Dianne Feinstein

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mrs. FEINSTEIN. Mr. President, I send an amendment to the desk and ask for its immediate consideration.

Mrs. FEINSTEIN. Mr. President, following my remarks, it will be my intention to offer an amendment to close a gaping loophole in legislation which we passed 4 years ago to make the streets of this country safe. That specific legislation was legislation that prohibited the manufacture and sale of 19 commonly used assault weapons, semiautomatic assault weapons, that have been used to kill police, used by grievance killers, used by gangs, used by cartels, used by drive-by shooters. The legislation also contained provisions that sought to eliminate the sale and transfer of the high-capacity clips and magazines that would hold more than 10 rounds of ammunition. And, in fact, today it is illegal in this country to domestically manufacture and sell a new clip, drum or strip that was made in this country, except to the military, police, or for nuclear power plant protection. It has become evident that though this legislation has been successful in reducing the criminal use of the 19 banned assault weapons, the provisions in this law aimed at reducing the availability of these large-capacity ammunition feeding devices have been rendered ineffective. At the request of the distinguished Senator from Idaho, who was on the floor a moment ago, the 1994 law grandfathered existing high- capacity clips which were manufactured before the effective date of the ban to allow those clips which had a bill of lading on them to enter the country and to allow dealers to recover their expenses by selling off their existing stocks. The same thing existed for assault weapons themselves. The President and Secretary of the Treasury closed this loophole through his executive decision which used the 1968 law, which said that any weapon imported into this country must meet a sporting use test. And 1.6 million of these semiautomatic assault weapons were essentially cut off from importation. The thrust of the legislation was to eliminate the supply over time --not to prohibit possession, but over time, because there are so many of these weapons and clips in this country now, to cut down on their supply. I will never forget, because the distinguished Senator from Idaho did approach me on the floor--we were standing right down in the well; I remember it as clear as if it was yesterday, although it was almost 5 years ago--and indicated that he was concerned about weapons that had a bill of lading on them which had been manufactured pre-assault weapons ban and which were in the process of transit into this country. My point, Mr. President, is that now, 4 or 5 years later, the existing supply of these clips surely has been used up. However, foreign clips have continued to pour into the United States. From July of 1996 to March of 1998, the Bureau of Alcohol, Tobacco and Firearms approved 2,500,000 large-capacity clips for importation into this country. Recently, that number has skyrocketed even further. In just the last 5 months, BATF has approved permits for 8.1 million large-capacity clips for importation into America. That represents a 314-percent increase in one-fourth of the time. These clips have been approved to come through at least 20 different countries. It is difficult to know the place of manufacture, but they come through 20 different countries into this country. I would like to just quickly go through the countries that they come through. And there are some interesting things. Austria, Belgium, Chile, Costa Rica, Czech Republic, Denmark, England--and clips manufactured somewhere abroad come through Great Britain; there are actually 250-round magazines--250-round magazines--for sale in this country and 177-round magazines for sale in this country--Germany, Greece, Hungary, Indonesia, Israel, Italy, Nicaragua, South Africa, Switzerland, Taiwan, and Zimbabwe. So the total is 8.8 million in two years approved to come in. Unfortunately, there is virtually no reliable method to determine the date of manufacture on the millions of clips that the BATF has estimated are in circulation now in the United States. The inability to determine the date of manufacture is particularly true regarding the foreign importation of large-capacity magazines because BATF has no ability to independently determine whether such clips imported into the country are legal or illegal. It has allowed the continued importation of clips represented to be manufactured before the assault weapons ban took place. Let me show you how this happened. Here is a clip from Shotgun News, dated February 1998: ``Banned semiautomatics, Bulgarian SLR 95. 1 free 40-rd magazine with each purchase.'' Here is another one: ``Quality replacements, 30 rounds, the choice of the Canadian military. Will not bend or rust, $8.99 a clip.'' Here is where you see the impact of, now, the foreign rounds: ``30-rd East German''--East German-made--``Ribbed back, AK-47 magazines, $7.99.'' Here is one: An ``AK magazine special,'' coming with the pouch, ``including 4 Chinese AK-47 30-rd magazines with pouch, $27.50.'' It also includes ``four East German AK-47, 20 rd magazines with a pouch, $29.95.'' Now, my staff called a shotgun store and asked to buy some of these magazines. The only question he was asked, ``Is it legal to buy this stuff where you are''--he was in Washington, DC, where it is not legal to own a gun, and he said, ``I don t know, as far as I know it is,'' and they said, ``We will send it to you.'' My point is, you can get these big clips very easily--on the phone, by mail order. And because now the supply of the domestic clips is running out, most of the clips being sold in this country are of foreign manufacture. So we have two sets. We have the domestic manufacturers prohibited. We have the sale and transfer of new clips prohibited. And you have the grandfather clause creating this gigantic loophole which allows these big clips to continue to come into the country. In April of this year, President Clinton and Treasury Secretary Rubin closed one loophole created by this grandfather clause by blocking further importation of modified semiautomatic assault weapons. About 30 of us sent him a letter. We pointed out there were 1.6 million of these which received approval that were coming in from all over the world. The Treasury Department looked at the 1968 law, which requires all imported weapons to meet a sporting test, and decided that they don't meet this sporting test, and therefore the Executive order is in place and this importation has been prohibited. The remaining loophole to close is this loophole for the big clips. The amendment that we will shortly offer will do just that. So the change to the law that I have proposed is simple: It would bar further imports of large-capacity clips and magazines, just as U.S. domestic manufacturers have been stopped from producing these magazines. This amendment would not--I repeat, not--ban further domestic sales and possession of large-capacity clips which are already legally in the United States. There are tens of millions of these already. Now, let's talk about who uses these high-capacity clips. I pointed out, coming through Great Britain, there were ammunition-feeding devices carrying 250 rounds. You can expel 250 rounds before you have to reload. Do hunters use them? Do marksmen use them? Do skeet shooters use them? Do Olympic team members use them? Let's take hunters. The answer is no, hunters don't use them. Most States limit the magazine capacity allowed for hunting, usually eight rounds or less. Federal law clearly outlines the ammunition magazine size limits for bird shooting. Federal law does not allow the use of a shotgun that has a capacity of more than three shells--one in the chamber and two in the magazine--when hunting migratory game birds. How about the Olympic team and other competitive shooters? No. So who really uses these large-capacity clips? Let me read a list of events that have taken place fairly recently. July, 1998, earlier this month, Rio Hondo, TX, a killing spree leaves five dead, including two Border Patrol officers. In one day, 24-year-old Ernest Moore killed four people in what police called a planned situation. He killed two people and wounded another in a private residence. Police at the scene recovered an MK-70 assault rifle and a 30-round clip. Approximately 30 minutes later, Moore fired as many as 100 rounds at law enforcement officers from a .223-caliber assault rifle. Two Border Patrol agents were killed at the scene and a sheriff's deputy was wounded. That is who uses these big clips. June 17, Coeur d'Alene, ID: A State trooper ambushed by merciless assassin. State trooper Linda Huff was ambushed and killed by a man wielding a 9-millimeter pistol with a 15-round clip. Police were not immediately certain why 34-year-old Scott David Yeager bicycled to the police station and fired 17 rounds at Huff in the rear parking lot. Investigators say Yeager fired all 15 rounds from one 15-round clip, disposed of it, reloaded, and continued to fire. In May of this year, Springfield, OR: A 50-round clip. High school student kills four, injures dozens. After killing his parents, went on a shooting spree at his high school--most of us are familiar with this. To carry out his fatal assault, he used a Ruger 10.22 hunting rifle, a Ruger .22 caliber handgun and a Glock model 19. Found attached to the rifle, a traditional hunting gun, was an empty 50-round clip and found on the student were four 30-round clips and two 20-round clips. During the attack, he fired from the rifle indiscriminately, and it was not until he emptied the 50-round clip that several of his classmates were able to tackle and subdue him. In March of this year, Jonesboro, AR: 15-round clips. Two middle school students ambush classmates. Two students, age 11 and age 13, pulled the fire alarm in their school in order to draw their classmates outside. The boys lay in wait and ambushed the other students when they got outside. They fired 24 shots into the crowd, 15 of which came from a Universal carbine rifle with a 15-round clip. The shots from the rifle were fired as fast as the shooter could pull the trigger. February of this year, New Orleans, LA: A 30-round clip. Police recover 30-round clip after chase. After a routine traffic stop, a man led police on a 3-mile chase during which he pointed a 9-millimeter assault pistol with a 30-round clip. And then it goes on and on and on. Elmhurst, NY, 30-round clip. Indianapolis, 30-round clip; traffic stop pulls the weapon. Orange, CA, 30-round clip; disgruntled employee kills five with 30-round clip; five people were killed, and a police officer was seriously wounded when a disgruntled Caltrans employee began randomly firing from an AK-47S with a 30-round clip. Denver, CO, last November, police officer killed by SKS with a 30-round clip; Denver police officer Bruce VanderJagt was killed by a barrage of gunfire from an SKS assault rifle as he chased a burglary suspect; police later recovered the rifle and the 30-round clip. Magna, UT, police officers shot by SKS with 20-round clip. It goes on and on and on. The point is, there are so many of these big clips available in this Nation that they become the ammunition- feeding device of choice for the grievance killer, the person going up against police, the gang that wants to engage in intimidation, drive-by shootings, the cartels--these are the weapons of choice, and the weapons of choice are useless if you don't have that big-round clip. What are we seeing? Five months and 8.1 million of these receiving approval to come into this country because BATF could not assert when they were manufactured. BATF can't go to another country to check a factory supply. Therefore, an understanding that I have with the distinguished Senator from Idaho--and I am pleased he is on the floor now; these would apply to clips or weapons that had bills of lading attached to them--is clearly not the case today. Bills of lading that preexisted a 4-year-old piece of legislation now. The time has come to close this grandfather clause. Now, a number of the tragedies that I have just indicated probably would have occurred without the availability of killer clips. Some are fond of saying, ``Guns don't kill, people do.'' Yes, that is true. But I don't think ever before in the history of this Nation we have ever had a time when more weapons of destruction were falling into the hands of children. The case that really struck me was a case in Memphis, TN, when a 5- year-old took a loaded weapon to school to kill a teacher who had given that youngster a ``time out'' the day before. All we are trying to do is close the grandfather clause, say all of the clips that were in transit on the day we passed this legislation, 4 years ago, have been used up, and now is the time to close the loophole. Interestingly enough, some have told me, and Members of this body have told me, ``Well, we know people who like to use them plinking.'' They told me, ``Yes, I like to use them plinking.'' Well, we are not taking away anybody's right to possess or to plink. There are plenty of clips around for plinking. What we are trying to do is stop what is now a massive flood of clips, even those that now carry 250 rounds in these magazines, from coming into this country. I don't like to do this amendment, frankly, this day, because this is a solemn day and I don't like to mix the two. Unfortunately, the Treasury-Postal bill is on the floor at this time, and this is an opportunity to move the amendment. I hope that those who know the intent of the grandfather clause to only affect those guns and clips that were in transit at the time of the enactment of the legislation--something that I agreed to because I thought it was fair--will agree to let this legislation go into place. It will not take a clip out of anyone's hands; it will not prohibit possession. Domestic manufacturers of ammunition feeding devices, today, cannot manufacture clips for general sale that are in excess of 10 bullets. We know they are not used in hunting, but we do know that in case after case they are used to kill police officers, they are used to kill employees, used by grievance killers, drive-by shooters, drug gangs, cartels, etc. The real question in my mind is: Do the rights of the majority outweigh the rights of those few who would like to plink, who would like to continue the flood of weapons coming into this country? There is no civilized, industrialized power on Earth in which there are more weapons or in which there are more of these big clips floating around. The instant case that really jettisoned me into the assault weapons legislation was the 1994 case of Luigi Ferri, who had Tec-9 copycats and a 9 millimeter pistol. When he went into 101 California Street, this was his array of ammunition-feeding devices that he brought with him. He carried with him 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25--25 different ammunition feeding devices, with enough rounds that exceeded 500 rounds. I think it was actually over a thousand rounds of ammunition used to do his dastardly deed. Indeed, he left 8 people dead and about 14 people wounded. And no one could get to him to disarm him. In this case, I don't know whether these are domestic or foreign made clips. The point I want to make is that the large number, the incredible fire power and the lack of sanity seemed to prevail. Amendment No. 3351 (Purpose: To ban the importation of large capacity ammunition feeding devices)

