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MINUTES OF THE MEETING PUBLIC HEALTH, WELFARE & SAFTETY
MONTANA STATE SENATE
January 14, 1981
The meeting of the Public Health, Welfare & Safety Committee was called to order by Chairman Tom Hager on Wednesday, January 14, 1981 at 2:00 p.m. in Room 410 of the State Capitol Building.
ROLL CALL: All members were present. Kathleen Harrington, staff researcher, was also present.
Many visitors were in attendance. (See attachment.)
CONSIDERATION OF SENATE BILL 37: Senator Matt Himsl of Senate District 9, sponsor of Senate Bill 37, gave a brief resume of the bill. This bill is an act to establish a Montana Tumor Registry and to require reporting by hospitals of information on patients with tumors. Senator Himsl stated that in the last session of the Legislature $60,000 was appropriated for a Tumor Registry in Montana, but that there was no statutory provisions for its operation. This act would require all hospitals to report and make available to the state all discovered cancer patients and their treatment for recording in the state registry which in turn would file data with the Rocky Mountain Cancer Data Systems of Salt Lake City. Information from the regional systems and followup data would be available to physicians and hospitals for improved patient care and treatment. Confidentiality would be protected and indentifiable reports made available only with the patients permission. The cost of the system would be borne by the state. The amended executive budget carries a $100,000 appropriation in the Department request for a registry and poison control.
Patricia Elliot of the Department of Health and program manager of the Montana Central Tumor Registry, stated the department's support of the bill. Mrs. Elliot gave a brief history of the registry and its workings. She stated that given the opportunity to collect future data for another two years would allow the M.C.T.R. to have at least four years of detailed cancer data and accomplish the goals and objectives of the program. She handed out several informational papers. (see attachment.)
PUBLIC HEALTH, WELFARE & SAFETY PAGE TWO
JANUARY 14, 1981
Ralph Gilroy of the Montana Health Systems Agency stated his support of the bill. Mr. Gilroy stated that there is a great need for an ongoing Tumor Registry. The Montana Health Systems Agency prepares and approves the Health Systems plan for Montana. In the Hospice care program components of that plan, they emphasize factors affecting the potential demand for Hospice- services and the ability of the Hospice Program to deliver care. One of the factors is the presence of occupational groups exposed to unusually high risk of cancer or other terminal diseases. The Preventive Health Services Bureau of the State Department of Health and Environmental Sciences has initiated a Tumor Registry with 46 hospitals in Montana participating. Data on cancer patients will be collected for a two year period and an analysis of cancer incidence patterns will be conducted.
Mary Kerins, the Tumor Registrar, stated that the tumor registry keeps track of all the patients who enter the hospital with the diagnosis of cancer.- A record of the type of cancer, location, operations performed, if any, and the treatment given are recorded and sent to a central collection agency. Here the information is computerized and broken down into geographical area, showing what cancers are prevalent in what areas, operations and treatment and that are effective on certain types of cancer. The patients are checked on periodically, to see what their status is and if more treatment is needed. This is a tremendous tool in research, to the hospital and to the patient. The tumor registry can do much in helping to conquer cancer.
Jerome Loendorf of the Montana Medical Association stated that at the present time physicians are able to treat many patients with medications for advancing cancer with success that was absolutely unheard of even four to five years ago. Mr. Loendorf stated that SB 37 is in the best interest of the patients of this state, and encouraged everyone to vote in favor of it.
Judy Olson of the Montana Nurses Association stated her groups supports of the bill and felt the information would be very valuable.
David Lackman of the Montana Public Health Association stated that for many years his group has worked trying to relate genetic defects in the immune system to cancer. Lack of data on occurance of tumors has been a road block in these investigations. The original registry was established in Missoula. It is important to continue the registry in
PUBLIC HEALTH, WELFARE & SAFETY PAGE THREE
JANUARY 14, 1981
Montana, especially because environmental factors have entered the picture.
William Leary of the Montana Hospital Association stated his support of SB 37, however, he did offer some amendments pee attachment)
Dr. John Anderson of the Department of Health Administrator stated his support of the bill. He does not fee~ however, that the hospitals need to be reimbursed for handing the reports.
Chad Smith of the Montana Hospital Association stated his support of the bill with the offered amendments of his group.
There were no opponents to the bill.
Senator Himsl closed by saying that the requirements and the cost of this program is a small price to pay in the desperate battle against cancer. Senator Himsl urged favorable consideration of the bill from the committee.
