Senate Vote Clarifies Course of Action

Voting mostly along party lines, on July 9 the U.S. Senate refused to take up S. 11, the Patients First Act. Modeled after California’s legislation, the Medical Injury Compensation Reform Act or MICRA, the bill would, among other things, cap noneconomic damages at $250,000 and establish expert witness standards in medical liability lawsuits.

The vote was 49 to 48, 11 votes shy of the 60 needed. All Republicans but two voted “yea,” 45 Democrats and one Independent voted “nay,” and three Democrats did not vote. The U.S. House of Representatives passed its reform bill on March 13, and the Bush administration fully supports the House-passed version of the bill, H.R. 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003. Therefore neurosurgery’s advocacy efforts now must focus on changing the votes of 11 senators. Senate leaders have vowed to bring medical liability legislation up for additional votes throughout the remainder of the 108th Congress, so neurosurgeons need to keep the pressure on those senators who blocked consideration of this critical legislation. The complete tally of the Senate vote is listed below.

The fact that the first attempt at passage in the Senate failed is not necessarily bad news. First, the 49 “yea” votes for the bill is the highest number of senators ever to vote in favor of such comprehensive reform legislation. Second, the vote provided a clear picture of current standings that will allow precise targeting of public education and advocacy efforts.

Further, the Republican leadership in the Senate has recently indicated its intention to pursue an incremental vote strategy. At press time, the expectation is that the Senate will vote on a medical liability reform bill that applies only to obstetric services sometime in October. The second bill, to be considered first thing next year, would apply MICRA-like protections to providers of emergency services, including neurosurgeons. The third and fourth bills likely will apply tort reforms to rural physicians and volunteer physicians. Finally, assuming the failure of all of these efforts, sometime before the 2004 elections the Senate will vote one last time on a comprehensive reform bill. It is possible, however, that Democrats will find it extremely difficult to vote against moms and babies, and should the first incremental bill pass the Senate, it could serve as the legislation that would be reconciled with the House-passed HEALTH Act.

Neurosurgeons are encouraged to contact their senators and stress the need to pass medical reform legislation. Sample letters that can be edited and sent via e-mail are available at https://capwiz.com/noc/issues/alert/?alertid=2801021.

Katie O. Orrico, JD, is director of the AANS/CNS Washington Office.