Mrs. FEINSTEIN

Mrs. FEINSTEIN. I thank the Chair.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. All right.

Mrs. FEINSTEIN. I thank the Senator from Massachusetts. Mr. President, I am really disappointed that this program is being ramrodded through on an appropriations bill. This program represents a huge new immigration program and no one should think to the contrary. Fifty percent of all the people that are going to come in from other countries under this program will go to one State--California. California has not been afforded the time to do the analysis to see how this program would affect it. This program is a Trojan horse. When I heard the testimony on a registry program on the Judiciary Committee I thought, ``Great idea; I want to support it.'' When the Senators made the announcement, I was a cosponsor. Then I saw that attached to the concept of the registry program was also a huge immigration program with no controls whatever, no way of asserting whether individuals go back, and as a matter of fact--and I will explain that shortly--setting up incentives for these people to remain in the country in a legal status. In California, this will mean literally tens of thousands of additional immigrants coming into the State. We currently have 2 million people in California in illegal status. This will only add to the number of illegal status. Let me say how this will happen. Under the amendment, if the Department of Labor cannot find American workers--and there is no registry in place in California--this bill will go into play. The large agricultural associations will apply for 20,000, 30,000 permits at a time. The Department of Labor has 7 days to respond to that. If they don't respond to that huge number in that period of time, the permits are authorized and the foreign workers come in. There is no way of knowing who they are, whether they have any bona fide documents. Additionally, once a worker is in this country for 10 months, they can apply for a 3-year extension. Therefore, you effectively are granting a stay of 3 years to someone who comes in. They then should return, and if they come back for one more year, they are here for all time. They gain legal status under this program. There are no caps on any numbers being brought in. The major part of concern in this bill--and I want this in the Record, is section 6(b)1, the application to the Secretary of State that sets up this 7-day period when the employer submits the application for alien workers directly to the Secretary of State with a copy of the application provided to the Attorney General seeking the issuance of visas and the admission of aliens for employment in the job opportunities for which the employer has not received referral of registered workers. Then there is an expedited consideration by the Secretary of 5 days. It is physically impossible to consider 20 or 30,000 applications in 5 days. It is set up to permit the entry of large numbers of people about whom nothing will be known--whether they really will go home, whether they really will stay at the job, work at the job. I think this is going to make the Bracero Program look good in retrospect. Now, what I object to is I would like to vote for something that would help what is becoming an increasing problem. That increasing problem is that increasingly farmers cannot find adequate labor to harvest their crops. In our State, you have these counties with 20 percent and 30 percent unemployment rates. It is amazing, but it is true. Unemployment rate is high, but the farmer cannot find the help. This is where the registry was supposed to help. But the registry and the importation program go into effect simultaneously. Consequently, if there is nobody on the registry, you have the opening to import 20, 30, 50, 75,000 workers with no limit. That is what I had hoped we would have the time to work out. We don't know whether the housing allowance will work in California. California isn't Oregon. Costs are much higher. Housing is unavailable. Amendment No. 3282 to Amendment No. 3258, as Modified

Mrs. FEINSTEIN. I thank the Chair. I yield the floor.

