A bill to authorize additional appropriations for the Reclamation Safety of Dams Act of 1978.

Mr. President, I rise today to join my colleague, Senator Bob Graham of Florida, in reintroducing the Medication Errors Reduction Act, which will serve to improve the quality of health care delivered in hospitals and skilled nursing facilities by reducing medical errors. The lack of quality assurances in America's health care system has been documented many times. We believe this bill is the first step in the process to correct this troubling circumstance and to ensure that the American health system is the world's safest.

We first began development of this legislation in 2001, following the release of the Institute of Medicine's (IOM) report ``To Err Is Human: Building a Safer Health System.'' We were prompted by the startling revelations contained in the report that showed up

to 98,000 people per year lose their lives because of a medical error and the annual financial impact that results from these mistakes is believed to be as high as $29 billion.

As you might imagine, a medical error can be many things, but the Institute defines it as ``the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.'' The Institute sites among the problems that commonly occur during the course of providing health care--adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers and mistaken patient identities. All of these can have tragic endings, but all are preventable.

In developing the solution, we looked to incentives that would prompt hospitals and skilled nursing facilities to utilize technology to identify inaccuracies and prevent medical errors before they happen. Senator Graham and I developed a proposal that provides Federal matching funds to hospitals and skilled nursing facilities that integrate into their medical systems technology that can prevent medical errors. Technology exists, as never before, that can help identify errors before they happen, and save lives. But this technology is rendered useless if it is not being utilized. That is why the Federal Government must step forward and provide the necessary incentives to prompt innovation.

In taking this step, we believe it is imperative that the Federal Government invest time and funding in not just identifying the solution, but to provide the means to implement the solution. It is the role of the Federal Government to lead, and I believe that providing grant funding to hospitals and skilled nursing facilities to integrate technology into their health care delivery systems will in fact provide the necessary leadership to see this idea become a reality.

More specifically, the grants provided by this legislation can be used to purchase or improve computer software and hardware, and provide education and training to staff on computer patient safety programs. They also may be used to improve patient safety at every stage of the medication delivery process through: electronic prescribing systems that can intercept errors at the time medications are ordered; electronic medical records to alert doctors to possible drug interactions and complications related to the patient's medical history; automated pharmacy dispensing to make sure the nurse receives the correct medication in the correct dosage for the correct patient; and bedside verification--using bar codes on patient wristbands and the medications to ensure that the right medication is administered to the right patient at the right time.

Further, we direct the funding to hospitals that serve predominately patients who receive insurance coverage through Medicare, Medicaid and S-CHIP. And to ensure that all hospitals, especially those in rural communities that have smaller operating margins, can afford to utilize this innovative new program, we set aside 20 percent of the funding for rural hospitals. I believe this is an important and necessary step to protect our rural communities and provide families with the highest quality care.

I hope my colleagues will join us in support of this legislation so we soon will be able to reduce the number of Americans who are harmed by medical errors.

Mr. President, I rise today to reintroduce the Women's Health and Cancer Rights Act. I am pleased to be joined by my friends, Senator Murray of Washington and Senator Biden of Delaware, and Senator Feinstein of California, as original cosponsors of this bill.

This bill has a two-fold purpose. First, it will ensure that appropriate medical care determines how long a woman stays in the hospital after undergoing a mastectomy--not a predetermined amount of time legislated by Congress. This provision says that inpatient coverage with respect to the treatment of mastectomy, lumpectomy, or lymph node dissection--regardless of whether the patient's plan is regulated by ERISA or State regulations--will be provided for a period of time as is determined by the attending physician, in consultation with the patient, to be medically necessary and appropriate. Second, this bill allows any person facing a cancer diagnosis of any type to get a second opinion on their course of treatment.

A diagnosis of breast cancer is something that every woman dreads. But for an estimated 192,020 American women, this is the year their worst fears will be realized. One thousand new cases of breast cancer will be diagnosed among the women in Maine, and 200 women in my home State will die from this tragic disease. The fact is, one in nine women will develop breast cancer during their lifetime, and for women between the ages of 35 and 54, there is no other disease which will claim more lives.

