Where I Stand: Assemblywoman Barbara Buckley stays on the health care scene

Saturday, Oct. 4, 1997 | 4:12 a.m.

DURING THE 1997 Nevada Legislature, Assemblywoman Barbara Buckley, D-Las Vegas, took the lead in producing meaningful health care legislation. Buckley's AB156 to protect doctors, nurses and patients from a few overbearing, money-grubbing managed care organizations was landmark legislation. The continuing good news is that after the passage of the law she is following up on its enforcement and will be actively participating in the interim study being conducted by the Legislative Committee on Health Care.

Buckley's strength as an advocate for people who need protection has made her a popular figure in the political world. Will she follow the pleas that she seek a higher office? "No, there's much more work to be done in the rapidly changing field of health care," she told me. Patients, nurses and doctors need her and her seniority in the Assembly where she has been so effective.

Assemblywoman Vivian Freeman's Health and Human Services Committee held a hearing on AB156 in the Sawyer State Office Building in February and the public was shocked. One horror story after another was told and it soon became obvious that the only way some people received adequate care from their managed care organization was to hire an attorney or be wise enough to use the government. One patient reported receiving some help from the Nevada insurance commissioner.

Testimony from several nurses and doctors also revealed how their attempts to provide good health care were stymied by managed care organization restrictions. Dr. Bill Harrington, a former assemblyman and experienced emergency room physician, told of some bad experiences. For example, a managed-care group held up approval for a needed specialist to save a patient, until the doctor threatened to go to the press. During the waiting time, an additional four pints of fresh blood were needed for the patient.

Harrington referred to the people running managed health care as gatekeepers who "have a financial incentive not to be available or respond" to the demands for needed care. Just as bad was the practice of some groups to refuse payment for emergency room care after it's provided, because they determine it wasn't an emergency.

Buckley's AB156 passed and last week she reminded an interested Nevada Medical Association of the reforms it provided:

* Emergency room care treatment denials -- Must pay for care if a prudent person would have believed it was a true emergency at the time -- may not deny care because it later turned out not to be an emergency.

* Incentives -- Prohibits managed care organizations from offering incentives for denying any necessary medical care (now done through use of bonuses for keeping tests such as MRIs under a certain level).

* Gag clauses -- Prohibits managed care organizations from limited communication between provider and patient.

* Whistleblower -- Prohibits any retaliation against a provider for advocating for a patient or assisting with an appeal.

* Protocols -- Requires any guidelines on length of stay to be reviewed by a Nevada physician, reviewed annually, and be based on sound medicine.

* Grievance procedure -- Requires all managed care organizations to have grievance procedures with a review committee consisting primarily of patients; to give decisions within 30 days or 72 hours if emergency.

That's what has been done and now Buckley is zeroing in on several remaining health care problems. Protection of physicians from being penalized unfairly by a managed health care provider; an effective ombudsman for patients and care providers; more complete disclosure of health care costs, profits and administration; and continuity of care from same doctor are among her targets.

What are her hopes for the interim legislative committee to consider? The Silver State has an extremely high rate of uninsured children. For them she wants the most children cared for with the best possible program at the least cost. The committee should learn how managed care is actually working and produce a consumer booklet explaining it to the general public. Long-term affordable and available care must also be given committee consideration.

Thanks to Buckley, Nevada has come a long way since February when I wrote "He tossed a handful of broken teeth on the witness table and then told of the pain and agony he had suffered along with hip and back injuries. All of his pain wasn't physical, much of it had been caused by the lack of sensitivity and medical treatment denied by his managed health care organization."

Yes, and we still have a ways to travel down the road to reach the level and quality of managed care the assemblywoman from Clark County believes we deserve.