Mrs. FEINSTEIN. What this does, and I quote from the amendment: Independent contractors, agricultural associations and such similar entities shall be subject to a cap on the number of H2-A visas that they may sponsor at the discretion of the Secretary of Labor. This would give the Secretary of Labor the opportunity to see that there is a reasonable number attached to this limited processing time because with the limited processing time, if you apply for 50,000 people, as could well be the case in California, you would not be able to meet the processing deadline.

Mrs. FEINSTEIN. I send an amendment to the desk.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. I thank the Chair. I compliment both Senators for this legislation. I think it is common sense. I think it is long overdue. I most profoundly disagree with the Senator from Idaho. If the gun is under lock and key, the owner is exempt from criminal liability. Let me repeat that. If the gun is under lock and key, the owner is exempt from criminal liability. On Monday, a 4-year-old boy in Maryland was shot with his grandfather's .22 caliber handgun. The gun was loaded. It was not equipped with a trigger lock. The children were playing with the gun. The gun discharged and struck the 4-year-old in the face. Fortunately, the boy was not seriously injured and is expected to recover. On Tuesday, unfortunately, 61 Senators voted against a common-sense requirement to require handgun manufacturers to include childproof trigger locks with every handgun they sell. A simply safety requirement that would help to stop the growing number of accidental gun-related injuries and deaths that involve children every year. In my view, the sharp contrast between these two events is striking. One day, a child is shot in the face because the gun he and his playmates find does not have a trigger lock. The next day, the Senate votes against requiring all guns to be sold with trigger locks. What is the matter when we cannot fulfill our basic responsibility to keep children safe from the dangers of irresponsible gun ownership? I believe that the legislation currently before us authored by Senators Durbin and Chafee, offers an excellent avenue for ensuring that gun owners who allow children access to their guns are held liable when their negligence leads to death or injury. The bipartisan Child Firearm Access Prevention Act will keep kids from taking guns owned by adults and, either purposely or accidentally, killing or injuring themselves or another person. The legislation puts the burden on the adults who own the guns to store their guns in a safe and secure manner--with a trigger lock, a combination lock, in a gun safe, or in a lock box. If an adult who owns a gun chooses to store the firearm in a loaded condition--unlocked and unsafe--and a child uses that gun to kill or injure someone or exhibits that firearm in a public place, then that adult can be imprisoned for 1 year and fined as much as $10,000. The need for this legislation should be entirely obvious. I would wager that there is not a single Senator who hasn't heard of the parade of senseless violence that has plagued our nation's schools. Some recent incidents include: Barry Loukaitas, 14, February 2, 1996, Moses Lake, Washington: Allegedly shot and killed two students and a teacher at his school. In his confession Barry said he got two of his guns from an unlocked cabinet in his house and one from the family car. Evan Ramsey, 17, February 19, 1997, Bethel, Alaska: Shot and killed a student and a principal, and wounded two other students, at his high school. According to police, the gun Evan used was kept unlocked at the foot of the stairs in his house. Luke Woodham, 16, October 1, 1997, Pearl, Mississippi: Allegedly stabbed his mother and then shot nine students, killing two, at his high school. Michael Carneal, 14, December 1, 1997, West Paducah, Kentucky: Accused of killing three students and wounding five students who were participating in a high school prayer circle. Andrew Golden, 11, and Mitchell Johnson, 13, March 24, 1998, Jonesboro, Arkansas: Accused of shooting to death four girls and a teacher, and wounding ten, at his school. The boys took the guns they used in the crime from Andrew's grandfather who said he usually kept his guns unlocked in the house. Andrew Wurst, 14, April 24, 1998, Edinboro, Pennsylvania: Shot a teacher to death at a school dance. Jacob Davis, 18, Fayetteville, Tennessee, May 19, 1998: Allegedly shot and killed a high school classmate. Kipland ``Kip'' Kinkel, 15, Springfield, Oregon, May 21, 1998: Shooting spree at both home and school which left four dead and twenty-two injured. In all, these tragedies total 20 deaths and 48 injuries. Other non-fatal incidents include: A 5-year-old kindergarten student in Memphis who took a loaded .25-caliber pistol to school because he wanted to kill his teacher for putting him in a ``timeout'', A police officer's 10-year-old son who was arrested when he took an unloaded, semiautomatic pistol to school in his bookbag, A 15-year-old high school student who was arrested when authorities confiscated 20 pistols, rifles, and shotguns from his home after the boy threatened his 9th grade teacher, And a 16-year-old boy, suspended from school for vandalism, who was caught by authorities on campus with a .22-caliber revolver in his front pocket. Indeed, the scope of this problem is reaching epic proportions. The National School Safety Center indicates that, during the 1997- 1998 school year, there were 41 school-associated violent deaths in the United States. That's nearly a 61 percent increase from the year before when there were 25 such incidents. And it's no wonder the incidents of school violence are increasing. A 1998 study by the National Center for Education Statistics and the Bureau of Justice showed that, of 10,000 students surveyed, 1,200 students knew someone who had taken a gun to school. It is amazing to me that, given the large number of students who have taken guns to school, there haven't been even more gun related deaths in our schools. Since the National School Safety Center began keeping track of school-associated violent deaths in July 1992, there have been 227 students who have died on campus. 53 of them--nearly 1 out of every 4-- were from my home state of California. In fact, the problem of gun fire on campuses has gotten so bad that students in some California schools practice ``duck and cover'' drills much in the same way that students in the 1950's and 1960's practiced taking cover during nuclear air-raid drills. An article in the Los Angeles Times last August detailed how the threat of gun fire has become like the new nuclear threat looming over today's elementary, middle, and high school students. The article reads: ``They're called drop drills, crisis drills, and even bullet drills. In many schools, a special alarm sounds, as it would during an actual nearby shooting. Teachers shout ``Drop!'' and students duck under their desks or sprawl on the ground, covering their heads. Many schools also immediately initiate a lock-down during the drill, as they would with a shooting, sealing the campus off from the violence outside.'' And it continues: ``The drop procedure was used by students at Figueroa Street Elementary School in February 1996 when teacher Alfredo Perez was hit by a stray bullet. Perez's fifth-graders ducked when the bullet flew through the window, and then they crawled out of the room and stayed on the floor until teachers told them they could get up. Principal Rosemary Lucente credits the drop bill, which they practice at least once a month, with keeping the students out of further danger.'' And so it has come to this. Our students are forced to practice duck and cover drills because their schools have gotten too hazardous for them to focus on what they're there for in the first place which is to learn. When the situation has gotten that bad it is my view that it is our responsibility to try and help provide some sanity in our schools and protect children from guns. We can do that by holding adults who own guns responsible if their careless storage of dangerous firearms results in the threat of death or injury. What's more, we must also encourage parents to spend more time with their children, to reconnect with them, to teach them that guns are not toys, and to teach them the difference between right and wrong. Opponents of this bill will argue that it won't solve all the problems of kids with guns, that it won't stop kids from getting killed or injured by firearms. Frankly, I don't know if that's true or not. But I do know that one thing this legislation will do is it will force adults to be more safe and more responsible with their guns and that will save lives. I support this legislation whole-heartedly and I encourage my colleagues in the Senate to do the same.

Mrs. FEINSTEIN. Yes. If I could have a half-hour.

