STATE OF GEORGIA COUNTY OF COWETTA AFFIDAVIT My name is Leona Black. I am 42 years old, and I live in Newnan, Georgia, with my son and my aged father. I get AFDC, which means we get Medicaid; and my father receives disability payments, which means he gets Medicare. We still have health care problems. For instance, there are no dentists in Newnan who take Medicaid or Medicare. Also, my father had trouble getting out of the hospital when he couldn't pay the difference between the hospital bill and what Medicare paid. The doctor ordered a private room, but Medicare only pays for semi-private rooms. They didn't want to release my father because he couldn't pay that medical bill. I had to talk to three different people before I could get him out of the hospital. I was scared that the hospital wouldn't let him go home, and would just keep running up the bill even higher. STATE OF GEORGIA COUNTY OF COWETTA AFFIDAVIT My name is Sylvia Cleveland. I am 20 years old, a resident of Newnan, Georgia, the mother of two, and I am expecting a third child in May. The inability to see a doctor is a continuing problem. In emergency, I can be run up to Cowetta County General Hospital, but routine medical care, or anything short of emergency, is almost unattainable. There are very few obstetricians or gynecologists in Newnan, and those that do practice here work in a clinic that demands payment in advance, or a session with the office manager to discuss payment before I could be Because I have so little money, I know I will not be able to get seen, and have been with a doctor only once since becoming pregnant. seen. In spring 1977, in the last stage of my second pregnancy, I became ill. Family and friends called my obstetrician, who would not see me; when my condition worsened, friends drove me to the emergency room at Cowetta County General Hospital. I was treated overnight and finally saw my doctor as he made rounds the following morning. This was only the third time I saw my doctor throughout the entire pregnancy. Senator KENNEDY. I think that is a very helpful-the whole panel has been excellent in covering the human aspects with Mr. Mitchell and the practical aspects of what is happening out in the field, and Mr. Suitts' comments about the general survey of some of the particular problems, and your wrapping this up together. I think you get a sense, both from Senator Schweiker and my own questions, there is substantial agreement. The real question is how it is going to be done. Hopefully, the first thing will be the regulations in terms of carrying it forward along the lines that you have outlined here. We will follow those very closely and work closely with you on that, and beyond that, in terms of the legislation itself and how we can do it in a way that doesn't create all kinds of problems which you indicate is obviously not the purpose, and yet, have meaningful progress in those areas of balanced representation. I am personally strongly committed toward achieving that goal and we would like to work with you on that. I don't know whether Barry Checkoway would like to say a word. Do you want to say a word? We have about 8 or 10 more minutes. Is there anything that you would like to add and then maybe I would ask Anne Fenerty if she would just like to say a word. Is there anything you would like to add? We have your testimony and I understand it is excellent. I will get a chance to read it. STATEMENT OF BARRY CHECKOWAY, ASSISTANT PROFESSOR OF URBAN AND REGIONAL PLANNING, UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN; CHAMPAIGN COUNTY HEALTH CARE CONSUMERS Professor CHECKOWAY. I can give about a four or five summary statement since you already have my testimony. Senator KENNEDY. You may proceed. Professor CHECKOWAY. Thank you, Mr. Chairman. My name is Barry Checkoway, and I am an assistant professor of urban and regional planning at the University of Illinois, at Champaign-Urbana and a leader of the Champaign County, Illinois Health Care Consumers. Senator KENNEDY. Were you up at our dinner the other night in Chicago of our consumer Professor CHECKOWAY. NO: but I am an elected board member of the Illinois Public Action Council, and I would like to take this opportunity to thank you for Senator KENNEDY. I am sorry, I didn't mean that. It was such a stormy night I was wondering. Professor CHECKOWAY. I am pleased that you made it back to Washington. My statement describes the local constraints on public involvement in health care planning under the Federal law. These are not the only local constraints with which we in our area are concerned but they are among the most important. The first constraint is the failure of consumer majorities on HSA governing and supporting bodies to approximate their area population. A recent report of a 3-month study of the East Central Illinois Health Systems Agency found this to be the case. This HSA comprises 16 counties in central Illinois, an area of more than 10,000 square miles. It is divided into five subarea advisory councils to provide the maximum potential involvement of the public. Among the findings of the study were that of 30 members of one subarea advisory council selected for analysis, of 30 members, 24 were from the highest income census tract, only one was from the lowest income census tract and no low-income minority or rural area was actively represented. Attendance at meetings was found so inadequate that fully one half of the board should have been terminated by its own bylaws. Among the conclusions were that the agency appears to give preference to people of higher socioeconomic status and that there is an immediate need for more public involvement. Studies elsewhere have found that in case after case providers and other vested interests have moved in and taken control. The second constraint is the failure of HSA's to allow effective public involvement in agency proceedings. The Federal law placed an emphasis on public accountability and open meetings on public notice and consumer involvement. But, the East Central Illinois HSA at its December meeting decided that 5 minutes, only 5 minutes be allowed for public comment on each substantive item on the agenda of board meetings. What this effectively means is in our area-and, again, it is a 16 county, 10.000-plus square mile area-that public involvement from consumers, providers, labor unions, women and minority groups, religious bodies and local elected officials will be restricted to only minutes per agenda item, and some agenda items involve public ex penditures of at least in the range of hundreds of thousands of dollars. Moreover, the agency at present has no specific plans to involve and benefit medically underserved population groups. The third and final constraint is the failure of HEW to intervene in local cases where it is believed that HSA's are not in compliance with Federal Government aims and with democratic principles. In response to the report of the compositional failures of our local Senator KENNEDY. Did you write the Secretary and ask him how many times he has intervened? Professor CHECKOWAY. Let me just briefly review our correspondence with HEW on this. In response to the report of the failures locally, the Director of the Bureau of Health Planning and Resources Development of HEW here in Washington thanked the researchers for sending him a copy of the report and promised to forward it along to the Chicago regional office. The deputy director of the Chicago regional office also thanked the researchers and promised to forward the report to the project officer of that office. A regional program consultant of that office in Chicago. wrote to us that after reading the report he contacted the HSA staff directly and was informed that the researchers had not afforded the courtesy to the HSA to review the report prior to its release, that they lacked knowledge and understanding of the public law and that the report had errors and inconsistencies. His conclusion was, "This office," this Chicago regional office of HEW-"feels that it would be inappropriate to comment on the substance of the report or to take its conclusions under consideration." I wrote in response to describe the thorough research on which the report was based; to explain the following an additional interview was held with the local executive director and that no errors and inconsistencies were found and to reaffirm that there was no evidence to place its accuracy in question. I pointed out that his information was incorrect and urged him to discuss the matter further. No further response from regional HEW was ever received. I simply would hasten to add in all this that the consumer responses, in comparison, were extensive. Local consumers had organized, had been effective in electing its representatives to the local subarea advisory council; this despite an internal hospital memo before the election at the board to the effect: "Urgent. The future of your hospital depends on your attendance at tonight's HSA election." We have received great aid from the Association of Health Care Consumers in Chicago and the Consumer Coalition for Health here in Washington and we only wish that we could have received, and we only hope that we will receive in the future the kind of similar aid from HEW which we believe is responsible for intervening on behalf of the public in these failures of local compliance. Thank you very much. [The prepared statement of Professor Checkoway follows:] |