say in a case like that, where there's evidence of a whole systematic pattern of incompetence and negligence and substandard health services delivery, maybe the right of the public to know takes precedence over the right of the hospital or the practitioner to privacy and confidentiality.

Ms. DYE. What we're dealing with is, at what point we would have enough knowledge and enough to base a decision on where we can go public with that.

The CHAIRMAN. If there's a hospital that has a whole stream of iatrogenic incidents, or a practitioner, I think you would agree the public has a right to know about that in making those choices.

Now, the question is where do we draw the line, and I think the line is probably drawn to protect the hospital or the institution from public scrutiny where there's one isolated episode.

Ms. DYE. I think this state leads the nation on identifying for the public where there's incidences in institutions and making that public. On behalf of the trustees, this is the one state where the character and competence of the trustee can be questioned on the basis of what's happened at that institution.

Ms. SCANLAN. Can I jump in for one moment, because I think there are two other factors that we have to remember, when we talk about individual hospital data.

One is patient confidentiality. We tend, when we talk about the release of information, about hospitals and physicians, to worry in the conversations about their due process and their confidentiality, but, we can't forget about the patient and his or her right to confidentiality, and depending upon the number of incidences of care or the physician or the kind of care, that may impact on information about a particular patient, particularly in some of our smaller communities where people can track and figure out who the family or patient is.

The CHAIRMAN. That's a very sensitive balancing act. Let's say, in a small community where even if you put John Doe or Mary Roe as the name for that patient, people could figure it out. Supposing there are a dozen incidents and a dozen Joe Does and Mary Roes. I think you may come to a point to which the public would clearly prevail in starting a process that would close down that institution.

Ms. SCANLAN. I agree with you provided that the civil rights of the individual patients are guarded. What happens if the physician that you want to take away his license or the hospital that you want to close is one that is trying a new experimental drug in regards to AIDS patient and in fact they're bilking those patients? And they should be closed down, but yet the names of the patients or the patients themselves could be discoverable by the way you go about doing the publicity.

The CHAIRMAN. Even if you used Joe Roe or Mary Roe?

Ms. SCANLAN. That's the balance that we have to be careful of. I agree that it's a very tight balance.

The CHAIRMAN. We can't assume that the answer is either in the direction of the patient's confidentiality or the institution's, or in the direction of always making everything public, no matter what. Ms. SCANLAN. The last item of importance is as we look at individual information and as hospital trustees evaluate and the chief

operating officer, and executive officers of hospitals evaluate information, and we release it to the public, we have to look for comparability of data. We have to look at hospital X and the data that it releases when compared against data from hospital Y, if it makes sense in a comparison. That in fact it's comparable, so that consumers and all of us are not misled in the use of the data.

It also is a tight balancing act. I believe we can come up with ways of doing that comparably, but I think it's something we have to remember as we move forward.

The CHAIRMAN. I agree.

Dr. LEVIN. I'm impressed about how much the hospitals are now interested in the confidentiality issue when for years and years it never bothered them.

The CHAIRMAN. The fact that they recognize that there's a balancing act to be done in the case shows that they're moving away from absolute confidentiality, no matter what.

Mr. RASKE. It's called market pressures.

Dr. LEVIN. There is a-DRGs are very helpful to us consumers, the people I represent, because it revealed the level of iatrogenic affect-data emerged out of the DRG process-quite accidently perhaps but there it was. It's sort of interesting to use that as a data base for making some judgments about the quality of medical care. With regard to protocols and care, I think it's a good ideathere's a care protocol for every DRG. 420 plus DRGs. There could also be a hazards protocol associated with each of the peer protocols.

For every care protocol, there's a hazard protocol. In the care of this particular condition, we can statistically know we're going to have a high probability of a boo-boo here and there. That information could be supplied to the patient on entry to that hospital. Here is your care protocol and here is what you can get in the way of trouble. And here is what you as an individual can do to reduce the likelihood of those so-called untoward events occurring, particularly those that are management within the hospital frame.