Mrs. FEINSTEIN. Mr. President, I rise in support of the Kyl Amendment, the Internet Gambling Prohibition Act. I am an original cosponsor of S. 474, on which this amendment is based. This amendment takes important steps to address the dangerous, billion-dollar-a-year threat to our communities and our laws of Internet gambling. The Senate Judiciary Subcommittee on Technology, Terrorism, and Government Information, on which I serve as Ranking Member, held hearings on the subject of Internet gambling in March of last year. At that time, I joined Senator Kyl in introducing S. 474, on which this amendment is based. The bill passed the Senate Judiciary Committee by voice vote in October of last year. Since that time, this proposal has been carefully fine-tuned to address concerns raised by various groups. This proposal enjoys the support of a wide range of groups, including law enforcement, family and consumer advocates, and professional and amateur athletics. Most importantly, FBI Director Louis Freeh, at a Senate Judiciary Committee hearing, when asked if the FBI supports the Internet Gambling Prohibition Act, Prohibition Act, replied, ``Yes, I think it's a very effective change. We certainly support it.'' Similarly, the National Association of Attorneys General explained why such legislation is important in letters to the Senate Judiciary Committee and to the full Senate. The State Attorneys General wrote: [M]ore than any other area of the law, gambling has traditionally been regulated on a state-by-state basis, with little uniformity and minimal federal oversight. The availability of gambling on the Internet, however, threatens to disrupt each state's careful balancing of its own public welfare and fiscal concerns, by making gambling available across state and national boundaries, with little or no regulatory control. This amendment brings our laws on gambling up to date with advances in technology. It ensures that the new medium of the Internet will not prove to be the latest frontier of illegal gambling. I am proud to be an original cosponsor of the Internet Gambling Prohibition Act, and I am proud to support this amendment, to provide law enforcement with the tools it needs to keep the Internet free of the scourge of illegal gambling. Mr. COATS addressed the Chair.

Mrs. FEINSTEIN. Mr. President, I rise today to commend the bi- partisan leaders of the appropriations subcommittee, Chairman Gregg and Senator Hollings, for providing adequate funding to allow the Census Bureau's census 2000 plan to proceed. The funding will permit the census professionals to continue their plan to guarantee that everyone in every city and rural area will be counted. I ask that when this Appropriations bill goes to conference with the House that the Senate conferees stand united against any effort to reduce the decennial census funding level or micro-manage the professional census gathering process. I am very concerned about the critical 2000 census, because I believe Senator Gregg and Senator Hollings will face a difficult conference with the House. Contrary to the Senate plan, the House funds the Census Bureau for only six months, crippling the bureau and denying the census professionals the tools they believe will help them conduct the most accurate 2000 census possible. The House leadership has also challenged the Census Bureau sampling plan in federal court, asserting it violates the United States Constitution. The federal court should proceed with their review, but the Census Bureau professionals need to proceed with their plan, which represents the best efforts of census professionals and academics to measure the population. Before we look forward to conference, I would like to briefly look back and put the current sampling dispute in its historical context. Regrettably, the public debate over the 2000 census has been dominated by the use of sampling, a simple, statistical method proposed by the Census Bureau to count the historically ``difficult to count'' populations of the nation's urban and rural poor. The Bureau's sampling plan was developed in direct response to the unprecedented census error rates in 1990, the first census in US history to be both more costly and less accurate than the census that preceded it. Why is an accurate census important for the nation? The decennial census is the basis for distributing funds throughout the country for more than one hundred federal programs. Is the local police force eligible for federal grants for cops on the beat or drug education programs? Check the census, which sets eligibility for Byrne grants, DARE funds or community policing grants. How about education funds for schools? The census determines title one or title two education grants. How about funds for homelessness, mass transit or other transportation funds? Again, the census determines state and local government eligibility for Social Services block grant money, highway and mass transit grants. What about health care for low-income families? Again, the census helps set state Medicaid reimbursement levels. The census is instrumental for the effective administration of government at all levels, providing the basis for distributing billions of dollars throughout the country through hundreds of programs. The nation cannot afford the error rates and inaccuracy experienced in the 1990 census. The General Accounting Office, the investigative arm of Congress, concluded the 1990 census failed to count about 15 million Americans, while an additional 11 million Americans were double-counted. The California population was undercounted by more than 2.7%, representing 20% of the nation's net undercount. If we squander this opportunity for reform and the 2000 census proves to be equally inaccurate as its 1990 predecessor, between 5 and 6 million individuals, would be ``missed.'' If we do not reform our census plan, 1 to 1.2 million Californians, 3% of the state's population, will fail to be counted. If the census misses 1 million people in California, about 300,000 children will not be counted, depressing state education funding and seriously compromising education in the state. Mr. President, concerns for undercounting the United States population are as old as the nation itself. Thomas Jefferson, transmitting the first census to President Washington, commented, ``we know in fact that the omissions have been very great.'' However, the Census Bureau sampling plan, which enjoys the support of the National Academy of Sciences, academics and census professionals, is a reasoned response to the unprecedented error rates of the 1990 census. Congress cannot make the same mistake again. The Census Bureau plan needs to go forward. It's time to allow the census professionals to implement their best plan to improve on the 1990 undercount and deliver the most accurate 2000 census possible. I thank the chairman, Senator Gregg, and ranking Democrat, Senator Hollings, for their efforts and extend my continuing support. iraq war crimes tribunal

