AFTER years of congressional wrangling, a proposal that would hold health maintenance organizations accountable for medical decisions finally may become law. Bipartisan agreement has been reached on several parts of the proposal but further compromise may be needed without putting roadblocks in front of patients seeking redress for medical blunders.
Lets heal differences
on patients rights bill
The issue: The U.S. Senate has
begun debate on a bill that would
give patients the right to sue their
Both sides of the issue seem to agree that it makes no sense to allow patients to sue physicians for medical malpractice but not HMOs. Doctors often operate within rules set by HMOs, which may be most responsible for medical decisions leading to injury or death. Labor unions, consumer groups and the American Medical Association support giving patients redress against HMOs.
The Senate, now controlled by Democrats, opened debate this week on a bill that would provide protection for more than 170 million Americans who have private health insurance. Senators Inouye and Akaka have voted in the past for guaranteeing strong legal rights to patients. They should do so again.
Republicans have fought the proposal for years but now seem to accept its passage as inevitable. President Bush said during last year's campaign, "I support a national patients' bill of rights," although he said last week that he "can't live with the bill" co-sponsored by Sens. Ted Kennedy, D-Mass., and John McCain, R-Ariz., and favored by Democrats.
The chief disagreement appears to be where patients may take their lawsuits -- in federal or state courts. Democrats favor state courts, where patients can file malpractice suits and recover damages allowed under state law.
Bush has threatened to veto any bill that does not restrict suits against HMOs to federal court, where patients' attorneys are less likely to win large judgments in front of sympathetic judges. Republicans argue that a nationwide standard would be preferable to 50 separate interpretations of federal law, especially as it affects HMOs operating in numerous states.
Under a Kennedy-McCain bill, patients could sue an HMO in federal court if it did not exercise "ordinary care" in non-medical decisions such as coverage and eligibility. This provision creates an avenue of compromise that Republicans should accept.
Other points that should be quickly resolved are whether the bill should have limits on damages, whether patients should be required to exhaust administrative appeals before filing suit in court and whether employers should be held liable if they participated in a decision to deny coverage to a patient. Like the disagreement over venue, differences should not lead to the bill's defeat.
The noisy infighting among the trustees of the Office of Hawaiian Affairs is sending a dispiriting message to candidates being considered for the job of OHA administrator. If the board finds someone willing to take the position, the person certainly won't be in the dark about the combative politics in which the board engages.
OHA fights over hiring
a new administrator
The issue: Some OHA trustees
object to interviewing candidates for
OHA administrator at a members-only club.
The renewal of the divisiveness that has impeded OHA before stands in sharp contrast to the commendable efforts of 'Aha Punana Leo, the organization that has quietly worked to preserve the Hawaiian language. OHA should find a way to emulate the atmosphere in which the language program has flourished.
OHA trustees have become entangled in a factional dispute about the venue for interviewing candidates. Four of the nine trustees -- Rowena Akana, Linda Dela Cruz, Clayton Hee and Charlie Ota -- are objecting to interviews at the Pacific Club. They contend that OHA should do business in a public place and that the club, which once forbad access to non-Caucasians and women, is inappropriate. The other trustees say the club gives candidates more confidentiality than OHA's offices and that the four trustees did not object to the site until the interviews began.
This issue appears to be a red herring. The real battle seems to be the continuing power struggle among the trustees. OHA's mandate requires its trustees to conduct business without these constant squabbles, if not at least to dispel the image of pettiness. The agency might do well to keep in sight of its goals, as 'Aha Punana Leo has.
In 1983, when it began as a small group of Hawaiian-speaking educators, fewer than 1,000 people were able to speak the Hawaiian language. 'Aha Punana Leo's work has increased that to 7,000 to 10,000, a bright spot in light of predictions that 90 percent of the world's 6,800 languages could become extinct during this century.
'Aha Punana Leo has worked with the University of Hawaii-Hilo to establish the only master's degree program in a native American language in the United States. It provides for a teaching certificate taught through Hawaiian and is a model for other native groups, such as the Blackfeet Nation in Montana, as they seek to revive their languages.
'Aha Punana Leo's aims are less complex than OHA's, but when the agency's trustees begin to throw political wrenches into the works, they only slow their own movement toward helping their community.
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