Regular Session - March 5, 1997
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9 ALBANY, NEW YORK
10 March 5, 1997
11 10:01 a.m.
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14 REGULAR SESSION
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18 SENATOR JOHN R. KUHL, JR., Acting President
19 STEPHEN F. SLOAN, Secretary
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1 P R O C E E D I N G S
2 ACTING PRESIDENT KUHL: The
3 Senate will come to order. Ask the members to
4 find their places, staff to find their places.
5 Ask everybody to rise and join me in saying the
6 Pledge of Allegiance to the Flag.
7 (The assemblage repeated the
8 Pledge of Allegiance to the Flag.)
9 In the absence of clergy, may we
10 bow our heads in a moment of silence.
11 (A moment of silence was
12 observed. )
13 Reading of the Journal.
14 THE SECRETARY: In Senate,
15 Tuesday, March 4th. The Senate met pursuant to
16 adjournment. The Journal of Monday, March 3rd,
17 was read and approved. On motion, Senate
18 adjourned.
19 ACTING PRESIDENT KUHL: Hearing
20 no objection, the Journal stands approved as
21 read.
22 Presentation of petitions.
23 Messages from the Assembly.
24 Messages from the Governor.
25 Reports of standing committees.
1252
1 Reports of select committees.
2 Communications and reports from
3 state officers.
4 Motions and resolutions.
5 The Chair recognizes Senator
6 Marcellino.
7 SENATOR MARCELLINO: Mr.
8 President, on behalf of Senator Skelos, please
9 place a sponsor's star on Calendar Number 223.
10 ACTING PRESIDENT KUHL: Calendar
11 Number 223, which is on the active list, is
12 starred at the request of the sponsor.
13 Any other motions or resolutions?
14 Hearing none, Senator Bruno, that
15 brings us to the calendar.
16 SENATOR BRUNO: Mr. President,
17 can we recognize Senator Farley for an
18 announcement, please.
19 ACTING PRESIDENT KUHL: Chair
20 recognizes Senator Farley for an announcement.
21 SENATOR FARLEY: There will be an
22 immediate meeting of the Banks Committee in Room
23 332. The Banks Committee will be meeting
24 immediately in 332.
25 ACTING PRESIDENT KUHL: There
1253
1 will be an immediate meeting of the Banks
2 Committee, immediate meeting of the Banks
3 Committee in the Majority Conference Room, Room
4 332.
5 Senator Bruno.
6 SENATOR BRUNO: Mr. President,
7 can we at this time take up the
8 non-controversial calendar.
9 ACTING PRESIDENT KUHL: Secretary
10 will read the non-controversial calendar.
11 THE SECRETARY: Calendar Number
12 123, by Senator LaValle, Senate Print 559, an
13 act to amend the Education Law, in relation to
14 community service opportunities.
15 ACTING PRESIDENT KUHL: Secretary
16 will read the last section.
17 THE SECRETARY: Section 3. This
18 act shall take effect on the 1st day of
19 September.
20 ACTING PRESIDENT KUHL: Call the
21 roll.
22 (The Secretary called the roll. )
23 THE SECRETARY: Ayes 38.
24 ACTING PRESIDENT KUHL: The bill
25 is passed.
1254
1 THE SECRETARY: Calendar Number
2 181, by Senator Kuhl, Senate Print 2060, an act
3 to amend the General Business Law, in relation
4 to automobile auctioneers.
5 ACTING PRESIDENT KUHL: Secretary
6 will read the last section.
7 THE SECRETARY: Section 2. This
8 act shall take effect immediately.
9 ACTING PRESIDENT KUHL: Call the
10 roll.
11 (The Secretary called the roll. )
12 THE SECRETARY: Ayes 39.
13 ACTING PRESIDENT KUHL: The bill
14 is passed.
15 THE SECRETARY: Calendar Number
16 187, by Senator Levy, Senate Print 929, an act
17 to amend the Vehicle and Traffic Law, in
18 relation to leaving the scene of injury to
19 certain animals without reporting.
20 ACTING PRESIDENT KUHL: Secretary
21 will read the last section.
22 THE SECRETARY: Section 2. This
23 act shall take effect on the 120th day.
24 ACTING PRESIDENT KUHL: Call the
25 roll.
1255
1 (The Secretary called the roll. )
2 THE SECRETARY: Ayes 39.
3 ACTING PRESIDENT KUHL: The bill
4 is passed.
5 THE SECRETARY: Calendar Number
6 191, by Senator Maltese, Senate Print 2440, an
7 act to amend the Vehicle and Traffic Law, in
8 relation to increasing the penalty for
9 obstructing access.
10 ACTING PRESIDENT KUHL: Secretary
11 will read the last section.
12 THE SECRETARY: Section 3. This
13 act shall take effect on the 1st day of
14 November.
15 ACTING PRESIDENT KUHL: Call the
16 roll.
17 (The Secretary called the roll. )
18 THE SECRETARY: Ayes 40.
19 ACTING PRESIDENT KUHL: The bill
20 is passed.
21 THE SECRETARY: Calendar Number
22 192, by Senator Stafford, Senate Print 799, an
23 act to amend the Labor Law, in relation to
24 licenses to possess and use explosives.
25 ACTING PRESIDENT KUHL: Secretary
1256
1 will read the last section.