The meeting was opened to a question and answer period from the committee. Discussion was held. Tumor will mean malignant. The cost of computer processing will be ~.30 per report and be going up to $2.55 per report as of the first of July of 1981.
CONSIDERATION OF SENATE BILL 73: Senator George McCallum of Senate District l~, sponsor of the bill, gave a brief resume. This bill is an act to automatically assign support rights of persons applying for public assistance to the Department of Social and Rehabiliation Services, and providing an effective· date.
Judy Carlson from the S.R.S. stated her support of the bill and stated that this bill would assign rights when application is made for Medicaid, and also child support. It would further emphasize the right of the state to collect payments due from parents or from insurance companies for medical bills paid by Medicaid. This bill would allow the SRS to reduce their error rate, decrease their paperwork and also decrease the possibility of fiscal penalties This bill meets the federal requirements for the assignment of support rights. It meets the goals for more efficient and effective operations. It meets the goals for providing care for the needy by collecting from those who have the resources to pay. It further cements the duty of parents to support their children. Mrs. Carlson asked for favorable consideration of the bill.
PUBLIC HEALTH, WELFARE & SAFETY PAGE FOUR
There were no opponents to the bill.
JANUARY 14, 1981
In closing Senator McCallum offered some amendments from the S.R.S. to help the bill be more efficient.
The amendments would be as such: (1) Title, line 8; Following: "THE"; Insert: "STATE, THE" (2) Title, line 8; Following: "SERVICES" Insert: "AND THE COUNTY WELFARE DEPARTMENT" (3) Page 1, line 20 Following: "2" Strike: "Effective at the time of application, a" Insert: "A" (4) Page 1, line 21 Following: "the" Insert: "state, the" (5) Page 1, line 22 Following: "department" Insert: "," (6) Page 2 line 7 Following: "support" Insert: "and medical".
DISPOSITION OF SENTATE BILL 73: A motion was made by Senator Norman that the above proposed amendments be accepted. Seconded by Senator Johnson. Motion carried. (See attachment.)
A motion was made by Senator Norman that Senate Bill 73 be given a "DO PASS,AS AMENDED" recommendation from the Committee. Motion carried Unanimously. (see attachment)
ADJOURN: With no further business at this time the meeting was adjourned with the next meeting to be held on Monday, January 19, 1981 at 1:00 p.m. in Room 410.
eg
ROLL CALL
PUBLIC HEALTH, WELFARE & SAFETY COMMITTEE
47th LEGISLATIVE SESSION - - 1981 Da te JANUARY 14
NAME PRESENT ABSENT EXCUSED
Tom Hager 'Ii
Matt Himsl , '.
S. A. Olson \ ,
Jan Johnson ,
Dr. Bill Norman
Harry K. Berg \
Michael Halligan , '.
Each day "attach to minutes.
DATE - CO~ITTEE ON~~~~~~~~~~~=========S=·~~~i-L~NO~.~3==7====
--'. .... VISITOR'S REGISTER Check One
- NAME REPRESENTING Support Oppose
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--- (Please leave prepared statement with Secretary)
S. B. 17 ESTABLISHING A STATE-TvIDE TUMO~ REGISTRY
In the last session of the Leqislature, ~60,OOO was approp
riated for a Tumor Registry in Montana but there was no stat
utory provision for its operation.
Since then 46 Montana hospitals have been participatinq
in the Montana Central Tumor Reaistry on a voluntary basis.
These hospitals providinq cancer data represent about two thirds
of all cancer patients in Montana.
This act would require all hospitals to report and make
available to the state all discovered cancer patients and their
treatment .f::or recording in the state registry ,.,hich in turn
would file data with the Rocky Mountain Cancer Data System of
Salt Lake City. Information from the reqional system and follow
up data would be available to physicians and hospitals for
improved patient care and treatment. Confidentiality would be
protected and indentifiable reports made available only with
the patients permission.
The larger hospitals already have a registry and abstracted
data could be put into the svstem by reports. Smaller hospitals
without reaisteries would be visited by state registry personnel
and not have to hire abstractors.
The cost of the system would be borne by the state. The
amended executive budaet, I am told, carries a ~IOO,000 approp
riation in the Departments request for a registry and poison
control.
