Wednesday, March 5, 1997

1250 1 2 3 4 5 6 7 8 9 ALBANY, NEW YORK 10 March 5, 1997 11 10:01 a.m. 12 13 14 REGULAR SESSION 15 16 17 18 SENATOR JOHN R. KUHL, JR., Acting President 19 STEPHEN F. SLOAN, Secretary 20 21 22 23 24 25 1251 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 1260 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. 1262 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 1263 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 1265 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 1266 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 1268 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? 1269 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 10