2 THE SECRETARY: Section 2. This
3 act shall take effect on the 1st day of
4 November.
5 ACTING PRESIDENT KUHL: Call the
6 roll.
7 (The Secretary called the roll. )
8 THE SECRETARY: Ayes 40.
9 ACTING PRESIDENT KUHL: The bill
10 is passed.
11 THE SECRETARY: Calendar Number
12 208, by Senator Levy, Senate Print 72, an act to
13 amend the Penal Law, in relation to including
14 the theft of dogs and cats.
15 SENATOR PATERSON: Lay aside.
16 ACTING PRESIDENT KUHL: Lay the
17 bill aside.
18 THE SECRETARY: Calendar Number
19 213, by Senator Velella, Senate Print 1189, an
20 act to amend the Criminal Procedure Law, in
21 relation to the use of electronically
22 transmitted documents.
23 ACTING PRESIDENT KUHL: Secretary
24 will read the last section.
25 THE SECRETARY: Section 2. This
1257
1 act shall take effect on the 1st day of
2 November.
3 ACTING PRESIDENT KUHL: Call the
4 roll.
5 (The Secretary called the roll. )
6 THE SECRETARY: Ayes 41.
7 ACTING PRESIDENT KUHL: The bill
8 is passed.
9 THE SECRETARY: Calendar Number
10 215, by Senator Saland, Senate Print 1292, an
11 act to amend the Criminal Procedure Law, in
12 relation to expanding the offenses concerning
13 which a child witness may testify.
14 ACTING PRESIDENT KUHL: Secretary
15 will read the last section.
16 THE SECRETARY: Section 3. This
17 act shall take effect on the 1st day.
18 ACTING PRESIDENT KUHL: Call the
19 roll.
20 (The Secretary called the roll. )
21 THE SECRETARY: Ayes 41.
22 ACTING PRESIDENT KUHL: The bill
23 is passed.
24 THE SECRETARY: Calendar Number
25 225, by Senator Cook, Senate Print 786, an act
1258
1 to amend the Facilities Development Corporation
2 Act, in relation to definitional provisions.
3 ACTING PRESIDENT KUHL: Secretary
4 will read the last section.
5 THE SECRETARY: Section 3. This
6 act shall take effect immediately.
7 ACTING PRESIDENT KUHL: Call the
8 roll.
9 (The Secretary called the roll. )
10 THE SECRETARY: Ayes 43.
11 ACTING PRESIDENT KUHL: The bill
12 is passed.
13 THE SECRETARY: Calendar Number
14 234, by Senator LaValle, Senate Print 761-A, an
15 act to amend the Insurance Law, in relation to
16 coverage for breast reconstruction.
17 SENATOR LaVALLE: Lay that
18 aside.
19 ACTING PRESIDENT KUHL: Lay the
20 bill aside for the day, Senator LaValle?
21 SENATOR LAVALLE: No, no.
22 ACTING PRESIDENT KUHL: Lay the
23 bill aside temporarily. And 236 also? 236 also
24 is laid aside temporarily.
25 Senator LaValle, that completes
1259
1 the reading of the non-controversial calendar.
2 SENATOR LAVALLE: Mr. President,
3 would you read the controversial calendar.
4 ACTING PRESIDENT KUHL: Secretary
5 will read the controversial calendar beginning
6 with Senator Levy's Bill Number 208, Senate
7 Print 72.
8 Secretary will read.
9 THE SECRETARY: On page 10,
10 Calendar Number 208, by Senator Levy, Senate
11 Print 72, an act to amend the Penal Law, in
12 relation to including the theft of dogs and
13 cats.
14 SENATOR LaVALLE: Last section.
15 ACTING PRESIDENT KUHL: Secretary
16 will read the last section.
17 THE SECRETARY: Section 3. This
18 act shall take effect on the 1st day of
19 November.
20 ACTING PRESIDENT KUHL: Call the
21 roll.
22 (The Secretary called the roll. )
23 THE SECRETARY: Ayes 45, nays 1,
24 Senator Mendez recorded in the negative.
25 ACTING PRESIDENT KUHL: The bill
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1 is passed.
2 THE SECRETARY: Calendar Number
3 234, by Senator LaValle, Senate Print 761-A, an
4 act to amend the Insurance Law, in relation to
5 coverage for breast reconstruction.
6 SENATOR LAVALLE: Mr. President.
7 ACTING PRESIDENT KUHL: Chair
8 recognizes Senator LaValle.
9 SENATOR LAVALLE: I would like to
10 make some brief remarks on both Calendar 234 and
11 236. These are both very, very important bills
12 that are before us, and let me just indicate the
13 problem and the reason why these bills are
14 here.
15 I think, as many of you know and
16 as has received much publicity, that some health
17 maintenance organizations had adopted a policy
18 that following a mastectomy operation that the
19 hospital stay period was 24 hours. There's also
20 a policy on breast reconstruction following such
21 a procedure that women were denied insurance for
22 such reconstructive surgery; and so once again
23 -- and I think we saw this last year with what
24 we called "drive-through maternities" -- this
25 Legislature last year responded very, very
1261
1 quickly. Senator Velella was the sponsor in
2 this house, bills passed both houses and
3 Governor Pataki signed that bill.
4 Once again, it seemed that we had
5 this year coined a phrase, "drive-through
6 mastectomies", and so this legislation is before
7 you.
