to the delivery of quality health and medical care for the American people, therefore be it Resolved, by the Louisiana State Medical Society in regular session May 57, 1974, in Lake Charles, Louisiana, that the Congress of the United States is hereby requested to repeal in its entirety Professional Standards Review, section 249F of Public Law 92-603, immediately. Our officers, counselors, and Executive Committee should be instructed to work for repeal and inform the AMA and all other state medical associations of our decision. (b) In addition, we should : (1) Urge the membership to work in a united way toward this end. (2) Notify our representatives in Congress of our position and request their help. (3) Ask the AMA for financial support and ask AMA to work with the Congress. (4) Communicate with those in health related organizations and ask for support. (5) Encourage the membership to inform its patients about the disadvantages of the law and mount a letter campaign to Congress asking for repeal of the law. GEORGIA GENERAL ASSEMBLY ADOPTS RESOLUTION URGING REPEAL A RESOLUTION Urging Congress to repeal the Professional Standard Review Organization Law; and for other purposes. Whereas, Section 249-F, Title XI of the Social Security Act, Public Law 92-603, Professional Standard Review Organization (PSRO), was enacted by the Congress of the United States in 1972 without due consideration and careful deliberation by both its bodies; and Whereas, operation of Professional Standard Review Organization will cause great harm and financial hardship to the elderly and poor people of our country because of its unrealistic requirements on physicians to practice their profession based on standards and norms approved by the Department of Health, Education, and Welfare; and Whereas, these segments of our population will suffer greatly if denied medical care and hospitalization deemed necessary by their physician but not in conformance with HEW standards based on averages and medians rather than human needs; and Whereas, this law may well inhibit the great advancement seen in American medicine during this century of progress in conquering many of man's dread diseases. Now, therefore, be it resolved by the General Assembly of Georgia that this body notify the Congress of the United States that the Professional Standard Review Organization Law is ill-conceived legislation, harmful to the public and pernicious in its effect on the practice of medicine. Be it further resolved that the Congress be urged to repeal the Professional Standard Review Organization Law as quickly as possible to prevent the damage it will cause to the public and the American health care system. Be it further resolved, that this Assembly encourage Georgia physicians to continue the ethical practice of their profession, to maintain the privacy and confidentiality of their patient's records, to retain their right to make medical decisions based on their own professional judgement, and to support the existing system of peer and utilization review available in hospitals and nursing homes, medical societies and associations, and the Georgia Medical Care Foundation. Be it further Resolved that the Secretary of State is hereby authorized and directed to transmit an appropriate copy of this Resolution to the Secretary of the Senate of the United States, to the Clerk of the House of Representatives of the United States, and to each member of the Georgia Congressional Delegation. [From the Wall Street Journal, Dec. 6, 1973] REVIEW AND OUTLOOK NO TIME FOR PATIENTS? We would never argue that any group should be exempt from accountability to the larger society, but we can understand why many doctors at an American Medical Association convention in Anaheim this week are up in arms over a new federal law purportedly designed to monitor the way doctors deal with federally insured patients. The law, described elsewhere on this page today by Dr. Winsten, requires the establishment of "Professional Standards Review Organizations," all around the country starting Jan. 1. These PSROS which will be comprised mainly of doctors, will have the task of second-guessing decisions made by other doctors in treating patients under Medicare, Medicaid and maternal and child health problems. Their findings will be used by a HEW bureaucracy to establish certain "norms" that doctors would be expected to follow in treating federally insured patients. Such questions as whether some doctors overprescribe or require unnecessary hospitalization will enter into the review and normsetting process. While we favor a businesslike administration of federal social programs, the PSRO legislation raises some questions which didn't get adequately asked or answered by Congress. It was attached by Senator Bennett (R., Utah), as a rider onto last fall's big and controversial Social Security bill and somehow rode through with almost no public attention. The House did not even hold public hearings on the PSROS. And yet the law empowers the government, through PSROS, to examine medical records in doctors' offices, not only of federally insured patients but private patients as well. The Association of American Physicians and Surgeons thinks this is an unconstitutional invasion of a private relationship. Further, it can be doubted that Congress gave sufficient thought to the cost of all this monitoring and normsetting. There is no clear picture of how many PSROS there will be but a minimum of 150, and probably considerably more, is likely. The man-hours of doctors who serve on them will be that many fewer man-hours devoted to practicing medicine, not to mention the man-hours that will have to be devoted in doctors' offices to meeting demands for information or justifying decisions. It might be noted that some 50 million patients and 10 million hospital admissions are potentially subject to monitoring and that the proposed norms cover some 350 procedures. It makes you wonder if doctors will have any time left to treat patients. Finally, the law seems to ignore that a great deal of peer review already goes on in medicine, by state and local medical societies and hospital boards that review decisions to operate and the like. While peer review has been criticized as ineffective a lot of the criticism remains unproved. In Louisiana last December, it was the state medical society that blew the whistle on a HEW-financed private birth control scheme that now is under criminal investigation, which suggests that the public interest may fare at least as well under private peer review as through the good offices of HEW. Many doctors claim that the PSRO sleeper actually was designed to open the medical profession up for full federal insurance, or, as the AMA once would have termed it, "socialized medicine." Interestingly, the AMA had a hand in the original conception of PSROS, apparently with some notion of displaying flexibility— thus avoiding the kind of pitched battle it lost over Medicare-and at the same time keeping PSROS in the hands of physicians. But a good many physicians are making it clear that they think that was a bad tactic. It would seem that they have a point. Medicare and Medicaid were a product of the mid-1960s and there is no denying the public support that then existed. But this is 1973 and Americans have seen quite a lot they don't like about federal social programs. There is no certainty they are yet ready for national health insurance and they certainly aren't ready for sneaky approaches to that end through innocent-looking riders to complex bills in Congress. As to monitoring Medicare and Medicaid, HEW might do well, or so the Louisiana case would suggest, to get better control of its existing auditing system. Rep. Rarick (D., La.) has introduced a bill to repeal PSROS. It may well be that the public has a bigger stake in repeal than it realizes. At any rate, the issue deserves a better hearing than it got when PSROs were so nimbly written into law last year. YOUNG MEN'S BUSINESS CLUB OF RESOLUTION Whereas, Public Law 92-603 created the Professional Standards Review Organization (PSRO) which is intended to monitor the way physicians deal with patients that are provided healthcare insurance through federal funds, which at time of passage was limited essentially to Medicare and Medicaid patients; Whereas, the recently enacted Health Maintenance Organization (HMO) Act of 1973, provides federal funds to aid in Development of HMO's which will further increase the number of patients receiving healthcare insurance through federal funds; Whereas, all proposed National Health Insurance plans will include more individuals in federally insured health care programs; Whereas, Public Law 92-603 empowers the government to examine medical records in doctors' offices, not only of federally insured patients but private patients as well; Whereas, this law may conceivably reduce the quality of healthcare since the physicians serving on a PSRO will not be able to devote their full time to the |