Mrs. FEINSTEIN. I thank the Chair.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, at the end of this week, Vice President Gore is scheduled to depart for Moscow to conduct meetings in preparation for a summit meeting between President Clinton and President Yeltsin in September. I believe this meeting and the future summit is really long overdue and extraordinarily important. I would like to take a few minutes to speak about the relationship between our country and the new Russia. United States-Russian relations today stand at a critical juncture. It has been almost a decade since the end of the cold war, and although we have made great strides in reestablishing the friendship that characterized relations between our two countries in the recent past, we have yet to establish the basis for the kind of partnership that is adequate to guide our two nations into the next century. The Russian Federation is nearly twice the size of the continental United States. It covers 11 time zones, with a population of close to 150 million people. Lest we not forget, Russia is a country with a nuclear arsenal capable of annihilating the Earth many times over. Few countries on this Earth have undergone the sort of wrenching political, economic, and social transformation that Russia is now going through. While China has moved slowly and carefully to release centralized control over its economy, the Russian model has moved rapidly, in a macro way, to embrace both economic and social democracy. Today, Russia remains fragile. The United States has a huge stake in what happens now. Our goal must be to see that Russia remains a stable, modern state, democratic in its governance, abiding by its constitution and its laws, market-oriented and prosperous in its economic development, at peace with itself and with the rest of the world. A Russia that reflects these aspirations is likely to be part of the solution, rather than part of the problem, to world peace. Conversely, a Russia that erects barriers against what it sees as a hostile world, that believes the best defense is a good offense--such a Russia could be in the 21st century just as it was for much of the 20th century--one of the biggest problems the United States and the rest of the world will face. Russia may be down as a major power, but it is far from out. Although it is all too easy for some to look at Russia today and conclude that it is not a country that demands attention as a top U.S. foreign policy priority, that, in my mind, would be a grievous error in judgment. To place United States-Russian relations in a secondary category of concern is a surefire recipe for disaster. The United States has an enormous stake in the outcome of the present Russian struggle for democracy and free markets. I believe that it is in Russia's own interests to conduct a concerted effort against the antidemocratic forces and the ultra nationalistic ones, against crime and corruption and, yes, against old Soviet attitudes and habits. This is the course which the government of President Yeltsin has undertaken, and he has done it despite many impediments that still stand in the way. Too often we have been quick to point out the shortcomings and imperfections of the Yeltsin government and of Russia--and as recent questions regarding Russian assistance to the Iranian missile program indicate, there is some reason for deep concern. I am fully supportive of the President's decision last week to sanction nine Russian companies for cooperation with Iran. In my mind, Russia's assistance to Iran indicates just how far Russia has yet to travel if it wants to be a full partner with the United States in the international community. But I must also note that the cooperation that Russia now provides is a welcome reversal of its stance of a few years ago. I hope that this new level of cooperation is a major harbinger of things to come. Indeed, for those who care to look, there have been many positive developments in Russia over the past years--positive developments that include President Yeltsin's constitutionally based election and reelection in 1996, the defeat of hyperinflation, the end of the war in Chechnya in 1997, the signing of the NATO-Russia Founding Act, and successful Russian participation in joint peacemaking operations in Bosnia. Russia has also made enormous strides in integrating into global economic and regional economic institutions, including the World Bank, the International Monetary Fund, the ASEAN Regional Forum, the Council of Europe, the Paris Club, and more. Russia has strengthened its ties to the European Union and is active in the United Nations and Organization for Security and Cooperation in Europe. That is not to say Russian reform has scored a knockout blow against crime and corruption, or that the Russian economy is home free. In fact, the current economic crisis and resulting political instability presents the new democracy with its greatest challenge to date. The package agreed to last week by Russia and the International Monetary Fund provides significant funding, we hope, to stabilize the Russian economy, and it contains major fiscal reform elements, including tax reform, some of which are going to be put in place, as well as far-reaching structural reforms to increase growth and free- market competition. It represents an important pledge by Russia to continue the development of a free-market democracy, and it is an important vote by the international community in the importance of this new Russia. Russia may still be struggling, but it is my belief that it is on the cusp of a constructive interaction in the international community as a democracy. This must be encouraged. As one analyst wrote about World War II era Germany and Japan, ``There are no dangerous peoples; there are only dangerous situations, which are the result, not of laws of nature or history, or of national character or charter, but of political arrangements.'' In Russia today, there is a growing ultranationalism which represents a major threat to its progress as a democracy, and we must be cognizant of that. It will take courage for Russia to look to the future positively, to abandon obsolete thinking, to reassess its national security needs and interests in light of new alliances. It will require a high level of determination and hard work by our country to work with Russia to develop these institutions, institutions which can encourage the growth of democracy and free markets and lead to a more stable and cooperative and prosperous new Russia. But if future generations are to be spared the danger, the expense, and the terror faced by my generation in dealing with Russia, if we are truly to reap the benefits of the end of the cold war, we cannot stand by and wait to see whether democracy and free markets will survive in Russia. In more concrete terms, I believe that the time is ripe for a full- scale, high-level, new initiative towards Russia as we approach the 21st century. The Vice President's trip and this September's summit, I hope, will contribute greatly toward this process, but the Senate bears a special responsibility for the conduct of our Nation's foreign policy. We must play a role, too. This initiative, I believe, should focus on ways in which the United States can work effectively with the new Russia to strengthen and encourage democratization; to support efforts by the IMF and the international community to assist Russia's economy to make the full transition to free markets; to examine and revise outdated legislation which has created roadblocks and bottlenecks in United States-Russian relations and which place United States firms doing business in Russia at a competitive disadvantage; to provide help in the fight against corruption and organized criminal enterprise in Russia; to expedite existing United States resources now available through OPIC, the Eximbank, and other financial institutions through the development of fast-track type programs which cut red tape for worthy business projects and investments; to encourage and expand existing academic, cultural, and other exchange programs, including those between the Congress and the Duma which aim to support Russia's reformers; and, finally, to work to fully integrate Russia as an equal partner in the international political, economic, and security institutions. We must understand how the right kind of foreign assistance can play a crucial role in assuring Russian economic growth and vitality. And we must understand how our assistance can help create the ability for Russia to consolidate its gains and provide the opportunity for Russia to work out its national identity and destiny in ways which will complement American interests. None of this will be easy and all of it will require sustained effort. To that end, the Vice President's trip this week is a first major step. And to that end also, I hope to be able to work with the chairman and ranking member of the Foreign Relations Committee of this body to conduct hearings to examine the nature and future direction of United States policy toward Russia. From these hearings I hope we can develop legislation to address United States policy in the areas I have outlined above, and to strengthen United States-Russian ties in an appropriate way. I deeply believe that this relationship needs the most intensive concern and interaction at the present time. We must give Russia both time and opportunity to consolidate the reforms that constitute the good news of the past few years, to work with them to beat back the forces that threaten this progress, and to assist them to become a stable, prospering, democratic republic which can be a partner for world peace in the next century. I thank the Chair and I yield the floor. Mr. CRAIG addressed the Chair.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, I ask unanimous consent for 15 minutes to speak in morning business.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. This is the last vote?