8 Before I explain a few provisions
9 of this bill, I must say that this bill and
10 companion in the Assembly that were passed and
11 will be before the Governor for his signature
12 could really not have been before us with the
13 speed and with the kind of provisions that are
14 in this bill had it not been for the leadership
15 of Senator Alphonse D'Amato who many, many weeks
16 ago brought the Majority Leader, the Speaker and
17 those individuals who would be the sponsors of
18 this legislation together at Sloan-Kettering in
19 New York City for a major conference and what
20 really turned out to be a hearing, because it
21 had many people who participated in the
22 physician community, from the advocacy
23 community, that talked about the need for this
24 kind of legislation and the kinds of provisions
25 that should be in this legislation.
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1 Senator D'Amato has played once
2 again a major, major role in bringing
3 legislation that affects breast cancer victims.
4 Last year, you will recall he played a very
5 major role in bringing before us the pesticide
6 registry bill that had been around for a long
7 time and he used his negotiating skills and
8 brokering skills to bring closure on that issue,
9 and again he's done that again on this issue.
10 Senate 761-A requires insurance
11 companies to provide coverage for in-patient
12 hospital care for a period of time as is
13 determined by the physician in consultation with
14 the patient to be medically appropriate, and I
15 think it's a very key feature and that's
16 something that we want not only here but in each
17 and every medical procedure, determina...
18 determination should be made by the physician
19 and the patient.
20 In Senate Bill 11-A, coverage is
21 provided for breast reconstructive surgery
22 following a mastectomy including surgical
23 reconstruction of the other breast to produce a
24 symmetry in appearance. Senate Bill 11-A
25 requires that insurance pay full coverage for
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1 second medical opinions whenever a positive or a
2 negative diagnosis of cancer has been made, or
3 for reoccurrence of cancer or recommendation of
4 a course of treatment for cancer.
5 Second opinion may be performed
6 by a clinical specialist, including a cancer
7 specialty care center. The insurance company
8 must also provide coverage for a second medical
9 opinion from a physician or cancer specialty
10 care center not participating in the insurer's
11 network.
12 Both Senate Bill 11-A and 761-A
13 prohibit insurers from denying women insurance
14 coverage solely for the purpose of avoiding the
15 requirements of this legislation. It prohibits
16 -- and this is very, very important -
17 prohibits incentives to encourage women to
18 accept less coverage than the legislation
19 provides, and it prohibits insurers from
20 penalizing -- from penalizing physicians who
21 recommend and provide care in accordance with
22 this legislation.
23 Those provisions, I know, after
24 we had some initial drafts, Senator D'Amato had
25 some very specific interest and we ensured that
1264
1 we provided this, and so with the leadership of
2 our Majority Leader, who has been absolutely
3 fantastic in getting the staff focused, that we
4 have these bills before us and before the
5 Governor at the earliest possible time. I
6 really salute our Majority Leader, Senator
7 Velella, Senator Hannon and the other sponsors
8 on this legislation.
9 Thank you very much, Mr.
10 President.
11 ACTING PRESIDENT KUHL: Chair
12 recognizes Senator Marcellino.
13 SENATOR MARCELLINO: Yes, Mr.
14 President. It's my pleasure to rise in support
15 of these two bills. I think they're landmark
16 pieces of legislation.
17 Certainly Senator LaValle
18 deserves commendation for his hard work.
19 Senator D'Amato for using his good offices to
20 bring this issue to the floor and before us for
21 public debate should be congratulated, and our
22 Majority Leader, Joe Bruno, certainly should be
23 congratulated for bringing this to the floor
24 with such expeditiousness and speed.
25 The HMOs seem to be somewhat out
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1 of control. This Legislature has had to take up
2 bills dealing with term limits, time limits for
3 women who are pregnant could only stay in the
4 hospital for 24 hours while the HMOs really had
5 to correct that problem. The HMOs are trying to
6 tell women who have been the victims of breast
7 cancer that they have certain limitations of a
8 kind of treatment they can be -- they can
9 receive, and that they can receive reimbursement
10 for.
11 This is not acceptable behavior.
12 It's actually being out of control. Everybody
13 wants to control costs. Everybody wants in
14 expensive medical care, but we also want quality
15 medical care, and we're not willing to sacrifice
16 quality for price.
17 There's no way you can put a
18 price on good health. There's no way you can
19 put a price on quality medical care if it saves
20 the life of yourself or a loved one or anyone
21 for that matter, and it's time we send a strong
22 and stern message to the HMOs and those who
23 would try to limit quality medical care in this
24 state and this nation, that this is unacceptable
25 and we will not tolerate it here, and Senator
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1 LaValle's efforts go a long way in sending that
2 stern message. Senator D'Amato's efforts, on a
3 national level, go a long way in sending that
4 message and the passage of these bills today
5 will be historic and go a long way toward
6 sending a message to these people and these
7 institutions that their behavior is
8 unacceptable.
9 We want to save money but not at
10 the cost of human life and human health. This
11 cannot be tolerated. So, ladies and gentlemen,
12 I urge all my colleagues to join on these bills
13 and vote for them. I know you will. I
14 certainly intend to.