The benefits would be a collection or a library of statewide
cancer data, helo ohysicians deliver better medical care, allow
monitorinq of treatment results, may make discoveries on
occuDational anu en'll ronment::' carcino(l(c;,:c), anc SUPP1 -- Cel'='-
datil for more scientific study--all designed to eradicate an
affliction which noVl appears to strike at least one out of ever-
four people!
The requirements an~ the cost of this oroaram is indeed a
small price to pay in the oesoerate battle against cancer.
I urge your favorable consideration of this bill!
NAME tJ~ C/ /;()/f- BILL NO. _~~?.::.-71--· __ _
ADDRESS cSt? ~ !~ DATE I'lL/-II WHOM DO YOU REPRESENT~JJ¥fll~/JJ!r~4J4ff SUPPORT ~ OPPOSE AMEND ______ _
PLEASE LEAVE PREPARED STATEMENT WITH SECRETARY.
Comments:
"l
1
DEPARTMENT OF HEALTH AND ENVIRONMENTAL SCIENCES PREVENTIVE HEALTH SERVICES BURE,r..U
MONTANA CENTRAL TUMOR REGISTRY
Patricia Elliott, Program Hanager Department of Health and Environmental Sciences
IN FAVOR OF THE SENATE BILL NO. 37
COGSWELL BU'LDING
HELENA. MONTANA 59620
In 1969, the first type of tumor registry was established by the Montana State Medical Association and existed for only 18 months. This activity was phased out after the federal government discontinued regional medical programs.
Five years later another attempt at a tumor registry by the Montana Foundation for Medical Care lasted for another 18 months. This attempt failed not by choice of the participating hospitals, but because federal funds were once again eliminated. At that time, when the registry folded, there were 33 hospitals participating 1n the program and the collection of cancer data was never utilized.
Nm" in 1979, the Montana Central Tumor Registry (MCTR) was approved for two years by the legislative session. Although the hospitals were very hesistant of funds collapsing again, we have won the confidence of a total of 46 hospitals who are very much in favor of contributing their cancer data in order to provide a uniform statewide cancer reporting, follow-up, end-result information data system for the use of everyone involved in cancer treatment and prevention--a goal that has never been achieved from the previous tumor registries.
Presently our 46 hospitals have either elected to be visited on a periodic basis from our contracted staff, The Montana Foundation for Medical Care, or have chosen to maintain their own tumor registry. We have already detailed cancer data on 1,482 cancer cases collected in the past six months on patients who were originally diagnosed with cancer in 1979 and the first half of 1980. After this data is submitted to the central office in Helena, it is quality controlled and is coded for computer entry.
The HeTR is a member of the Rocky }1ountain Cancer Data System (RMCDS) and is utilizing the central data processing capabilities of this system. We have begun distributing monthly reports to our hospitals reflecting their patients' cancer experience (for example, common forms of cancer, confirmation of diagnosis, stage of disease at diagnosis, cumulative treatment, etc.) and have begun to facilitate the systematic follow-up of cancer patients by the use of re-examination reminder letters in a manner that may save patients' lives by early detection and treatment of second primaries, local and regional recurrences, and distant metastases
AN fQUAL OPPCRTUN,T\' €A.lDlOtfR
,Patr~~ia Elliott, Program Manager In Favor of the Senate Bill No. 37 ~o;t:)
Many people question the value of a tumor registry. In agreement with the American College of Surgeons, one of the most important functions of a tumor registry is the reporting of registry data. Unfortunately this has not been done due to the collapse of funds in the past, which has led many to adopt the opinion that a tumor registry has little value.
However, on the contrary, with data that has been collected thus far from 1979 and 1980 cancer patients, and given the opportunity to collect future data, we cannot only provide meaningful feedback to the health professions regarding cancer, but on a statewide level we can provide statistical detailed studies which have the potential of pointing out a high incidence of cancer of a certain type in one geographic area or occupation group; of determining the relationship of treatment with long term survival; or identifying geographic areas where patients initially see their physicians too late for effective treatment.
In order to establish a population-based state registry and have completed information on all cancer patients in Montana, it is essential to have total representation from all institutions. Due to federal regulations and concern of patient confidentiality being broken, some hospitals are not participating. Therefore, having cancer made a reportable disease would assure complete documentation and the reporting of accurate data.
Given the opportunity to collect future data for another two years would allow the Montana Central Tumor Registry to have at least four years of detailed cancer data and accomplish the goals and objectives of the program -- something i~s never been able to acquire due to elimination of funds.