It's not hard to understand why the words ``you have breast cancer'' are some of the most frightening words in the English language. For the woman who hears them, everything changes from that moment forward. No wonder, then, that it is a diagnosis not only accompanied by fear, but also by uncertainty. What will become of me? What will they have to do to me? What will I have to endure? What's the next step?

For many women, the answer to that last question is a mastectomy or lumpectomy. Despite the medical and scientific advances that have been made, despite the advances in early detection technology that more and more often negate the need for radical surgery, it still remains a fact of life at the beginning of the 21st century these procedures can be the most prudent option in attacking and eradicating cancer found in a woman's breast.

These are the kind of decisions that come with a breast cancer diagnosis. These are the kind of questions women must answer, and they must do so under some of the most stressful and frightening circumstances imaginable. The last question a woman should have to worry about at a time like this is whether or not their health insurance plan will pay for appropriate care after a mastectomy or lumpectomy, or that she won't be able to remain in a doctor's immediate care for as long as she needs to be. A woman diagnosed with breast cancer in many ways already feels as though she has lost control of her life. She should not feel as though she has also lost control of her course of treatment.

The evidence for the need for this bill--especially when it comes to so-called ``drive through mastectomies'', is more than just allegorical. Indeed, the facts speak for themselves--between 1986 and 1995, the average length of stay for a mastectomy dropped from about six days to about two to three days. Thousands of women across the country are undergoing radical mastectomies on an outpatient basis and are being forced out of the hospital before either they or their doctor think it's reasonable or prudent.

This decision must be returned to physicians and their patients, and all Americans who face the possibility of a cancer diagnosis must be able to make informed decisions about appropriate and necessary medical care.

I urge my colleagues to join me in supporting this bill and work towards passing it this year.

Mr. President, I ask unanimous consent that the Committee on Agriculture, Nutrition, and Forestry be authorized to meet during the session of the Senate on Wednesday, May 19, 2004. The purpose of this meeting will be to mark up legislation to reauthorize child nutrition programs.

Mr. President, I ask unanimous consent that the Committee on Armed Services be authorized to meet during the session of the Senate on May 19, 2004, at 8:30 a.m., in open session, to continue to receive testimony on allegations of mistreatment of Iraqi prisoners.

Mr. President, I ask unanimous consent that the Committee on Banking, Housing, and Urban Affairs be authorized to meet during the session of the Senate on Wednesday, May 19, 2004, at 10:00 a.m. to conduct a hearing on ``Congressional Oversight of the IMF and World Bank.''

Mr. President, I ask unanimous consent that the Committee on Commerce, Science, and Transportation be authorized to meet on Wednesday, May 19, 2004, at 9:30 a.m. on from public service to private sector: Spinning the Revolving Door for Personal Gain.

Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate on Wednesday, May 19 at 11:30 a.m., to consider pending calendar business.

Agenda

Agenda Item 1: S. 155--A bill to convey to the town of Frannie, WY, certain land withdrawn by the Commissioner of Reclamation.

Agenda Item 2: S. 180--A bill to establish the National Aviation Heritage Area, and for other purposes.

Agenda Item 3: S. 203--A bill to open certain withdrawn land in Big Horn County, WY, to locatable mineral development and bentonite mining.

Agenda Item 4: S. 211--A bill to establish the Northern Rio Grande National Heritage Area in the State of New Mexico, and for other purposes.

Agenda Item 5: S. 323--A bill to establish the Atchafalaya National Heritage Area, LA.

Agenda Item 9: S. 1241--A bill to establish the Kate Mullany National Historic Site in the State of New York, and for other purposes.

Agenda Item 13: S. 1467--A bill to establish the Rio Grande Outstanding Natural Area in the State of Colorado, and for other purposes.

Agenda Item 14: S. 1521--A bill to direct the Secretary of the Interior to convey certain land to the Edward H. McDaniel American Legion Post 22 in Phrump, NV, for the construction of a post building and memorial park for use by the American Legion, other veterans' groups, and the local community.

Agenda Item 16: S. 1727--A bill to authorize additional appropriations for the Reclamation Safety of Dams Act of 1978.