Mr. FEINSTEIN

Mr. FEINSTEIN. Mr. President, today Senator D'Amato, Senator Ford and I are introducing a bill to require health insurance plans to cover the length of hospital stay for any procedure or illness as determined by the attending physician, in consultation with the patient, to be medically appropriate. This bill will return medical decision-making to medical professionals because it is time to stop insurance plans' interference into this important area of physician decision-making. It is endorsed by the American Medical Association, the American College of Surgeons, the American College of Obstetricians and Gynecologists, the American Academy of Neurology and the American Psychological Association. Only a physician, taking care of the patient who understands the patient's history, medical condition and needs, can make a decision on how much hospital care a person needs. Physicians are trained to evaluate all the unique needs and problems of each individual patient. Every patient is different and the course of illness has great variation. Lengths of stay should not be determined by insurance company clerks, actuaries or non-medical personnel. It is the attending physician, not a physician or other representative of an insurance company, that should decide when to admit and discharge someone. Professional physician organizations develop practice guidelines that guide them in determining medical necessity. These are intended as guidance and are medical judgments made by qualified medical people. Physicians know what medical necessity and generally accepted medical practice are. We are introducing this bill because we have had a virtual parade of doctors come to us and in essence say, ``We are fed up. We spend too much of our time trying to justify our decisions on medical necessity to insurance companies. Insurance company rules have supplanted doctor decision making.'' Donna Damico, a nurse in a Maryland psychiatric unit of a hospital, told National Public Radio on October 1, 1997: I spend my days watching the care on my unit be directed by faceless people from insurance companies on the other end of the phone. My hospital employs a full-time nurse whose entire job is to talk to insurance reviewers. . . . The reviewer's background can range anywhere from high school graduate to nurse, social worker or even actual physicians. A number of examples have come to my attention: In 1996, we addressed the problem of ``drive-through'' baby deliveries, insurance plans covering minimal hospital stays for newborns and their mothers because of examples like this: One California new mother was readmitted after a Caesarean section because of severe anemia from excessive blood loss. She didn't know how much blood loss was normal after a delivery. Two California women were readmitted after vaginal deliveries with endometritis, an infection of the uterus. We've had examples of ``drive-through'' mastectomies, insurance plans shoving women out the door to deal on their own with drainage tubes, pain and disfigurement. S. 249, which I introduced with Senator D'Amato last year, addresses that abuse and we are trying to get it passed. A California pediatrician told us of a child with very bad asthma. The insurance plan authorized 3 days in the hospital; the doctor wanted 4-5 days. He told us about a baby with infant botulism (poisoning), a baby with a toxin that had spread from the intestine to the nervous system so that the child could not breathe. The doctor thought a 10-14 day hospital stay was medically necessary for the baby; the insurance plan insisted on one week. A California neurologist told us about a seven-year-old girl with an ear infection who went to the doctor feverish. When her illness developed into pneumonia, she was admitted to the hospital. After two days she was sent home, but she then returned to the hospital three times because her insurance plan only covered a certain number of days. The third time she returned she had meningitis which can be life threatening. The doctor said that if this girl had stayed in the hospital the first time for five to seven days, the antibiotics would have killed the infection and the meningitis would never have developed. A 27-year-old man from central California had a heart transplant and was forced out of the hospital after 4 days because his HMO would not pay for more days. He died. Nurses in St. Luke's Hospital, San Francisco, say that women are being sent home after only two nights after a hysterectomy and two nights for a Caesarean section delivery, both of which are major abdominal surgeries, even though physicians think the women are not ready to go home.. Just last week Lisa Breakey, a San Jose speech pathologist, came to my office and told us that she is providing home healthcare for stroke patients she used to see in the hospital. She sees patients in their homes who have G tubes in their stomachs for feeding and trach tubes in their throats for breathing. The trach tubes have an inflated balloon or cuff which a family members must deflate and inflate by using a needle. Family members are supposed to suction the patient's mouth and throat before they deflate the cuff. Families, she stressed, are providing intensive care, for which they are unprepared and untrained. Bedrooms have become hospital rooms. Another California physician told us about a patient who needed total hip replacement because her hip had failed. The doctor believed a seven-day stay was warranted; the plan authorized five. Rep. Greg Ganske, a physician serving in the House, told the story of a six-year-old child who nearly drowned. The child was put on a ventilator and it appeared that he would not live. The hospital got a call from the insurance company, asking if the doctor had considered sending the boy home because home ventilation is cheaper. These cases can be summarized in the comments of a Chico, California, maternity ward nurse: ``People's treatment depends on the type of insurance they have rather than what's best for them.'' As these cases illustrate, premature discharges can increase readmissions and medical complications. During the ``drive-through delivery'' debate, we heard about babies who were jaundiced and dehydrated and had to come back to the hospital. Similarly, as reported in American Medical News on March 23, 1998, according to Dr. David Phillips, ``a shift toward outpatient treatment actually has come at quite a high price . . . an increased loss of lives.'' This University of California study found that medication errors are 3 times higher among outpatients than inpatients; that medications side effects provides limited oversight by medical personnel and that the patient-physician relationships is compromised. Ms. Damico said, ``Patients return to us in acute states because their insurance will no longer pay the same amount for their outpatient treatment . . . [They] deteriorate to the point of suicidal thoughts or attempts and need to return to the hospital.'' She cited the example of a suicidal woman whose plan denied a hospital admission requested by her physician. After the doctor told her of the denial, she took twenty 50-milligram tabs of Benadryl, was then admitted, and the plan then had to pay for hospital care, an ambulance and emergency room fees. So not only do premature discharges compromise health, they ultimately cost the insurer more. Physicians say they battle daily with insurance companies to give patients the hospital care they need and to justify their decisions on medical necessity. An American Medical Association review of a managed care contract (Aetna US Healthcare) found that the contract gives ``the company the unilateral authority to change material terms of the contract and to make determinations of medical necessity . . . without regard to physician determinations or scientific or clinical protocols . . . .,'' according to the January 19, 1998 American Medical News. A study by the American College of Surgeons found that guidelines published by Milliman and Robertson and used by many insurers represent a minimum length of stay, compared with surgeons' estimates. A study by the American Academy of Neurology found that the Milliman and Robertson guidelines on length of stay are ``extraordinarily short in comparison to a large National Library of Medicine database . .. And that [the guidelines] do not relate to anything resembling the average hospital patient or attending physician . . . .'' The neurologists found that these guidelines were ``statistically developed,'' not scientifically sound or clinically relevant. A study in the April 1997 Bulletin of the American College of Surgeons found that surgeons stated that the appropriate length of stay for an appendectomy is zero to five days, while insurance industry guidelines set a specific coverage limit of one day. According to 134 interviews reported in the March 15, 1998 Washington Post, 7 in 10 physicians said, in dealing with managed care plans, they have exaggerated the severity of an patient's condition to ``prevent him or her from being sent home from a hospital prematurely.'' Dr. David Schriger, at UCLA Medical Center in Los Angeles, said that he routinely has patients, such as a frail, elderly woman with the flu, who is not in imminent danger, but could encounter serious problems if she is sent home during the night. He told the Post, ``At this point I have to figure out a way to put her in the hospital. . . And typically, I'll come up with a reason acceptable to the insurer,'' and orders a blood test and chest x-ray, to justify admission. The Post article also cited Kaiser Permanente's Texas division which ``warned doctors in urgent care centers not to tell patients they required hospitalization, as one Kaiser administrator recalled. ``We basically said [to] the UCC doctors, `If you value your job, you won't say anything about hospitalization. All you'll say is, I think you need further evaluation . . . .''' Ms. Damico, the psychiatric nurse interviewed on NPR said, ``Our utilization review nurse gives all of us, including the doctors, good advice on how to chart so that our patients' care will be covered . . . We all conspire quietly to make certain the charts look and sound bad enough.'' The American College of Surgeons wrote: ``We believe very strongly that any health care system or plan that removes the surgeon and the patient from the medical decision-making process only undermines the quality of that patient's care and his or her health and well being . . . . specific, single numbers [of days] cannot and should not be used to represent a length of stay for a given procedure.'' (April 24, 1997) ACS on March 5 wrote, ``We believe very strongly that any health care system or plan that removes the surgeon and the patient from the medical decision making process only undermines the quality of that patient's care and his or her health and well being.'' The American Medical Association wrote on May 20, 1998, ``We are gratified that this bill would promote the fundamental concept, which the AMA has always endorsed that medical decisions should be made by patients and their physicians, rather than by insurers or legislators . . . We appreciate your initiative and ongoing efforts to protect patients by ensuring that physicians may identify medically appropriate lengths of stay, unfettered by third party payers.'' The American Psychological Association, on March 4, 1998 wrote me, ``We are pleased to support this legislation, which will require all health plans to follow the best judgment of the patient and attending provider when determining length of stay for inpatient treatment.'' Americans' faith in their medical system has plummeted as almost daily we hear of more horror stories of care denied and HMO hassles. Arbitrary insurance company rules cannot address the subtleties of medical care. A March 1998 U.S. News and Kaiser Family Foundation survey found that three in four Americans are worried about their health care coverage and half say they are worried that doctors are basing treatment decisions strictly on what insurance plans will pay for. The bill we introduce today begins to address some of these problems. I am also a cosponsor of the Patient Bills of Rights (S. 1890) and the Patient Access to Responsible Care Act (S. 644), bills proposing comprehensive reforms. I hope these initiatives will send a strong message to the health insurance industry and return medical decision-making to those medical professionals trained to make those decisions. Mr. President, I ask unanimous consent that a summary of the bill and letters in support be printed in the Record.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, I rise today in support of the India- Pakistan Relief Act, which I am cosponsoring with my colleague from Kansas. Even as we have implemented a strict regime of sanctions on India and Pakistan as called for by law, it is my belief that we must also look to the future and to creating the sort of environment which will allow the United States to engage India and Pakistan in a positive relationship and to restore stability to South Asia. To that end, this Amendment does something very simple, and something much needed. It is also something which I believe the great majority of this body supports. The Amendment provides the President with the discretion to waive the application of any sanction or prohibition, for a period of 1 year. It contains an exception for those sanctions dealing with dual-use exports or military sales, which will remain off-limits. Before the waiver authority is exercised, the President is required to consult with Congress. And, prior to the expiration of the waiver authority granted in this Amendment, the Secretary of State must report to Congress on developments in India and Pakistan. This last point is crucial. The waiver authority granted in this Amendment is limited to 1 year. Should India and Pakistan prove to be unwilling to resolve their differences--should the Secretary be unable to report on substantial and significant progress--this Amendment will sunset, and the current sanctions will go back into effect. It is my belief that the President be given flexibility to use and shape sanctions as most appropriate to attempt to create a positive and constructive environment for the resolution of political and security problems in South Asia. Our current sanctions policy does not provide for that flexibility. In fact, without this flexibility it is difficult to conceive how the United States can play a positive and constructive role in attempting to head off a potential nuclear arms race in South Asia or to restore stability to the region. Indeed, the Administration currently has a high-level delegation, headed by Deputy Secretary Talbott, en route to the region to continue talks with India and Pakistan and to continue discussions on bringing the current crisis to a close. Hopefully, this Amendment will send a positive signal to India and Pakistan that the United States is interested in working with them to resolve their problems, and will provide our negotiators with the leverage that they need if they are to have success in moving the process in a positive direction. This Amendment structures U.S. policy to secure commitments from India and Pakistan to make real and meaningful progress in rolling back the current crisis, to settle their differences, and to bring peace to South Asia. Although we do not spell out explicit conditions that India and Pakistan must meet in this Amendment, it is my hope and belief that the flexibility that this Amendment introduces will allow the Administration to work with India and Pakistan to take necessary actions to resolve their political and security differences, including ceasing any further nuclear tests; engaging in a high-level dialogue, putting confidence and security building measures in place; and, take steps to roll-back their nuclear programs and come into compliance with internationally accepted norms on the proliferation of weapons of mass destruction. Indeed, my support of this Amendment lies, in part, in my belief that this is that path that India and Pakistan themselves have indicated that they would like to pursue. Both India and Pakistan have made statements indicating that they will refrain from future testing. Both have indicated that they are prepared to consider joining the Comprehensive Test Ban Treaty. And, in a message to the Security Council on July 9, Secretary General Annan wrote that ``I have been encouraged by indications from both sides of their readiness to enter into dialogue addressing peace and security matters and causes of tension, including Kashmir.'' In South Asia today it appears to be too late to talk about preventing the capability of developing nuclear weapons. As I stated on this floor immediately following the first Indian nuclear test, the international community cannot successfully impose nonproliferation policies on South Asia. Ultimately, India and Pakistan must determine for themselves that their own interests are best served by ridding South Asia of weapons of mass destruction--and not by turning the region into a potential nuclear battleground. The United States, however, must seek ways to work with India and Pakistan to help them reach that determination. It is my belief that this Amendment serves to structure our policies to make that outcome more likely. I urge my colleagues to join me in support of this Amendment.