DEPART~""ENT OF HEALTH AND ENVIROl\JlvlENTAL SCIENCES PREVENTIVE HEALTH SEr~VICES BURE·\U
TED SCHWINDEN. GOVERNOR COGSWELL BUiLDING
- STATE OF MONTANA,------_. (406)449-2645 HELENA. MONTANA 59620
TOTAL HOSPITAL PARTICIPATION IN THE MONTANA CENTRAL TID{OR REGISTRY
The following hospitals bave elected to participate and are being visited periodically by our contracted staff, The Montana Foundation for Medical Care:
Holy Rosary Hospital-Miles City Mountainview Hemorial Hospital-White Sulphur Springs Phillips County Hospital, Ass'n-Malta Toole County Hospital-Shelby Boulder River School and Hospital-Boulder Garfield County Hospital-Jordan Poplar Community Hospital-Poplar Powell County Hemorial Hospital-Deer Lodge Galen State Hospital-Deer Lodge Teton Medical Center-Choteau Madison Valley Hospital-Ennis Stillwater Community Hospital-Columbus Big Sandy Medical Center-Big Sandy Frances Habon Deaconess Hospital-Glasgow Dahl Memorial Hospital-Ekalaka Fallon !-lemorial Hospital-Baker McCone County Hospital-Circle Rosebud Community Hospital-Forsyth Bozeman Deaconess Hospital-Bozeman Mineral County Hospital-Superior Community Memorial Hospital-Sidney Trinity Hospital-Wolf Point Livingston Memorial Hospital-Livingston Sheridan Nemorial Hospital-Plentywood Central Hontana Hospital-Lewistown Glendive Community Hospital-Glendive Liberty County Hospital-Chester Marcus Daly Hemorial Hospital-Hamilton Nissoula Community Hospital-Missoula Missoula General Hospital-Missoula St. Patrick Hospital-Missoula Roosevelt Hemorial Hospital-Culbertson Shodair Children's Hospital-Helena St. Peter's Hospital-Helena Chouteau County District Hospital-Fort Benton Granite County Memorial Hospital-Philipsburg St. Joseph Hospital-Polson
TOTAL HOSPITAL PARTICIPATION IN THE MONTANA CENTRAL Tm-IOR REGISTRY
(Cont. )
The following hospitals have elected to participate and are maintaining their own hospital-based tumor registry:
Barrett Hospital-Dillon Daniels Memorial Hospital-Scobey St. John's Lutheran Hospital-Libby Northern Rockies Cancer Treatment Center-Billings Billings Deaconess Hospital-Billings St. Vincent's Hospital-Billings Mary Swift Tumor Clinic (St. James Community Hospital and Silver Bow General)
-Butte Clark Fork Valley Hospital-Plains
Hospitals contemplating participation:
Broadwater Hospital-Townsend Big Horn County Hemorial Hospital-Hardin Northern Montana Hospital-Havre St. Luke Community Hospital-Ronan Roundup Memorial Hospital-Roundup Hission Valley Hospital-St. Ignatius Prairie Community Hospital-Terry North Valley Hospital-Whitefish Carbon County Memorial Hospital-Red Lodge
Hospitals ~efusing to participate:
Sweet Grass Community Hospital-Big Timber Wheatland Hemorial Hospital-Harlowton Ruby Valley Hospital-Sheridan Community Hospital of Anaconda-Anaconda Kalispell Regional Hospital-Kalispell Aemorial Hospital-Cut Bank Pondera Hedical Center-Conrad Columbus Hospital-Great Falls Montana Deaconess Medical Center-Great Falls Fort Harrison Veteran's Administration Hospital-Helena Miles City Veteran's Administration Hospital-Miles City
OBJECTIVES OF THE HO~'TANA CENTRAL
Tm10R REGISTRY:
1. To facilitate the systematic follow-up of cancer patients at regular intervals in order to help save lives by early detection and treatment of local recurrence, recurrence in regional lymPD nodes, solitary distant metastases, and additional primary lesions.
2. To provide meaningful feedback to the medical profession regarding cancer in their practice,.hospital, state, and if possible, region.
3. To define areas of further research and planning.
4. To determine statistical facts about early diagnosis, treatment and survival' in various malignant diseases in order to help evaluate and formulate educational efforts.
