Login | October 22, 2014

Plan would require hospitals to inform cancer patients about breast reconstruction

TIFFANY L. PARKS
Special to the Legal News

Published: October 3, 2013

Sen. Charleta Tavares has reintroduced a bill into the Ohio General Assembly she once described as “critical to address the emotional and medical needs” of women facing a mastectomy, lymph node dissection or lumpectomy.

The proposed legislation, Senate Bill 156, would require hospitals to provide such women with information on breast reconstruction.

In the last legislature, Tavares, D-Bexley, introduced the bill as Senate Bill 182.

That measure stalled after two committee hearings.

SB 156 was referred to the Senate Medicaid, Health and Human Services committee last week.

Although federal law mandates insurance coverage for reconstructive surgery, Tavares said there is no requirement to information patients about reconstructive surgery options and their right to access such procedures.

“Without this knowledge, patients can potentially undergo one of the procedures covered in the bill and not have reconstructive surgery because they do not know it is covered by their insurance,” she said.

SB 156 states that before obtaining a patient’s consent to a mastectomy, lymph node dissection or lumpectomy, a hospital must provide specific information to the patient in writing including descriptions of the various breast reconstruction options and the advantages and disadvantages of each option.

Hospitals also would have to outline information on how to obtain breast reconstructive surgery, including information about getting the procedure done at the same hospital (if provided) and at another facility.

The proposal also charges medical facilities with relaying information on the timing of reconstructive surgery, including the option of waiting until any chemotherapy or radiation treatments have been completed.

Hospitals also would have to provide patients with an explanation of the availability of health insurance coverage for breast reconstruction and related services.

The federal “Women’s Health and Cancer Rights Act of 1998” requires that, if a group health plan or health insurance issuer offering group or individual health insurance policies provides coverage for mastectomies, then coverage for breast reconstruction and related services must also be provided.

Under the federal measure, such coverage includes all stages of reconstruction of the breast on which the mastectomy has been performed, as well as reconstruction of the other breast to produce a symmetrical appearance.

If enacted, SB 156 would authorize the director of the Ohio Department of Health to require that hospitals pass along any other breast reconstruction information to patients that has been deemed appropriate.

In campaigning for the bill, Tavares cited a study that found that 60 to 70 percent of women are not offered reconstructive surgery options.

“This bill does not mandate that patients undergo breast cancer surgery,” she said. “It simply educates them about their options.”

Dr. K. Roxanne Grawe, a plastic and reconstructive surgeon, offered proponent testimony for SB 182 and, like Tavares, noted that in 2007, only 29 percent of breast cancer patients were offered reconstruction.

Grawe said such procedures are vital for a woman’s “self confidence, sense of well-being and hopefulness which, in turn, affects healing.”

SB 156 is similar to a proposal being championed by Reps. Bill Patmon, D-Cleveland, and Lynn Wachtmann, R-Napoleon.

House Bill 147, also known as the Lizzie B. Byrd Act after Patmon’s mother, would require a surgeon performing a mastectomy in a hospital to guide the patient and provide referrals in a manner consistent with standards of the National Accreditation Program for Breast Centers.

“If a surgeon who is to perform a mastectomy considers breast reconstruction appropriate for the patient, the surgeon or designated person shall offer the patient a preoperative referral to a reconstructive or plastic surgeon in accordance with NAPBC standards,” HB 147 states.

The House measure unanimously passed the House in June and had its first Senate committee hearing Wednesday.

Wachtmann has said HB 147 doesn’t “leap too far” in regulating how surgeons carry out their duties but “ensures a woman has the information she needs to make a good, informed choice.”

SB 156 has yet to be scheduled for a committee hearing.

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