15 Thank you.
16 ACTING PRESIDENT KUHL: Chair
17 recognizes Senator Mendez, on the bill.
18 SENATOR MENDEZ: Mr. Chairman, I
19 rise in support of these two very important
20 bills and also to congratulate Senator LaValle
21 for making it possible for women who suffer from
22 breast cancer to at least be a little bit more
23 at ease while they deal with the psychological
24 problems that such a disease or causes for many,
25 many women and to have women who have to go
1267
1 through a mastectomy to give them the true
2 option, the real option of reconstruction to me
3 is one of the very great things that anybody
4 could do here in this chamber for a public
5 policy, that it will ensure that women that are
6 thus unfortunate at a specific moment in their
7 time are able to breathe more easily through the
8 conditions and policies taken in both bills.
9 So as a breast cancer survivor
10 myself and as a person who underwent
11 reconstruction, I appreciate enormously -
12 enormously -- the significance of these two
13 bills that we are voting on today, thanks to
14 Senator LaValle and others and thanks to the
15 intervention of Senator D'Amato, as was stated
16 here earlier by Senator LaValle.
17 So it is with great joy that I
18 support these two very important bills.
19 Thank you, Mr. Chairman.
20 ACTING PRESIDENT KUHL: Chair
21 recognizes Senator Dollinger, on the bill.
22 SENATOR DOLLINGER: Mr.
23 President, will the sponsor yield to a couple
24 questions?
25 ACTING PRESIDENT KUHL: Senator
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1 LaValle, will you yield to Senator Dollinger for
2 a couple questions?
3 SENATOR LAVALLE: Yes, I will.
4 ACTING PRESIDENT KUHL: Senator
5 yields.
6 SENATOR DOLLINGER: Mr.
7 President, since the sponsor has included both
8 the calendar numbers, these questions may
9 dovetail on both the bills.
10 The first question through you,
11 Mr. President, is that the concept, as I
12 understand it, Senator, involves the notion of
13 any time there's a detection of cancer or a
14 cancer opinion, either one of positive or
15 negative, that under this bill all insurance
16 policies in the state, all health insurance
17 policies, will permit the insurer to seek a
18 second opinion; is that correct?
19 SENATOR LAVALLE: That is
20 correct. That's exactly what I stated.
21 SENATOR DOLLINGER: And that's
22 for all forms of cancer.
23 SENATOR LAVALLE: Yes.
24 SENATOR DOLLINGER: Would that
25 involve also forms of skin cancer?
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1 SENATOR LAVALLE: Yes.
2 SENATOR DOLLINGER: O.K.
3 SENATOR LAVALLE: Any cancer.
4 SENATOR DOLLINGER: My question
5 is, through you, Mr. President, I understand why
6 given the nature of our science and technology
7 cancer is of enormous concern in our population,
8 but why would we provide a second opinion for
9 cancer and not for other diseases as well? Why
10 do we differentiate? Why doesn't this bill say
11 that if you have -
12 SENATOR LAVALLE: Well, Senator -
13 SENATOR DOLLINGER: -- an adverse
14 diagnosis of a potentially life-threatening
15 diagnosis, that you're entitled to a second
16 opinion?
17 SENATOR LAVALLE: We get into
18 these discussions many times on other
19 legislation. This legislation narrowly deals
20 with a specific area. We have actually
21 broadened it beyond the breast cancer to include
22 all cancers, but the topic that, or the issue
23 that we were dealing with was specifically
24 cancer, so that's why we direct, in terms of
25 insurers to address some of the issues
1270
1 concerning this particular topic.
2 SENATOR DOLLINGER: Again through
3 you, Mr. President. I agree, Senator LaValle,
4 you're absolutely correct, we can focus the
5 legislative power at a particular problem, a
6 particular narrow problem. We don't have to, as
7 a matter of course, address the broader issue.
8 My question is, doesn't this bill
9 really set precedents that from now on whenever
10 there's a life-threatening opinion rendered by
11 any physician in the state, that we're going to
12 start down a path that says everybody is
13 entitled to a second opinion and, mind you,
14 through the President, I'm not necessarily
15 convinced that's such a bad idea. I'm just
16 concerned, are we walking down -- starting down
17 a path that suggests that everybody, when
18 diagnosed either with or without a life
19 threatening illness now has the right to a
20 second opinion?
21 SENATOR LAVALLE: Whenever we
22 pass legislation, we establish precedents. We
23 open Pandora's box for exploration, and
24 certainly others may, if they feel they have a
25 grievance, come before this Legislature and ask
1271
1 for a redress through the legislative process,
2 and, therefore, there would be a debate and
3 discussion about specific kinds of procedures,
4 but obviously every time we pass a bill, we
5 establish a precedent.
6 Senator, just to -- you know, in
7 general, as I explained in my opening remarks,
8 that the need for this legislation was
9 precipitated by what many felt was a harsh
10 policy on the part of the HMOs to require a very
11 narrow, limited period for a hospital stay and
12 also by turning away from, as Senator Mendez
13 said, the trauma and the psychological effect
14 and the need for reconstructive surgery, that
15 that also be part of the inclusionary provisions
16 for the insured.
17 SENATOR DOLLINGER: Again through
18 you, Mr. President, I -- again, Senator LaValle,
19 you -
20 ACTING PRESIDENT KUHL: Senator
21 LaValle, do you continue to yield?
22 SENATOR LAVALLE: Yes.
23 ACTING PRESIDENT KUHL: Senator
24 continues to yield.