, I
DEPARTMENT OF HEALTH AND ENVIRONMENTAL SCIENCES PREVENTIVE HEALTH SERVICES BUREAU
COGSWELL BU!LDING
HELENA. MONTANA 59620
1-IONTANA CENTRAL TUHOR REGISTRY
There are 46 Hontana hospitals participating 1n the Montana Central Tumor Registry on a voluntary basis. These hospitals providing cancer data represent about two-thirds of all cancer patients in Montana. However, in order to establish a population-based state registry and have completed information on all cancer patients in Montana it is important to have total participation from all institutions.
Due to federal regulations which prohibit opening medical files unless it is mandatory, major institutions, for instance, veterans hospitals, are not participating. There are other hospitals not participating due to major concerns of breaking patient confidentiality laws. The results of these hospitals not participating may hinder complete documentation of cancer cata and allowing studies of the occurrence and distribution of cancer in Montana. A regular lifetime follow-up program for each individual patient with cancer is also an integral part of the Montana Central Tumor Registry. Not reporting patient cancer data from' these non-participating hospitals to the Hontana Central lUllior Registry may be a major disadvantage to the individual patient in detecting early metastatic disease, secondary new growths, and some diffuse recurrences.
In conclusion, having cancer made a reportable disease in Montana would allow total representation of aU cancer patients in this state to be entered into the Montana Central Tumor Registry to provide for:
1. A collection of statewide cancer data used to study the diagnosis and therapy of cancer patients.
2. Assistance to the physician in delivering the best possible medical care to the patient with cancer.
3. A regular lifetime follow-up program for each cancer patient which will not only permit the monitoring of the results of initial therapy in a~stematic and optimal way, but may also save patientJ lives by early detection of metastatic disease, secondary new growths, and some diffuse recurrences.
4. Documenting and allowing studies of the occurrence and distribution in Montana. Observe any unusual patterns of cancer cases in a community either in the incidence, a changing pattern, or the results of therapy over a period of time.
S. Nonitoring for possible occupational and environmental carcinogens. 6. Surrunarizing each hospital or institution's cancer experience from statis
tical reports on a monthly, semi-annual, and yearly basis which may prove to be of considerable benefit to the hospital staff, since it relates to their patients and practices specifically.
7. Utilizing the data for continuing education which will enliven and arouse interest at professional staff meetings, tumor board conferences and other appropriate educational activities that are ongoing in all institutions.
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inall
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Reg
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info
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an
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can
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se
vera
l o
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s av
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to
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this
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:
1.
Ex
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tu
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s
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in su
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th
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ata
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Cen
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TU
lllor
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Th
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ata
w
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rev
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for
co
nsi
ste
ncy
an
d
com
ple
ten
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thu
s ass
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all
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s are
cla
rifi
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, all
ab
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ca
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then
b
e co
mp
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r iz
ed
.
2.
Sm
all
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spit
als
an
d o
ther
facil
itie
s
cu
rren
tly
wit
ho
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tum
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p
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y M
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tan
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en
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Tum
or
Reg
istr
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per
son
nel.
H
osp
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o
r fa
cil
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thu
s do
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h
ir,
or
train
th
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n ab
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CANCER REGISTRY ABSTRACT FORM f!NS . R I ed 2178 AS 14
T~ Reporting Hospital Abstracted By I Date I Coded By I Date IChecked By
u Cantral Office Information (2·12) HOsPital No. (15-36) :;: F
~
~ntral Reg. No. Seq. CK No. HOIP. Abstract No. Seq. CK No. Date 1st Admitted Chart No.
Nama of Patient (13-42) CARD NO.2 Name of Spouse CARD NO.