Mr. FEINSTEIN

Mr. FEINSTEIN. Mr. President, today Senator D'Amato, Senator Ford and I are introducing a bill to require health insurance plans to cover the length of hospital stay for any procedure or illness as determined by the attending physician, in consultation with the patient, to be medically appropriate. This bill will return medical decision-making to medical professionals because it is time to stop insurance plans' interference into this important area of physician decision-making. It is endorsed by the American Medical Association, the American College of Surgeons, the American College of Obstetricians and Gynecologists, the American Academy of Neurology and the American Psychological Association. Only a physician, taking care of the patient who understands the patient's history, medical condition and needs, can make a decision on how much hospital care a person needs. Physicians are trained to evaluate all the unique needs and problems of each individual patient. Every patient is different and the course of illness has great variation. Lengths of stay should not be determined by insurance company clerks, actuaries or non-medical personnel. It is the attending physician, not a physician or other representative of an insurance company, that should decide when to admit and discharge someone. Professional physician organizations develop practice guidelines that guide them in determining medical necessity. These are intended as guidance and are medical judgments made by qualified medical people. Physicians know what medical necessity and generally accepted medical practice are. We are introducing this bill because we have had a virtual parade of doctors come to us and in essence say, ``We are fed up. We spend too much of our time trying to justify our decisions on medical necessity to insurance companies. Insurance company rules have supplanted doctor decision making.'' Donna Damico, a nurse in a Maryland psychiatric unit of a hospital, told National Public Radio on October 1, 1997: I spend my days watching the care on my unit be directed by faceless people from insurance companies on the other end of the phone. My hospital employs a full-time nurse whose entire job is to talk to insurance reviewers. . . . The reviewer's background can range anywhere from high school graduate to nurse, social worker or even actual physicians. A number of examples have come to my attention: In 1996, we addressed the problem of ``drive-through'' baby deliveries, insurance plans covering minimal hospital stays for newborns and their mothers because of examples like this: One California new mother was readmitted after a Caesarean section because of severe anemia from excessive blood loss. She didn't know how much blood loss was normal after a delivery. Two California women were readmitted after vaginal deliveries with endometritis, an infection of the uterus. We've had examples of ``drive-through'' mastectomies, insurance plans shoving women out the door to deal on their own with drainage tubes, pain and disfigurement. S. 249, which I introduced with Senator D'Amato last year, addresses that abuse and we are trying to get it passed. A California pediatrician told us of a child with very bad asthma. The insurance plan authorized 3 days in the hospital; the doctor wanted 4-5 days. He told us about a baby with infant botulism (poisoning), a baby with a toxin that had spread from the intestine to the nervous system so that the child could not breathe. The doctor thought a 10-14 day hospital stay was medically necessary for the baby; the insurance plan insisted on one week. A California neurologist told us about a seven-year-old girl with an ear infection who went to the doctor feverish. When her illness developed into pneumonia, she was admitted to the hospital. After two days she was sent home, but she then returned to the hospital three times because her insurance plan only covered a certain number of days. The third time she returned she had meningitis which can be life threatening. The doctor said that if this girl had stayed in the hospital the first time for five to seven days, the antibiotics would have killed the infection and the meningitis would never have developed. A 27-year-old man from central California had a heart transplant and was forced out of the hospital after 4 days because his HMO would not pay for more days. He died. Nurses in St. Luke's Hospital, San Francisco, say that women are being sent home after only two nights after a hysterectomy and two nights for a Caesarean section delivery, both of which are major abdominal surgeries, even though physicians think the women are not ready to go home.. Just last week Lisa Breakey, a San Jose speech pathologist, came to my office and told us that she is providing home healthcare for stroke patients she used to see in the hospital. She sees patients in their homes who have G tubes in their stomachs for feeding and trach tubes in their throats for breathing. The trach tubes have an inflated balloon or cuff which a family members must deflate and inflate by using a needle. Family members are supposed to suction the patient's mouth and throat before they deflate the cuff. Families, she stressed, are providing intensive care, for which they are unprepared and untrained. Bedrooms have become hospital rooms. Another California physician told us about a patient who needed total hip replacement because her hip had failed. The doctor believed a seven-day stay was warranted; the plan authorized five. Rep. Greg Ganske, a physician serving in the House, told the story of a six-year-old child who nearly drowned. The child was put on a ventilator and it appeared that he would not live. The hospital got a call from the insurance company, asking if the doctor had considered sending the boy home because home ventilation is cheaper. These cases can be summarized in the comments of a Chico, California, maternity ward nurse: ``People's treatment depends on the type of insurance they have rather than what's best for them.'' As these cases illustrate, premature discharges can increase readmissions and medical complications. During the ``drive-through delivery'' debate, we heard about babies who were jaundiced and dehydrated and had to come back to the hospital. Similarly, as reported in American Medical News on March 23, 1998, according to Dr. David Phillips, ``a shift toward outpatient treatment actually has come at quite a high price . . . an increased loss of lives.'' This University of California study found that medication errors are 3 times higher among outpatients than inpatients; that medications side effects provides limited oversight by medical personnel and that the patient-physician relationships is compromised. Ms. Damico said, ``Patients return to us in acute states because their insurance will no longer pay the same amount for their outpatient treatment . . . [They] deteriorate to the point of suicidal thoughts or attempts and need to return to the hospital.'' She cited the example of a suicidal woman whose plan denied a hospital admission requested by her physician. After the doctor told her of the denial, she took twenty 50-milligram tabs of Benadryl, was then admitted, and the plan then had to pay for hospital care, an ambulance and emergency room fees. So not only do premature discharges compromise health, they ultimately cost the insurer more. Physicians say they battle daily with insurance companies to give patients the hospital care they need and to justify their decisions on medical necessity. An American Medical Association review of a managed care contract (Aetna US Healthcare) found that the contract gives ``the company the unilateral authority to change material terms of the contract and to make determinations of medical necessity . . . without regard to physician determinations or scientific or clinical protocols . . . .,'' according to the January 19, 1998 American Medical News. A study by the American College of Surgeons found that guidelines published by Milliman and Robertson and used by many insurers represent a minimum length of stay, compared with surgeons' estimates. A study by the American Academy of Neurology found that the Milliman and Robertson guidelines on length of stay are ``extraordinarily short in comparison to a large National Library of Medicine database . .. And that [the guidelines] do not relate to anything resembling the average hospital patient or attending physician . . . .'' The neurologists found that these guidelines were ``statistically developed,'' not scientifically sound or clinically relevant. A study in the April 1997 Bulletin of the American College of Surgeons found that surgeons stated that the appropriate length of stay for an appendectomy is zero to five days, while insurance industry guidelines set a specific coverage limit of one day. According to 134 interviews reported in the March 15, 1998 Washington Post, 7 in 10 physicians said, in dealing with managed care plans, they have exaggerated the severity of an patient's condition to ``prevent him or her from being sent home from a hospital prematurely.'' Dr. David Schriger, at UCLA Medical Center in Los Angeles, said that he routinely has patients, such as a frail, elderly woman with the flu, who is not in imminent danger, but could encounter serious problems if she is sent home during the night. He told the Post, ``At this point I have to figure out a way to put her in the hospital. . . And typically, I'll come up with a reason acceptable to the insurer,'' and orders a blood test and chest x-ray, to justify admission. The Post article also cited Kaiser Permanente's Texas division which ``warned doctors in urgent care centers not to tell patients they required hospitalization, as one Kaiser administrator recalled. ``We basically said [to] the UCC doctors, `If you value your job, you won't say anything about hospitalization. All you'll say is, I think you need further evaluation . . . .''' Ms. Damico, the psychiatric nurse interviewed on NPR said, ``Our utilization review nurse gives all of us, including the doctors, good advice on how to chart so that our patients' care will be covered . . . We all conspire quietly to make certain the charts look and sound bad enough.'' The American College of Surgeons wrote: ``We believe very strongly that any health care system or plan that removes the surgeon and the patient from the medical decision-making process only undermines the quality of that patient's care and his or her health and well being . . . . specific, single numbers [of days] cannot and should not be used to represent a length of stay for a given procedure.'' (April 24, 1997) ACS on March 5 wrote, ``We believe very strongly that any health care system or plan that removes the surgeon and the patient from the medical decision making process only undermines the quality of that patient's care and his or her health and well being.'' The American Medical Association wrote on May 20, 1998, ``We are gratified that this bill would promote the fundamental concept, which the AMA has always endorsed that medical decisions should be made by patients and their physicians, rather than by insurers or legislators . . . We appreciate your initiative and ongoing efforts to protect patients by ensuring that physicians may identify medically appropriate lengths of stay, unfettered by third party payers.'' The American Psychological Association, on March 4, 1998 wrote me, ``We are pleased to support this legislation, which will require all health plans to follow the best judgment of the patient and attending provider when determining length of stay for inpatient treatment.'' Americans' faith in their medical system has plummeted as almost daily we hear of more horror stories of care denied and HMO hassles. Arbitrary insurance company rules cannot address the subtleties of medical care. A March 1998 U.S. News and Kaiser Family Foundation survey found that three in four Americans are worried about their health care coverage and half say they are worried that doctors are basing treatment decisions strictly on what insurance plans will pay for. The bill we introduce today begins to address some of these problems. I am also a cosponsor of the Patient Bills of Rights (S. 1890) and the Patient Access to Responsible Care Act (S. 644), bills proposing comprehensive reforms. I hope these initiatives will send a strong message to the health insurance industry and return medical decision-making to those medical professionals trained to make those decisions. Mr. President, I ask unanimous consent that a summary of the bill and letters in support be printed in the Record.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. The bill uses the language, ``academic content areas in which the teachers plan to teach.'' I am concerned that this would limit grants to programs that train teachers pursuing certain academic majors, such as biology or history or French. My concern is that individuals in teacher preparation courses preparing to teach in the elementary grades might be excluded. Students in preparation to teach at the elementary level would not have an academic major, in the traditional sense that is directly related to the subject that they plan to teach, in part because elementary teachers teach all subjects. Yet, I'm sure we all agree that strong teaching, particularly the teaching of reading and math at the elementary level, in the primary grades, is critical. It is fundamental to a student's educational success in the subsequent grades. Do you not agree?