Agenda Item 17: S. 2046--A bill to authorize the exchange of certain land in Everglades National Park.

Agenda Item 18: S. 2052--A bill to amend the National Trails System Act to designate El Camino Real de los Tejas as a National Historic Trail.

Agenda Item 20: S. 2180--A bill to direct the Secretary of Agriculture to exchange certain lands in the Arapaho and Roosevelt National Forests in the State of Colorado.

Agenda Item 21: S. 2319--A bill to authorize and facilitate hydroelectric power licensing of the Tapoco Project.

Agenda Item 23: H.R. 961--To promote Department of the Interior efforts to provide a scientific basis for the management of sediment and nutrient loss in the Upper Mississippi River Basin, and for other purposes.

Agenda Item 25: H.R. 1446--To support the efforts of the California Missions Foundation to restore and repair the Spanish colonial and mission-era missions in the State of California and to preserve the artworks and artifacts of these missions, and for other purposes.

Agenda Item 26: H.R. 1658--To amend the Railroad Right-of-Way Conveyance Validation Act to validate additional conveyances of certain lands in the State of California that form part of the right-of-way granted by the United States to facilitate the construction of the transcontinental railway, and for other purposes.

In addition, the committee may turn to any other measures that are ready for consideration.

Mr. President, I ask unanimous consent that the Committee on Finance be authorized to meet during the session on Wednesday, May 19, 2004, at 10 a.m., in 215 Dirksen Senate Office Building, to hear testimony on Oversight and Nomination Hearing: The Treasury Department and Terrorism Financing; and, to consider the nominations of John O. Colvin, to be Judge of the U.S. Tax Court; Juan C. Zarate, to be Assistant Secretary for Terrorism Finance, U.S. Department of the Treasury; and, Stuart Levey to the Under Secretary for Enforcement, U.S. Department of the Treasury.

Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Wednesday, May 19, 2004 at 9:30 a.m. to hold a hearing on Iraq's Transition--The Way Ahead (Part II).

Mr. President, I ask unanimous consent that the Committee on Indian Affairs be authorized to meet on Wednesday, May 19, 2004, at 10 a.m. in Room 485 of the Russell Senate Office Building to conduct a business meeting on S.J. Res. 37, resolution to acknowledge a long history of official depredations and ill-conceived polices by the United States Government regarding Indian Tribes and offer an apology to all Native peoples on behalf of the United States, and S. 2277, a bill to amend the Act of November 2, 1966 (80 Stat. 1112) to allow binding arbitration clauses to be included in all contracts affecting the land within the Salt River Pima-Maricopa Indian Reservation; to be followed immediately by a hearing on S. 1696, a bill to amend the Indian Self-Determination and Education Assistance Act to provide further self government by Indian tribes.

Mr. President, I ask unanimous consent that the Special

Committee on Aging be authorized to meet Wednesday, May 19, 2004 from 2:30 p.m.-5 p.m. in Dirksen 628 for the purpose of conducting a hearing.

Mr. President, I ask unanimous consent that the subcommittee on Water and Power of the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate on Wednesday, May 19th, at 2:30 p.m.

The purpose of the hearing is to receive testimony on S. 900, a bill to convey the Lower Yellowstone Irrigation Project, the savage unit of the Pick-Sloan Missouri Basin Program, and the Intake Irrigation Project to the pertinent irrigation districts; S. 1876, a bill to authorize the Secretary of the Interior to convey certain lands and facilities of the Provo River Project; S. 1957, a bill to authorize the Secretary of the Interior to cooperate with the States on the border with Mexico and other appropriate entities in conducting a hydrogeologic characterization, mapping, and modeling program for priority transboundary aquifers, and for other purposes; S. 2304 and H.R. 3209, bills to amend the Reclamation Project Authorization Act of 1972 to clarify the acreage for which the North Loup division is authorized to provide irrigation water under the Missouri River Basin Project; S. 2243, a bill to extend the deadline for commencement of construction of a hydroelectric project in the State of Alaska; H.R. 1648, a bill to authorize the Secretary of the Interior to convey certain water distribution systems of the Cachuma Project, California, to the Carpinteria Valley water district and the Montecito water district; and H.R. 1732, a bill to amend the Reclamation Wastewater and Groundwater Study and Facilities Act to authorize the Secretary of the Interior to participate in the Williamson County, TX, Water Recycling and Reuse Project, and for other purposes.