D61T5:2l:j:: [j: (Last) (First) (Middle) (Malden) 1
TE Current Address Street City County Stata Zip Code .. Social Security No . e E
1 1 1 I 1 148 149 1 1 I l! Address at ox Street City County State Zip Coda 43 44 45 46 47 50 61
e Telephone No. I Race Isex I Moritol StotUSIAge at Dl Birth Date(Mo.·Doy.Yr Place of Birth Zip Code at OX Residence at OX -.;
I 1 1 1 1 I I 1 1 I II D-
T Friend or Relative (other than sPouse). I Relationship Address and/or Telephone No. 52 53 54 55 56 57 58 59
Race Sex ORr
tI9!1" (gerDI 0 60 0 61 Data of Initial DiagnOSI1 Place of Diagnosis: (It diagnosed elsewhere, please indicate piece and DXT 2' '63
T ' , L.. ___ .J
Birth Date 64 65
This Hospltel__ Other HOsPltal __ Physician's Offlce __ Unk. __ Month Day Year Place of Birth
T OJ OJ OJ I I I I
66 67 68 69 70 71 72 73 74
Primary Site l5equenc. Poired Orgon Involvement Other Promary Tumors Date of Initial OX CARD Primary Site
mm NO.3 I 1 1 I l~ Extent of Disease or Stage 13 14 15 16 17 18 19
t- Insltu __ Locallzed __ Regional __ Distant Unstaged, No Info. __ Paired Organ MultI. Areas m ... -- 0 20 r--'
CO I 121 c -23 1 i Substantiate: L __ ...J
T N M Other Sta1
I I I I ] I II I 1"0,",0"'" TNM
1 1 Other Staging (sPecify) 24 25 26 27 28 29 30 31 32 33
Diagnostic Confirmation DC HlstOIO: Grade
Hlstology ___ Cytology __ X-ray ___ Cllnlcal ___ Autopsy ___ Unknown ___ Q I 0 Histology (Specify Dates, Place, Histologic Type and Slide No.) 35 136 137 1 sl/Q 1 S~eclal Studies
I I 1 1 1 I I I 1 I 1 41 42 43 44 45 46 47 48 49 60 , I TREATMENT DATE Rx BEGAN
• Cumulative summary of a\l tumor directed therapy for this tumor. Include surgery (type of operation), type Surgery 0 I I I I D of radiation therapy and details of chemical. hormonal or other kinds of treatment. List therapy and dates. If no therapy Is given, record reason. 13 14 15 16 17 18
1~ Radiation D I 1 I I ~ 19 20 21 22 23 .,
Q I I I I Q II Hormonal E
1! Chemo., 26 27 28 29 Immuno, 0 I 1 I I Q and/or c Other e 31 32 33 34 35 E .. r-- -, r---,
1~ I I CARD I I : :37 NO.4 l 1 :38 '- __ ...J L. __ J
Dote of lost FoIlowup Exom Polient Tumor Quolity or Death for CA? Status Status of life
IIIQ:J 1---. o U r __ l
1~ Physician responsible for follow·up
, , Date of Last Follow-up or Death: 39 40 41 L43-J L<Q;-'
~T!QrDJm ADSY e Status of Patient: Alive __ Status of Tumor: No Evldence ___ 2nd Physician I I DCancer
~ (In remission) Contribution to Death
• Dead __ Evidence 47 48 49 50 51 52 ---13rd PhysiCian
"""AutoPSY:
r-- ..,
m I , Yes_ No __ Unknown __ Unknown --- : :55 Physicians
--!! Place of Death 1 56-60
,~ 53 54 Cause of Death
2 61-65 I Misc. Comments:
3 66-70
BILL NO. S 13, 37 NAME ?Al PH G ; I, 1>& ";!1 DATE I /; ~
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/ OPPOSE _____ _ SUPPORT ~ TARY
PLEASE LEAVE PREPARED STATEMENT WITH SECRE .
Comments:
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NAME .",/) BILL NO.
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WHOM DO YOU REpREsENT ______________________________________ _
SUPPORT _____ ~ _____ OPPOSE ___________ ~AMEND ______________ __
PLEASE LEAVE PREPARED STATEMENT WITH SECRETARY.
Conunents:
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NAME If p t R"" 4. T L (, t'..,,fo (
ADDRESS '222;: (Iff N I ~, I ( >
BILL NO. ~3_Z.l--__ _ Air fi/t'IDATE / -Iy -~I
WHOM DO YOU REPRESENT ..... 17'--'-...... , 11<...-:....: .. "-"(["'-"-'--____________ _
SUPPORT_~~~ _____ OPPOSE ___________ AMEND ____________ __
PLEASE LEAVE PREPARED STATEMENT WITH SECRETARY.
Comments:
,-'
MONTANA MEDICAL
2021 Eleventh Avenue • Suite 12 • Helena, Montana 59601 f' ,
'A'SSOCIATION " ..::;;;;,;;;;.., , " '
TO THE SENATE PUBLIC HEALTH COMMITTEE
" SENATE BILL ,37, "AN ACT TO ESTABLISH A MONTANA TUMOR REGISTRY AND TO REQUIRE REPORTING BY HOSPITALS OF INFORMATION OF PATIENTS WITH TUMORS"
Mr. Chairman and Members of the COInnti ttee:
Many of us concerned about the best possible management of patients:.,with cancer have been working toward the establishment of a state-\,,~;;'~S<;~ wide tumor registry for a number of years. Several' years, ago the, i ,.