25 SENATOR DOLLINGER: I'm not
1272
1 suggesting that this isn't the right thing to
2 do. I just want to make sure that I fully
3 understand it and fully understand where this
4 starts us or finishes us on the line of moving
5 away from a managed care model that many of us
6 have applauded, that many of us think holds the
7 opportunity to significantly reduce utilization
8 and health care costs in this state, and I
9 understand that, as we did with the
10 "drive-through delivery" bill, that we have the
11 power and the obligation in many cases to
12 protect the health of the people in this state
13 and to make sure that the HMOs are not
14 sacrificing that on the altar of simply
15 controlling costs.
16 But, again, through you, Mr.
17 President, what is the anticipated cost, if you
18 know, of requiring the insurers to provide a
19 second opinion, and I would just add as a
20 corollary, Mr. President, through you, could you
21 give me some statistics as to how many times the
22 insurers have refused to grant a second opinion
23 or refused to pay the cost of -
24 SENATOR LAVALLE: I can't. You
25 know, obviously, it would be misleading; but
1273
1 what I can give to you is something that may -
2 may be helpful as a statistic. 1995 in New York
3 State for all in-patient mastectomies where the
4 mastectomy was the principal procedure, the
5 average length of stay was 4.2 days. Now, I
6 can't do the math, but what I would say is that
7 the HMOs were providing a 24-hour period when
8 the average stay was 4.2 days, so you have
9 approximately a 3.2-day difference in terms of
10 what they were willing to provide for and what
11 will probably be the average -- the average
12 stay.
13 SENATOR DOLLINGER: Again through
14 you, Mr. President. Senator, do you know any
15 specific HMOs that have 24-hour provisions in
16 their policies in New York State?
17 SENATOR LAVALLE: No.
18 SENATOR DOLLINGER: So we don't
19 know whether the -- there were any limitations
20 on hospital stays in this state for
21 mastectomies?
22 SENATOR LAVALLE: Senator, I'm
23 just -- just as one other piece of information,
24 and I can't answer the second question, but in
25 terms of a number that I have for 1995 as
1274
1 out-patient mastectomies, we have a total of
2 124; for Medicare, 72; Medicare HMOs 2; Medicaid
3 3; Medicaid HMOs 2; HMOs 15; Blue Cross 15;
4 commercial insurers 10; self-paid 3 and Other,
5 2. Now, I -
6 SENATOR DOLLINGER: Mr.
7 President, if I could just ask the sponsor to
8 clarify.
9 ACTING PRESIDENT KUHL: Senator
10 LaValle, do you continue to yield?
11 SENATOR LAVALLE: Yes.
12 ACTING PRESIDENT KUHL: Senator
13 continues to yield.
14 SENATOR DOLLINGER: Senator, I
15 apologize, I'm confused.
16 SENATOR LAVALLE: Those were the
17 out-patient mastectomies for the year 1995, and
18 I gave you a breakthrough -- breakout of what
19 were out-patient.
20 SENATOR DOLLINGER: I missed the
21 term "out-patient". I missed the introduction
22 that said that those were just -- that those
23 were out-patient. So at least at this point,
24 again through you, Mr. President, we don't know
25 what the cost of either the second opinion would
1275
1 be or what the cost of transforming out-patient
2 mastectomies into in-patient mastectomies would
3 be?
4 SENATOR LAVALLE: No, and I
5 indicated that.
6 SENATOR DOLLINGER: Again through
7 you, Mr. President, dealing with the second
8 opinion requirement, which I think is a very
9 good idea, my question is, is it the intention
10 of this bill that the second opinion would
11 involve not only the opinion about diagnosis but
12 an opinion about proposed treatment as well?
13 For example, Senator, I go in and
14 I'm diagnosed as having cancer and then I'm
15 entitled to a second opinion as to whether or
16 not I have it or if I get a recommendation from
17 my oncologist of a prescribed course of
18 treatment, do I get the opportunity to go get a
19 second opinion simply on the question of whether
20 the treatment is appropriate?
21 SENATOR LAVALLE: We're talking
22 about both, the diagnosis and treatment.
23 SENATOR DOLLINGER: So that the
24 -- I think -
25 SENATOR LAVALLE: I want to make
1276
1 this, because we could go down this path which I
2 know you want to go down, but the provisions in
3 this bill were very, very carefully put together
4 as we did a year ago for the maternity, because
5 policymakers, both in the Assembly, in the
6 Senate, and I remember very vividly being at the
7 bill signing Governor Pataki, who said very
8 firmly while we in the state want to save money,
9 and so forth, we will not compromise patient
10 care; and so what this body and from the people
11 that have put this bill together in both houses
12 and the second floor -- it's been mentioned
13 several times, Senator D'Amato's involvement -
14 is certainly not to try and micromanage the
15 system, the HMO system. We want to give that an
16 opportunity, but advocates, physicians, people
17 who deal with this on a daily basis, say these
18 provisions, second opinion provisions, the
19 length of stay provisions, the reconstructive
20 surgery provisions, are important in the fact
21 that we not compromise patient care.
22 So I -- I mean we're not here
23 throwing to the wind the issue of trying to save
24 money. We all want to do that.