Mr. President, I ask unanimous consent that the Committee on Commerce, Science, and Transportation be authorized to meet on June 16, 2004, at 9:30 a.m. on The VOIP Regulatory Freedom Act.

Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate, on Wednesday, June 16 at 11:30 a.m. to consider pending calendar business.

Agenda

Agenda Item 1: Nomination of Suedeen G. Kelly to be a Member of the Federal Energy Regulatory Commission.

Agenda Item 2: S. 155--A bill to convey to the town of Frannie, Wyoming, certain land withdrawn by the Commissioner of Reclamation.

Agenda Item 3: S. 180--A bill to establish the National Aviation Heritage Area, and for other purposes.

Agenda Item 5: S. 211--A bill to establish the Northern Rio Grande National Heritage Area in the State of New Mexico, and for other purposes.

Agenda Item 6: S. 323--A bill to establish the Atchafalaya National Heritage Area, Louisiana.

Agenda Item 10: S. 1241--A bill to establish the Kate Mullany National Historic Site in the State of New York, and for other purposes.

Agenda Item 14: S. 1467--A bill to establish the Rio Grande Outstanding Natural Area in the State of Colorado, and for other purposes.

Agenda Item 15: S. 1521--A bill to direct the Secretary of the Interior to convey certain land to the Edward H. McDaniel American Legion Post No. 22 in Pahrump, Nevada, for the construction of a post building and memorial park for use by the American Legion, other veterans' groups, and the local community.

Agenda Item 17: S. 1727--A bill to authorize additional appropriations for the Reclamation Safety of Dams Act of 1978.

Agenda Item 18: S. 1957--A bill to authorize the Secretary of the Interior to cooperate with the States on the border with Mexico and other appropriate entities in conducting a hydrogeologic characterization, mapping, and modeling program for priority transboundary aquifers, and for other purposes.

Agenda Item 19: S. 2046--A bill to authorize the exchange of certain land in Everglades National Park.

Agenda Item 22: S. 2180--A bill to direct the Secretary of Agriculture to exchange certain lands in the Arapaho and Roosevelt National Forests in the State of Colorado.

Agenda Item 23: S. 2243--A bill to extend the deadline for commencement of construction of a hydroelectric project in the State of Alaska.

Agenda Item 24: S. 2319--A bill to authorize and facilitate hydroelectric power licensing of the Tapoco Project.

Agenda Item 29: H.R. 1648--To authorize the Secretary of the Interior to convey certain water distribution systems of the Cachuma Project, California, to the Carpinteria Valley Water District and the Montecito Water District.

Agenda Item 30: H.R. 1658--To amend the Railroad Right-of-Way Conveyance Validation Act to validate additional conveyances of certain lands in the State of California that form part of the right-of-way granted by the United States to facilitate the construction of the transcontinental railway, and for other purposes.

Agenda Item 31: H.R. 1732--To amend the Reclamation Wastewater and Groundwater Study and Facilities Act to authorize the Secretary of the Interior to participate in the Williamson County, Texas, Water Recycling and Reuse Project, and for other purposes.

Agenda Item 32: H.R. 3209--To amend the Reclamation Project Authorization Act of 1972 to clarify the acreage for which the North Loup division is authorized to provide irrigation water under the Missouri River Basin project.

In addition, the Committee may turn to any other measures that are ready for consideration.

Mr. President, I ask unanimous consent that the Committee on Finance be authorized to meet during the session on Wednesday, June 16, 2004, at 11 a.m., to hear testimony on Strengthening Regulations and Oversight to Better Ensure Agriculture Financing Integrity.

Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Wednesday, June 16, 2004 at 2 p.m. to hold a Nominations Hearing.