Montana Foundat~on for Medical Care ~ook o~er_, this pr~grani',an~,;"4;with~~7'.i;l,\ two years had,l.n fact, all the hospl.tals' l.n the state but three'J.n~'l;<i""'~:'~'
- ,:,,;.' .~ .. -'. ~'~, "' ,-" "'1;"~I?)";"''':'\;,i:
volved with the program. Unfortunately, ',the ,funding{tocontinue,the-"'; "'" program through the Foundation was terminated!';~~~According1.y:'Jin'the last leg~slative sess~on, in your wisdom, you did';'~~i~~c_t;'kestiib.!!~h a statewl.de tumor regl.stry through the State Department:':-q;Hea"lth'and •• • '. "''''i?r~'r<'',- 1>.,.,f'·, ..... ,e'l!-"" "-}', -~,\,_
Envl.ronmental SCl.ences. The present program l.S run by the, state')~e~ll partment with the cooperation of the Foundation. We ~ertain1.y;~,d~~o ' expect the majority of you as lay people to understand thefunctio' of a tumor registry. In fact, many physicians are undlea£'about1E its utilization and its aims. Most recently, the Legislative"Audl tor's Office has reconunended that the registry not be funded in~th session. This is in contrast to the reconunendations of Governortt~l!5~:" Schwinden in that he includes funding for the registry in his bu~get~
When we learned that the Legislative Auditor's budget and that of the immediate past governor did not include continued funding for the tumor registry we did, in fact, contact the office of Governor Schwinden and were most pleased to see that his budget included appropriate funding for the registry. However, the entire issue certainly notified us that the general understanding of what the tumor regis-try was all about and what it could accomplish on behalf of the citizens of this state were poorly understood.
SENATE PUBLIC HEALTH COMMITTEE January 14, 1981 Page 2
A few years ago the tumor registry in the Oakland area of Califorr-ia was responsible for identifying an industrial pollutant in one single industry that was responsible for a number of cancers in that are~. The individual patients were seen by multiple physicians and treatec at multiple areawide hospitals. Because there was a central registry through which all these cases were reported the staff of that registry was rapidly able to determine that all of these patients were, in fact, employees of a single industry. Because the registry existed, mUltiple future employees of that industry were protected from the continued exposure to the offending agent. It probably would have been years before anyone physician or anyone institution would have accumulated enough cases to make the same determination without the presence of the registry.
At the present time, physicians are able to treat many patients with medications for advancing cancer with success that was absolutely unheard of even four to five years ago. Particular examples of such diseases which are now greatly helped with medications are cancer of the ovary in women and oatcell carcinoma of the lung in both men anc women. The latter cancer was, at one time, associated with the absolutely worst prognosis possible for cancer of the lung in humans.
Too, with advances in chemotherapy physicians are now able to radically change the course of this disease in a great majority of those patients. In fact, oatcell carcinoma of the lung has a better prognosis than either squamous cell or adeno carcinoma of the lung unless the latter two are localized diseases and amendable to surgical resection. Chemotherapy has changed the prognosis for the grade three and grade four carcinomas of the ovary radically in the last few years.
Unfortunately, some of the medications utilized to treat these diseases are, in fact, in themselves potentially carcinogenic. That is, they may ultimately be responsible for the development of other cancers in these patients. We may well find out in ten to fifteen years that patients whose treatment brought about a cure of ther malignancy orginally may well now be responsible for a new cancer. A registry with detailed summaries of treatment will allow the immediate recall of vast numbers of patients for early diagnosis and appropriate management if in fact that proves to be the case in the future. Without the registry, or some similar vehicle, patients in our widely dispersed population with their unbelievable mobility from community to community will not be so readliy located.
Many physicians are currently Objecting to including their patients in the program for fear of a breach of confidentiality. The proposed bill will alleviate that problem by insuring that cancer is a reportable disease and as such physicians and hospitals will not be breaching in any way patient confidentiality by reporting their diseases.
SENATE PUBLIC HEALTH COMMITTEE January 14, 1981 Page 3
As an individual physician, I am notified on a regular basis that my patients are due for a follow-up for their cancer. I can elect to have those notifications sent at whatever intervals I request. At the time of that request, I simply state the present condition of the patient, any change in their disease state since my last reporting, and any change in therapy.