25 SENATOR DOLLINGER: I -- again
1277
1 through you, Mr. President. I don't mean to
2 suggest that this isn't the right thing to do,
3 Senator, but I do believe and, frankly, I've
4 learned in my experience here when I've gotten
5 up on the floor and I think answered questions
6 from all kinds of people when -- who say, you
7 know what the cost is of what you're doing, and
8 I'm just suggesting that that's something that
9 we should at least know in making a public
10 policy choice about quality of care.
11 I had this discussion with the
12 chairman of the Health Committee innumerable
13 times about trying to raise the bar. He made a
14 very eloquent presentation to the Health
15 Committee that says we're raising the bar, and
16 he said what this is going to require for those
17 people who have cancer, that the HMOs in the
18 guise of cost cutting can't take away.
19 But I still think it's important
20 to try to draw some sense of what this cost is
21 because I think, as we go down this path and I
22 think it's probably a proper path in determining
23 when we're going to intervene in the HMO
24 marketplace to set higher standards, we should
25 at least know what the cost is.
1278
1 I just have one other question
2 and then I'll speak on the bill.
3 ACTING PRESIDENT KUHL: Senator
4 LaValle, do you continue to yield?
5 SENATOR LAVALLE: Yes.
6 SENATOR DOLLINGER: This also
7 raises the question of clinical trials which I
8 believe you also know is an issue we're going to
9 have to deal with in this budget, which is the
10 issue of clinical trials, because it seems to me
11 if we allow a second opinion in a cancer case
12 and that second opinion can relate to a form of
13 treatment, the question becomes are we going to
14 allow the HMOs, after a patient gets a second
15 opinion and the opinion is to try an
16 experimental treatment, to try clinical trial -
17 to try a method of cancer treatments that may be
18 experimental.
19 It seems to me that this bill
20 requires us -- requires us to move down to that
21 next level and say we're going to support the
22 notion of both state dollars through the
23 Medicaid system and other dollars in HMOs to
24 contribute, to fund the kinds of treatments that
25 may be recommended in the second opinion.
1279
1 My question is, do you see it
2 moving in that same direction and doesn't this
3 commit us to do that? Again, I think it's a
4 good thing to do.
5 SENATOR LAVALLE: I think you
6 probably know the answer having read the bill,
7 that there is nothing in the bill that suggests,
8 because this is not a clinical trial bill, nor
9 is there any language in here that would suggest
10 that.
11 SENATOR DOLLINGER: O.K. Mr.
12 President, on the bill.
13 ACTING PRESIDENT KUHL: Senator
14 Dollinger, on the bill.
15 SENATOR DOLLINGER: I thank
16 Senator LaValle for answering my somewhat
17 technical questions about this bill, but it
18 seems to me that this bill does a good thing.
19 It does raise the bar in health care. It is a
20 statement by this Legislature, by the Senate,
21 that we're required to provide additional
22 protections in the name of improving the quality
23 of public health, regardless of the cost to the
24 HMOs.
25 I would prefer, quite frankly,
1280
1 that as we legislate bills like this, we have
2 some sense of what that costs so that we can at
3 least evaluate the consequence of raising public
4 standards, of improving health care for both
5 women and for the general population that are
6 afflicted with cancer.
7 I also think, and I know Senator
8 LaValle talked about moving down the road, I see
9 this bill as moving down a road. I see it
10 moving down a road that we should move down,
11 that we should examine our health care system
12 and realize that there are savings available in
13 managed care but that they should not come at
14 the cost of the public health, and I believe
15 that this bill, by providing access to second
16 opinions, by providing access to treatment
17 opinions, commits us to do things like funding
18 clinical trials which I think is a good idea, by
19 committing our resources to make sure that
20 quality health care is available for every New
21 Yorker.
22 (Senator D'Amato entered the
23 chamber.)
24 I'm not in the habit of
25 commending, necessarily, Senator D'Amato, but I
1281
1 recognize he has had leadership on this issue.
2 I think he has brought and perhaps focused our
3 attention on this. I think it's a good thing
4 that we've done this bill in a timely fashion.
5 I still think that there are issues about what
6 this leads to, what the road symbolizes, that we
7 ought to look at, which ought to evaluate the
8 cost of, but at least at this point, this step
9 is at least well warranted.
10 ACTING PRESIDENT KUHL: Chair
11 recognizes Senator Rath, on the bill.
12 SENATOR RATH: Thank you, Mr.
13 President.
14 I rise, as many of my colleagues
15 have, to congratulate Senator LaValle, Senator
16 Bruno, Senator D'Amato as they've brought up the
17 consciousness on what is one of the pressing
18 health issues of the day. The bills that are
19 being passed today will move forward with what
20 at one time was considered a, quote, women's
21 health issue. It is, but it's bigger than a
22 women's health issue. It's a family health
23 issue. I don't need to expand on why it's a
24 family health issue, because women are single
25 heads of household, traditional mothers,
1282
1 someone's sister, someone's daughter, someone's
2 aunt. It's a family issue.
3 It's a psychological issue, as
4 Senator Mendez pointed out, but a larger issue
5 was raised, and I don't know if Senator
6 Dollinger realized that he raised a larger issue
7 and at that point I knew I needed to speak on
8 what I think is a larger issue, and Senator
9 Dollinger raised it in relation to the second
10 opinion, diagnosis, appropriate treatment.