Those are very constructive possibilities internal to the hospital. Now to an advanced array of data that will help filter out some of the things that could have been avoided in the first place.

People not going to that hospital because they know the hospital's a disaster area or people going to a hospital because its record is so attractive.

What kind of information should we offer? I think the OTA's prescription is superb. I think you can break it down further and begin to build some very specific, distant warning signal data and that's what we're after initially. Right now we want to protect the public at the grossest level.

I would say strengthen the muscle of your community-someone said you can't have a policeman in every room. You can't. What we have to do is nurture and strengthen the muscle of that community in terms of its existing, community organizations, particularly in its advocacy areas.

I think this has been a very productive session. I didn't agree with anything Dr. Sherman said, but you wouldn't expect me to.

The CHAIRMAN. I agree with everything that you say and I agreed with everything Dr. Sherman said. You must admit he showed a little movement.

Dr. LEVIN. I always take a black and white position because we don't have time to make shades of gray.

The CHAIRMAN. In my business we have to.

Dr. LEVIN. In your business you do, and I think it's important to point out that Dr. Sherman and organized medicine is making a

move.

The CHAIRMAN. Making a lot of moves in a lot of different directions and there's a lot more give and take. We have more forthcoming attitudes than you would have dreamed possible as little as five years ago.

Dr. LEVIN. I'm a very greedy fellow, and my consumers are very greedy, too. Once they smell the possibility of change, and it is in the wind, they want more of it and they want it faster.

The CHAIRMAN. Dr. Sherman understands that, and they all understand that, and they're taking a whole new look at the work to be done.

Dr. LEVIN. My group and groups like it will be helpful to any of these groups that want some assistance from the consumer side; we'll give it to them. I'll give you my telephone number and you call us. We'll be there with our troops to help push, facilitate this goal.

The CHAIRMAN. Do any of you want to respond to Dr. Levin?
Dr. LEVIN. Anybody want my telephone number?

The CHAIRMAN. Let me just dismiss the panel and-

Ms. LIVEO. I would like them to hear what I have to say..

The CHAIRMAN. Let me thank this panel. Any of you who want to hear Ms. Rose Ann Liveo, president of SHAME, you're welcome to do so. But you've been here many hours and if you'd like to liberate yourself and go home and see your wives and kids, I will reiterate my thanks for your very constructive, forthcoming testimony. Now, we'll recognize Ms. Rose Ann Liveo, president of SHAMË, for 5 minutes.

STATEMENT OF ROSE ANN LIVEO, PRESIDENT OF SHAME

Ms. LIVEO. Thank you. I appreciate your efforts and what you're trying to do to bring some light as to what's going on in the medical profession.

SHAME came about out of personal tragedies within the members. It was a very hard thing to get this organization going because of our personal problems, most of the members of SHAME are victims of medical malpractice and are in wheelchairs and can't get around, but the ones who can, do speak on behalf of SHAME.

I gave you written testimony of how I got started in this organi

zation.

The CHAIRMAN. That statement will be printed in full in the record.

Ms. LIVEO. I appreciate that, but I won't go through the whole thing.

It was out of a personal tragedy-it started with my mother-inlaw back in 1984. She entered a Brooklyn hospital for removal of a bunion which I felt was unnecessary surgery to place this woman in a hospital, but given the fact that she was on Medicare, that's why I believe now as an educated consumer, she was placed in that hospital.

After surgery was over, she was left brain dead and for 28 days

The CHAIRMAN. How can that be possible? What happened?

Ms. LIVEO. At that point, the doctors told us they didn't know what happened.

The CHAIRMAN. This was a bunion that was removed?

Ms. LIVEO. Yes. This is something that could be done in the doctor's office. Statistics show that over two and a half million unnecessary operations are done each year resulting in at least 12,000 deaths and my mother-in-law was one of them.