Accumulative data are regularly gathered by the central tumor registry and disseminated throughout the region. We cannot at a glance determine if in fact patients with cancer of the colon or cancer of the uterus or cancer of the skin have a poorer or better prognosis in Montana than say in Utah. If we were to find out that in fact patients statistically consistently were having a better outcome in Utah thaL they were in Montana, it would certainly stimulate us to see if in fact we were either 1) not diagnosing the cancer early enough in Montana or 2) inappropriately treating it in Montana.
On behalf of the Hontana Hedical Association I certainly wish to thank Senator Himsl for his enthusiasm in helping us make the mos~ optimal care possible available for cancer patients. Senate Bill #37 is in the best interests of the patients of this state. We certainly encourage you in your wisdom to give this bill an affirmative vote and we certainly hope and encourage you to insure the appropriate funding for this legislation when given the opportunity later in the session.
,n'lM:vm
Sincerely,
~ tv ~"g6l4.,i ~ John W. Mcl-lahon, M.D., Chairman Committee on Legislation
NAME ___ g---=lA:;....::cLcr~\or--'-'()'--I:.....::S:....;,o.:......:.....:n _____ BILL NO. .s () ,,3 7 ADDRESS _____________________________________ DATE I-/~'!
WHOM DO YOU REPRESENT __ ~rn~T~ __ ~N~~~r~s~e~~_I __ ~t9~~~S~Q~~~-________ _ SUPPORT X OPPOSE AMEND ____ -L4._____ ------------- ______________ __
PLEASE LEAVE PREPARED STATEMENT WITH SECRETARY.
Comments:
•
~HONE: 1'13-3 i9 ¥ "REPRESENTING WHOM? M...ct4N<t.- PUb/'-,,- Ikall-i- /loSs ct:../4-f,,"A.)
.APPEARING ON WHICH PROPOSAL: S f3 3 7 - fsrq".jf,'6h 1:th)4IC cp~"s7'"'..J
.00 YOU: sUppoRT?----i><~_AME~D? ____ OPPOSE? _______ _
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~EASE LEAVE ANY PREPARED STATEMENTS WITH THE COMMITTEE SECRETARY.
•
-
SENATE BILL NO. 37
Mr. Chairman: I move to amend Senate Bill no. 37 on page 2
following the period in line 5 by adding the following sentence:
"The department shall pay the hospital $3 for each report received."
I move to further amend Senate Bill No. 37 on page 3, lines
2 through 9 by deleting all of Section 7.
Testimony on S.B. 73 - An Act to Automatically Assign Support Rights of Persons Applying for Public Assistance
The Department of Social and Rehabilitation Services fully supports this
proposed legislation. Federal la\.;r requires that each applicant for Aid
to Dependent Children sign over any child support which may be due. This
amount is used to pay back county, state, and federal money used in the
ADC grant.
The present process goes like this. The applicant comes to the county
welfare office to apply. The county eligibility technician has about
fifteen different forms for the applicar.~ to sign. One is a form giving
the state all rights to child support. SRS then refers the case to the
Department of Revenue, Child Support Enforcement Bureau, for investigation.
From then on, it is up the the Department of Revenue to determine whether or
not child support action is posjible, to pursue it, and to collect the money for
deposit in the General Fund.
So what's the problem? The problem is that we have over 200 eligibility
technicians throughout the 56 counties. Because of turnover, some are
new and may miss part of the standard procedure. And because of the large
amount of paperwork involved, tae assignment form may be missed. This form
must be signed not only at application time but each time there is a
redetermination of eligibility - at least once every six months.
As a result, the state's error rate, our "mistake rate," is higher than
it needs to be. When we check our own work, through our quality control
program, we find mistakes and the federal government may penalize the state
for those mistakes.
This bill also assigns similar rights when application is made for
Medicaid. It would further emphasize the right of the state to collect
.1'
-2- S.B. 73
payments due from parents or from insurance companies for medical bills
paid by Medicaid.
If passed, this law will automatically allow us to reduce our error rate,
decrease our paperwork, and decrease the possibility of fiscal penalties.
We have been assured by the federal officials that this bill meets
federal requirements for the assignment of support rights. It meets
our goals for more efficient and effective operations. It meets the
goals for providing care for the needy but collecting from those who
have the resources to pay. It further cements the duty of parents to
support their children.
The Department of Social and Rehabilitation Services solicits your
favorable consideration of this bill.
Judith H. Carlson Deputy Director, SRS