11 In discussions of women's health
12 issues, a larger area has come to the fore as
13 we've discovered that much of the women's health
14 issues, many of the women's health issues that
15 we discuss and that we evaluate are predicated
16 on research that was done on men. Certainly not
17 breast cancer, that's a different issue, but
18 take a look at heart disease and how that has
19 started to increase in women.
20 When you talk about life style,
21 when you talk about genetic make-up, you talk
22 about hormonal make-up and you talk about the
23 interaction of those, there is not much
24 research. It's just becoming a cause that
25 people are getting interested in, and I would
1283
1 like to suggest that, when drug levels are
2 prescribed, I would certainly want us to have a
3 second opinion before I allowed anyone to
4 prescribe a drug level that was most likely
5 predicated on research that had been done on
6 men.
7 We have a whole other discussion
8 that is about to develop, and today is the
9 beginning of a new role. Senator Dollinger
10 again characterized it as both the raising of
11 the bar in the discussion and beginning down the
12 road, and I would suggest that any road as we
13 are going from here to there in legislation and
14 in government is not a straight road. It zigs
15 and zags, and we must start down the road
16 though.
17 And as we start down the road, is
18 it a straight road? No, it's straight at the
19 start. And will we find some places where there
20 are some glitches? Yes, and then that will be a
21 zig or a zag depending on which side of the road
22 you're on; and so, in this new day of cost
23 containment and quality health care, I would
24 suggest that the balance that we are trying to
25 achieve in both of those is started today.
1284
1 We're on our way down the road,
2 and we have a whole lot of other stops to make
3 in our lifetime. I don't know if we'll see the
4 end of the road, but we certainly are on it and
5 I welcome this bill and congratulate the
6 sponsors.
7 ACTING PRESIDENT KUHL: Senator
8 Bruno.
9 SENATOR BRUNO: Mr. President, I
10 would like to ask the chamber to receive with
11 our hospitality our very distinguished United
12 States Senator, Al D'Amato, who has joined us
13 here for just a few moments and, as has been
14 commented on in the chamber by Senator LaValle
15 and others, Senator D'Amato has been the
16 catalyst, the leader in getting this legislation
17 where it is on the floor of the Senate, and soon
18 on the floor of the Assembly and then on the
19 Governor's desk to become the law of this
20 state.
21 So we are indebted to Senator
22 D'Amato, and I want to just express, Mr.
23 President, a welcome from all of our colleagues
24 here in the chamber, to the good Senator.
25 (Applause)
1285
1 ACTING PRESIDENT KUHL: Senator
2 Lachman, on the bill.
3 SENATOR LACHMAN: Yes, very
4 briefly on the bill. I do not share some of the
5 positive aspects of the evaluation of HMOs and
6 managed care as one of my colleagues does, but I
7 do share with him the positive virtues of this
8 bill.
9 Very briefly, I do think it sets
10 a major precedent for the good, not only in
11 terms of -- and I think it's gender-free because
12 what can be done in terms of aiding patients of
13 breast cancer can be done with aiding patients
14 with prostate cancer and other forms of
15 life-threatening disease.
16 I think that the leadership of
17 this chamber should be amended and this is a
18 non-partisan bill, and I also think that Senator
19 D'Amato, who is with us today, should be
20 commended in terms of his input into the
21 development and fruition of this legislation
22 today.
23 I proudly support this bill and
24 bills that I assume will follow from this
25 precedent.
1286
1 Thank you.
2 ACTING PRESIDENT KUHL: Senator
3 Abate.
4 SENATOR ABATE: Yes, very briefly
5 on the bill.
6 I commend Senator LaValle and
7 other leaders in making sure this legislation is
8 introduced and hopefully passed today, but I
9 look to the leadership of Senator LaValle,
10 Senator Kemp Hannon, Senator Stafford, to amend
11 this bill maybe not today but at a later point
12 in time, so it talks about a fair right of
13 appeal when health care is denied, particularly
14 for experimental trials, for clinical trials.
15 It's very important that the HMOs not be judge
16 and jury in deciding about these very important
17 programs and drugs and devices be utilized.
18 Many of the doctors I've spoken
19 with, many of the patients remind us all that
20 today's experiment may become tomorrow's cure,
21 and it's very important that there be built into
22 this legislation and other HMO legislation a
23 fair right of appeal, so not only will there be
24 a second opinion, but there will be an oppor
25 tunity for an independent panel of medical ex
1287
1 perts to make a decision whether an experimental
2 trial is warranted or not.
3 So I look forward to the
4 leadership. I know Senator Stafford has been a
5 leader on this issue. I'm hoping to look
6 forward to the passage of either an amendment of
7 this bill or another bill in the future that
8 would address this issue.
9 ACTING PRESIDENT KUHL: Is there
10 any other Senator wishing to speak on Calendar
11 Number 234?
12 Senator Nanula.
13 SENATOR NANULA: Thank you, Mr.
14 President.
15 I, too, would like to rise in
16 support of this bill and also to commend Senator
17 LaValle not only in regards to moving forward on
18 this issue but allowing both sides of the aisle
19 to participate in regard to the bill in an
20 environment where this legislative body has had
21 to intervene regarding procedures not provided
22 or inadequately provided by HMOs.