Mrs. FEINSTEIN. I would like to engage in a colloquy with the bill's manager, Senator Jeffords. In Title II, Improving Teacher Quality, the bill authorizes the Secretary of Education to award grants to states to reform teacher preparation and, on page 363, lines 13-15, ``to ensure that current and future teachers posses the necessary teaching skills and academic content knowledge in the subject areas in which the teachers are assigned to teach.'' In (1) beginning on lines 18, the bill includes as an authorized activity that can be funded by a grant, ``reforms that hold institutions of higher education with teacher preparation programs accountable for preparing teachers who are highly competent in the academic content areas in which teachers plan to teach, which may include the use of rigorous subject matter competency tests and the requirement that a teacher have an academic major in the subject area, or related discipline, in which the teacher plans to teach.'' I commend the committee for these provisions and believe they will be very helpful in training good teachers. Could the gentleman clarify a point for me?

Mrs. FEINSTEIN. And so, could you clarify that these funds could be used for teacher preparation programs preparing teachers to teach in elementary and secondary schools, in particular elementary reading and mathematics?

Mrs. FEINSTEIN

Mrs. FEINSTEIN. I thank the clerk. Mr. President, this amendment is sent to the desk on behalf of Senator Boxer and myself. Essentially, what this amendment would do is authorize the U.S. Secretary of Education to award, on a case-by-case basis, Pell grants for students taking a 5th year of postbaccalaureate teacher education courses in order to get a teaching credential in a State that requires a 5th year. This was brought to my attention, Mr. President, by the new chancellor of the California State University, Dr. Charles B. Reed. I want to just read an opening paragraph. When I came to the California State University in March of this year, I established as a top system priority strengthening and improving the quality of our teacher preparation programs. Over the next decade, in California alone, we will need an additional 250,000 new K-12 classroom teachers. In addition to our changing demographics, the shortage of teachers in California is particularly acute due to the State's classroom size reduction initiative. . . . The Governor of our State has quite rightly determined that K through 3 should have class sizes of not more than 20 students per teacher. This is a real improvement and, of course, it will mean that more teachers will be necessary in the future. Additionally, there is an extraordinarily large number of teachers who are due to retire over the next 10 to 20 years. Mr. President, I ask unanimous consent to have that letter printed in the Record at the end of my statement.

Mrs. FEINSTEIN. Mr. President, I join with those who have congratulated the committee for what I consider to be really a fine higher education bill. I want to extend my personal congratulations, representing Californians, both to the chairman and the ranking member of this committee. This is a bill that really meets the needs of the day with respect to higher education. And I think we can all, hopefully, support it with great pride and enthusiasm. I have been very involved in education in California because I have seen this great State, once in the lead, sink to below mediocrity in terms of its K-through-12 education system. And there are many reasons for it that the Federal Government cannot control, decisions that have to be made by the State itself, such as eliminating social promotion, setting specific standards of achievement for students in each of the grades, no-nonsense tests, remedial programs, and so on. But one thing the Federal Government can do is provide funds to help with the development of good teachers. And that is what this bill does and does so well. I want to bring to the attention of the Senate one anomaly which the amendment I am about to send to the desk seeks to address. And that is that in the Pell grant program, there are two States that require a 5th year of teacher education. One of those States is New Hampshire; the other State is California. New Hampshire provides the 5th year before the baccalaureate degree and California requires the 5th year after the baccalaureate degree, ergo, California's higher education students are not currently eligible for Pell grants. And so, if I may, I send an amendment to the desk.