A month after that, my nephew had to enter the hospital, so we made sure we got the best doctor, the best hospital. We wanted to make sure that this wouldn't happen again. Because now we were educated.

My nephew entered the hospital, the doctor told him it would be a week to 10 days with this procedure. My nephew spent nine months in the hospital. He lost half of his stomach, they perforated his colon, he's left with severe lung damage where he has to sleep with a machine. It goes on. The child is a disabled child now on Social Security and can't get around.

My sister saw what was going on, nine months in a hospital. She oversaw her son's care. He was in an intensive care unit for close to five months. She saw the abuse within the system, people that were dying and how they did unnecessary testing on these people that should have been left to go home and die in peace. Where she had to intervene and educate the families to say "enough is enough". Let her die in dignity.

By her intervening and telling the parents and educating them as to what can happen and what procedures were being done on this child, they got the proper care for the child.

My sister used the staff bathroom on two occasions, and the smell of marijuana was so overwhelming she said if she stayed in there long enough she would have got high.

These were the things that started opening our eyes. I couldn't believe that this could happen twice in one family. I started to go to the library, I said how could this happen?

In going to the library and researching this, I found numerous books on the mishaps in the medical profession, including the book Take This Book to the Hospital with You. It educated me, but I felt I shouldn't stay at that level. I should bring my education out to the public and try to educate them and make sure this doesn't happen to them.

In the 28 days we were in the hospital in my mother-in-law's case, not once did the administrator, even though we asked several times to see this man, and meet with the family and tell us what happened, he never had the decency to meet with us.

I didn't know that the State Health Department did investigations. I read an article in the paper about phony doctors, that there

were over 15,000 doctors practicing medicine and that they bought their license.

This doctor, there was a question in his credentials, so I wrote a letter to the Attorney General telling them what I saw in this hospital and what I believed was the problem. They said a lot of the problems were with foreign doctors.

In turn, they sent my letter to the State Health Department and they responded back to me telling me that they were going to do an investigation.

Their investigation concluded that patients rights, medical care and contents of medical records were violated. They also fined the hospital $43,000 in the care that my mother-in-law received, and also there was a woman who was infested with maggots.

I personally saw when I was there, roaches in the intensive care unit; I saw nurses that couldn't draw blood in the intensive care unit and were asking the lab technician if she was doing it right. She was a Philippine nurse. The woman was on a respirator, she didn't even know what was going on. I said is this really a hospital?

The CHAIRMAN. I would have to intervene and say that I regret you mentioned Philippine nurses because if we didn't have Philippine nurses in this country, we'd be in deep sushi. We have an enormous shortage of nurses around the country and thousands of Philippine nurses are rendering services.

You had a series of tragic occurrences happen to you. There's no question about it, but I want the record to be clear that we owe a great deal to the fact that tens of thousands of Philippine nurses are in this country who are rendering competent and highly professional services.

Ms. LIVEO. I'm not singling out anybody. I just saw a lot of foreign staff within the hospital. The article that I read said that numerous doctors with phony licenses were foreign doctors.

Dr. Axelrod himself ordered a thorough investigation into the care that my mother-in-law received from the doctors. They concluded that there was insufficient evidence of gross incompetence on the doctors' part.

I met with these people, the investigator. I wanted her to define for me exactly what gross incompetence was. How gross can it get when a woman walks in a hospital totally healthy to have a bunion removed and comes out brain dead and nobody punished for it? Nobody's disciplined. They're not teaching them to respect human life. They're telling them that you can take someone's life away and nothing will be done about it.

I believe this to be wrong and this is what's driving me, left frustrated, to improve the quality of care.

Let me tell you also-by being educated and getting involved, me and my sister personally saved my father's life. My father was brought into Coney Island Hospital and he was suffering with severe headaches. He was away a week with my mom. I didn't know nothing about it, that he went to see the doctor prior to the week he left.

The doctor gave him muscle relaxer for the headaches. My mom was away a week with my father. The headaches got so bad, to the