23 It's appropriate we address the
24 issue of reconstructive surgery for those women
25 suffering from breast cancer. We've seen this
1288
1 in the past. Today there's another bill
2 regarding the, quote/unquote, "drive-through
3 mastectomies" and also in regard to the managed
4 care bill of rights which I think this
5 legislative body as well as the Assembly was
6 very progressive in bringing to New York State.
7 It's quite unique to this country.
8 As many of us know, this bill is
9 now or this law is now going to begin to go into
10 effect and already we're beginning to hear some
11 concerns and issues from the industry in regard
12 to the quality and accessibility and afford
13 ability as well as accountability, and I think
14 it's really going to be incumbent upon us as a
15 Legislature to ensure that this HMO industry
16 ensure -- it does ensure that quality and
17 accessibility and affordability are provided as
18 well as accountability.
19 Senator Abate just mentioned an
20 appeal process. I think that certainly that is
21 an issue that we may have to look at moving
22 forward in regard to the issue of managed care
23 and that is not to say that I'm not a supporter
24 of managed care and HMOs. Certainly the
25 approach to, quote/unquote, "managing care" is
1289
1 something that it certainly makes a lot of sense
2 from a lot of perspectives, but as long as that
3 approach to, quote/unquote, "managing care" is
4 done in an environment of quality and
5 accessibility, really we'll be in good shape in
6 regards to this approach and again, it's
7 unfortunate that this legislative body has to be
8 reactive in regards to moving forward
9 initiatives like this one today.
10 It would certainly be more
11 pleasing to me at least if the industry itself
12 would be proactive in regards to addressing
13 these issues, but until and unless they do,
14 we're going to have to continue to look at
15 issues like this and others and, again, I want
16 to commend Senator LaValle and others involved
17 in this in addressing this issue today.
18 Thank you.
19 ACTING PRESIDENT KUHL: Secretary
20 will read the last section.
21 THE SECRETARY: Section 4. This
22 act shall take effect January 1st, 1998.
23 ACTING PRESIDENT KUHL: Call the
24 roll.
25 (The Secretary called the roll. )
1290
1 THE SECRETARY: Ayes 56.
2 ACTING PRESIDENT KUHL: The bill
3 is passed.
4 THE SECRETARY: Calendar Number
5 236, by Senator LaValle, Senate Print 11-A, an
6 act to amend the Insurance Law and the Public
7 Health Law, in relation to establishing
8 mandatory care.
9 ACTING PRESIDENT KUHL: Secretary
10 will read the last section.
11 THE SECRETARY: Section 6. This
12 act shall take effect January 1st, 1998.
13 ACTING PRESIDENT KUHL: Call the
14 roll.
15 (The Secretary called the roll. )
16 THE SECRETARY: Ayes 56.
17 ACTING PRESIDENT KUHL: The bill
18 is passed.
19 Senator Waldon.
20 SENATOR WALDON: Thank you very
21 much, Mr. President.
22 Mr. President, I was at a
23 committee meeting off the floor when the house
24 acted on 208. I respectfully ask unanimous
25 consent to be recorded in the negative on that
1291
1 bill.
2 ACTING PRESIDENT KUHL: Without
3 objection, hearing no objection, Senator Waldon
4 will be recorded in the negative on Calendar
5 Number 208.
6 Senator Johnson.
7 SENATOR JOHNSON: Mr. President,
8 without objection, I'd like to be recorded in
9 the negative on Calendar Number 123.
10 ACTING PRESIDENT KUHL: Without
11 objection, hearing no objection, Senator Johnson
12 will be recorded in the negative on Calendar
13 Number 123.
14 Senator Skelos.
15 SENATOR SKELOS: Mr. President, I
16 believe -- if you could return to reports of
17 standing committees, I believe there is a report
18 of the Banks Committee at the desk. I ask it be
19 read.
20 ACTING PRESIDENT KUHL: We'll
21 return to the order of reports of standing
22 committees. The Secretary will read a report of
23 the Banking Committee.
24 THE SECRETARY: Senator Farley,
25 from the Committee on Banks, reports the
1292
1 following bills:
2 Senate Print 2144, by Senator
3 Farley, an act to amend the Banking Law and the
4 Criminal Procedure Law;
5 2145, by Senator Farley, an act
6 to amend the Banking Law, in relation to money
7 transmitters.
8 Both bills reported directly to
9 third reading.
10 ACTING PRESIDENT KUHL: Senator
11 Skelos.
12 SENATOR SKELOS: Is there any
13 housekeeping at the desk?
14 ACTING PRESIDENT KUHL: Without
15 objection, the bills are ordered directly to
16 third reading.
17 There is no housekeeping.
18 SENATOR SKELOS: Then, Mr.
19 President, there being no further business, I
20 move we adjourn until Monday, March 10th, at
21 3:00 p.m., intervening days to be legislative
22 days.
23 ACTING PRESIDENT KUHL: Without
24 objection, hearing no objection, the Senate
25 stands adjourned until Monday, March 10th, at
1293
1 3:00 p.m., intervening days to be legislative
2 days.
3 Senate stands adjourned.
4 (Whereupon at 10:46, a.m., the
5 Senate adjourned.)
6
7
8
9
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