Mr. President, I ask unanimous consent that the Committee on Indian Affairs be authorized to meet on Wednesday, June 16, 2004, at 10 a.m. in Room 485 of the Russell Senate Office Building to conduct a Business Meeting on pending committee matters, to be followed immediately by an oversight hearing on the implementation in Native American communities of the ``No Child Left Behind Act.''

Mr. President, I ask unanimous consent that the Committee on Indian Affairs also be authorized to meet again on Wednesday, June 16, 2004, at 2 p.m. in Room 485 of the Russell Senate Office Building to conduct a hearing on S. 1996, the Oglala Sioux Tribe Angostura Irrigation Project Rehabilitation and Development Act.

Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet to conduct a hearing on Wednesday, June 16, 2004 at 10 a.m., on ``Judicial Nominations'' in the Dirksen Office Building, Room 226.

Witness List:

Panel I: Senators.

Panel II: Richard A. Griffin, to be United States Circuit Judge for the Sixth Circuit; and David W. McKeague, to be United States Circuit Judge for the Sixth Circuit.

Panel III: Virginia Maria Hernandez Covington, to be United States District Judge for the Middle District of Florida.

Mr. President, I am very pleased to introduce the Medication Errors Reduction Act of 2003 with my friend and colleague Senator Olympia Snowe.

In recent years we've heard much about the consequences of medication errors. What we haven't heard as much about are the root causes for the medication errors, or the solutions that are available to us to reduce errors, save lives, prevent injuries, and reduce costs. Simply put, our legislation is necessary because as a nation we face a serious patient- safety problem. The good news is that we have a solution to the problem: we have the technological ability to dramatically reduce medication errors and thus save lives.

The bad news is that the start-up costs and a lack of awareness have to this point been preventing us from reaping the benefits of the new technologies. The solution is right in front of us, but has been just out of reach.

The legislation we are introducing today would bring the solution within our reach. It would address the causes of medication errors-- which are systems breakdowns--and the solutions--use of clinical computerized information systems that can save lives.

We are here today to lend a helping hand, not to point a finger. We all share the goal of improving patient safety, and our bill will do that in a very simple, straightforward manner. The legislation establishes a voluntary grant program to encourage hospitals and skilled nursing facilities to become the pioneers of new, life-saving technologies. It does that by assisting with the often prohibitive start-up costs associated with purchasing and implementing information systems--systems that are designed to reduce medication errors and improve patient safety.

I want to stress the goal of this legislation: to help build a safer medication-delivery system. The great successes of our health care system are largely due to our highly committed and talented doctors, nurses, pharmacists, hospitals, nursing homes and other health care providers. The problem we are addressing today is not theirs, but is a problem with the system they rely on to provide inpatient care.

The Institute of Medicine report that kicked off much of this discussion 4 years ago tells us that we must address the ``systems problems'' and design systems that will prevent errors--just as cars are designed so that drivers cannot start them while in reverse helps prevent automobile accidents.

The systems we want to fund would improve the medication-delivery system at many stages.

We leave it up to the hospitals and nursing homes to determine exactly what types of technology would best fit their institutions and their needs. The grants could be used to purchase or improve computer software and hardware, purchase or lease communications capabilities, or provide education and training staff on computer patient safety programs.

The grants could be used to improve patient safety at every stage of the medication delivery process. For example, a hospital or nursing home could use the funds to implement 1. electronic prescribing systems that can intercept errors at the time medications are ordered, 2. electronic medical records to alert doctors to possible drug interactions and complications related to the patient's medical history, 3. automated pharmacy dispensing to make sure the nurse receives the correct medication in the correct dosage for the correct patient, and 4. bedside verification--using bar codes on patient wristbands and the medications to ensure that the right medication is administered to the right patient at the right time.

We could only have dreamed about clinical computerized information systems when the Medicare program was implemented. Today, we have them at our disposal. The sooner we get them into our hospitals and nursing homes, the sooner we start saving lives.

