Copyright 1999 Federal News Service, Inc.
Federal News Service
JULY 21, 1999, WEDNESDAY
SECTION: IN THE NEWS
LENGTH:
1070 words
HEADLINE: PREPARED TESTIMONY OF
STANLEY
KLAUSNER, MD
FACS
BEFORE THE HOUSE COMMERCE COMMMITTEE
HEALTH AND ENVIRONMENT SUBCOMMITTEE
SUBJECT - H.R 1070, A BILL TO AMEND
TITLE
XIX OF THE SOCIAL SECURITY ACT. JULY 21, 1999
BODY:
My name is Dr. Stanley and I am a board
certified General Surgeon specializing in the treatment of diseases of the
breast. I live and practice on Long Island where breast cancer is extremely
prevalent. During my 25 years in practice, I became focused on treatment of
breast cancer, a disease which attacks one in eight women. I am currently the
Director of Breast Services at Brookhaven Memorial Hospital in Patchogue New
York, a medium sized community hospital located on Suffolk County's south shore.
I maintain a busy private practice devoted almost exclusively to breast disease
and run a weekly breast clinic at two Health Centers in Suffolk
County.
I recently learned of Congressman Lazio's bill H.R. 1070 to amend
Title XIX of the Social Security Act to provide medical assistance for certain
women screened and found to have breast or cervical cancer under a federally
funded screening program. I am compelled to speak to you in support of its
enactment. I am not here representing any political or special interest group.
Rather, I speak to you as a "hands on" community doctor and want to tell you my
experiences in treating the population addressed by this bill, a population
called the "working poor".
In 1995 I became aware of a growing need to treat
the working poor in my community who were unable to obtain comprehensive breast
care at a local level. These patients were being seen by primary care physicians
in the private sector and at the County Health Centers. When a
diagnosis of breast cancer was made (often through the National Breast and
Cervical Cancer Early Detection Program or NBCCEDP) they were being referred to
a tertiary care facility such as Stony Brook University Hospital. There they
worked their way through the system trying to obtain treatment. Unfortunately,
the care of breast cancer patients is multifaceted and many patients often
obtained inconsistent levels of care. At that time, I was asked by the
administrator of the South Brookhaven Health Center in
Patchogue to set up a program for the total care of patients with breast
disease. He would in turn attempt to fund the program through the County. My
task, besides developing the mechanics of a breast clinic, was to assemble a
group of volunteer specialists willing to treat these patients, often for free.
Problems abounded especially when physician's services required durable medical
supplies or drugs. This problem still exists. We were able to prevail and the
program is quite successful. I have attached an abstract of the 1998 statistics
from the Health Center for your consideration labeled Exhibit
A. It provides you with percentages of breast cancer in our sampling population.
It also lists the patient's financial class. You will note in the exhibit, 59%
of our patients were uninsured. When I started the program in
1995 that percentage was 33 %.
I previously alluded to the treatment of
breast cancer as multifaceted. It is important for you to understand the many
services needed to treat this disease and the costs they represent to the
working poor. Once a diagnosis of breast cancer is made, the following services
may be required (depending on the type and severity of the tumor):
Breast
Surgeon-to perform either a mastectomy or a breast sparing surgical procedure
such as a lumpectomy and axillary lymph node dissection. Medical oncologist to
provide chemotherary and hormonal therapy. Radiation oncologist to provide
radiotherapy.
Plastic surgeon-to provide reconstruction to the mastectomy
site. Prosthetics for the patient to use if reconstruction is not done.
Psychological counseling. 3. Various support groups. These services are in
addition to the more mundane ones such as pathology, laboratory, in-hospital
services and even pain medications. All of these modalities must be in place in
order to provide "standard of care" for the breast cancer patient. Having only a
part of these services funded, while somehow believing the patient can pay for
the others, is unrealistic. Over the years that my breast program has been in
effect, a disturbing trend has been emerging. With the advent and penetration of
managed care, physicians are faced with new challenges. They must see higher
volume in order to maintain an acceptable bottom line. The "free services" they
render to the working poor are straining their ability to adapt and is making
the breast program more difficult to implement. I fear that in the near future
the altruistic feelings of my fellow physicians may be supplanted by the adage
"charity begins at home."
Even more disturbing is my gradual awareness that
the working poor are afraid to elect breast conserving surgery. They are so
terrified of medical bills that their medical judgement is biased. Take for
example a working mother supporting two children and not qualified for medicaid.
Even if her breast cancer is amenable to breast conserving surgery, she often
elects a mastectomy because she knows the cost of the additional treatments
needed in breast conservation, such as radiation and chemotherapy, are too
expensive. What a difficult decision this woman must make when she opts to
sacrifice her breast rather than incur medical bills she can't pay. As for
plastic surgical reconstruction of her mastectomy site, this has simply never
been an option.
I can continue giving you my personal experiences in
treating the working poor and tell you of the courage and dignity most all have
shown. Unfortunately it would take considerably more than my allotted time. Most
simply put, these patients have been thrust into the healthcare arena through no
fault of their own. They know they can't pay for expensive treatments yet they
must "work the system" in order to survive. Every one of us has a cause we
support. We all love to rally for a wrong that needs to be made right. Mine is
to continue to be able to treat this disease in all of my patients. My being
here today is to urge you, the Congress of the United States, to provide some
economic support to ease the hard choices the working poor must make and to help
the system accommodate their care. I firmly believe enacting H.R.1070 gives the
Congress an opportunity to improve the outcomes of the working poor afflicted
with breast cancer. You wisely legislated funds for diagnosis, now I urge you to
complete the job by funding treatment as well.
I thank you for your
attention.
END
LOAD-DATE: July 22, 1999