The Medication Errors Reduction Act is supported by the Florida Hospital Association, National Rural Health Association, National Association of Children's Hospitals, Healthcare Leadership Council, AFSCME, Federation of American Hospitals, Catholic Health Association of the United States, Association of American Medical Colleges, Premier, Inc., the American Society of Heath-System Pharmacists, McKesson Corporation, IBM, VHA, Inc., Vanderbilt University Medical Center, New York Presbyterian Hospital, Aetna, Siemens, AmerisourceBergen Corporation, American Health Packaging, AutoMed, Choice Systems, Inc., Pharmacy Healthcare Solutions, Telepharmacy Solutions, Verizon, Becton Dickinson, American Health Care Association, AFL-CIO, Cardinal Health, and the eHealth Initiative.

I ask their letters of support to be included for the Record. With their help, this bill will become law and we will be well on our way to improving patient safety.

Mr. President, I ask unanimous consent that the Committee on Armed Services be authorized to meet during the session of the Senate on March 25, 2004, at 9:30 a.m., in open and closed session to receive testimony on the role of U.S. Northern Command and U.S. Special Operations Command in defending the homeland and in the global war on terrorism, in review of the defense authorization request for fiscal year 2005.

Mr. President, I ask unanimous consent that the Committee on Banking, Housing, and

Urban Affairs be authorized to meet during the session of the Senate on March 25, 2004, at 2 p.m., to conduct a hearing on ``The Administration's Proposed Fiscal Year 2005 Budget for the Federal Transit Administration.''

Mr. President, I ask unanimous consent that the Committee on Commerce, Science, and Transportation be authorized to meet on Thursday, March 25, 2004, at 9:30 a.m., on Cable Rates.

Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions, Subcommittee on Employment, Safety, and Training be authorized to meet for a hearing on Hazard Communication in the Workplace during the session of the Senate on Thursday, March 25, 2004 at 10 a.m. in SD-430.

Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Thursday, March 25, 2003 at 9:30 a.m. to hold a hearing on AGOA III: the United States Africa Partnership Act of 2003.

Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Thursday, March 25, 2004 at 2:30 p.m. to hold a hearing on Nominations.

Mr. President, I ask unanimous consent that the Committee on Veterans' Affairs be authorized to meet during the session of the Senate on Thursday, March 25, 2004, for a joint hearing with the House of Representatives' Committee on Veterans' Affairs, to hear the legislative presentations of the National Association of State Directors of Veterans Affairs, AMVETS, American Ex-Prisoners of War, the Vietnam Veterans of America, and the Military Officers Association of America.

The hearing will take place in room 345 of the Cannon House Office Building at 10 a.m.

Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session of the Senate on March 25, 2004 at 2:30 p.m. to hold a closed hearing on intelligence matters.

Mr. President, I ask unanimous consent that the Subcommittee on Economic Policy of the Committee on Banking, Housing, and Urban Affairs be authorized to meet during the session of the Senate on Thursday, March 25, 2004, at 10 a.m. to conduct a hearing on ``National Flood Insurance Repetitive Losses.''

Mr. President, I ask unanimous consent that the Subcommittee on Strategic Forces of the Committee on Armed Services be authorized to meet during the session of the Senate on March 25, 2004, at 2:30 p.m., in open session to receive testimony on National security space programs, and management, in review of the defense authorization request for fiscal year 2005.

Mr. President, I ask unanimous consent that the Subcommittee on Water and Power of the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate on Thursday, March 25 at 2:30 p.m. to receive testimony regarding the following bills: S. 1085, a bill to provide for a bureau of reclamation program to assist states and local communities in evaluating and developing rural and small community water supply systems, and for other purposes; S. 1732, a bill to direct the Secretary of the Interior to establish a rural water supply program in the reclamation states to provide a clean, safe, affordable, and reliable water supply to rural residents: S. 2218, a bill to direct the Secretary of the Interior to establish a rural water supply program in the reclamation states to provide a clean, safe, affordable, and reliable water supply to rural residents and establish guidelines for projects and for other purposes; S. 1727, a bill to authorize additional appropriations for the Reclamation Safety of Dams Act of 1978; and S. 1791, a bill to amend the Lease Lot Conveyance Act of 2002 to provide that the amounts received by the United States under that act shall be deposited in the reclamation fund, and for other purposes.