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Local reaction to approval of bill of rights by Cindy A. Abole  Public Relations Not even July's temperatures rivaled the heated discussion within the Capitol's chambers which led up to the Senate's adoption of a new patient's rights legislation.           In a close vote, 53-47, the Senate approved the GOP's version of the patients' bill of rights on July 15. President Clinton has threatened to veto the bill and the issue now moves to the House for further debate and approval.    “It's been a complicated issue,” said R. Duren Johnson Jr., M.D., chairman of the board, South Carolina Medical Association's (SCMA) Board of Trustees. “The outcome has made us ask, who's in control? Is it the physician, patient, health care provider or any combination of these which make the ultimate decision regarding a patient's health care?”           For four days, members of the Senate discussed and debated key measures that would give patients basic protections under health maintenance organizations or HMOs and other managed care plans.   It was hoped that the health care debate would result in legislation that would help level the playing field between patients, physicians and insurance companies.            Daniel W. Brake, M.D., an SCMA member and American Medical Association delegate from Summerville, can predict no real changes concerning the bill's passage. “Its been more politcking and political gridlock and nothing for the American people.”           At the heart of the debate was passage of a Republican amendment which prevents patients from suing their HMOs.    Skeptics feared an increase in legal suits would lead to a possible rise in insurance premium costs, thus increasing the number of uninsured Americans.   “It's interesting how our society holds doctors responsible for the care of patients,” said Brake. “This main issue created many dividing points between parties. With decision-making being so important for patients, is it really good medicine?”           Other Republican-backed measures adopted by the Senate include $13 billion in tax breaks, including bigger tax-free health care savings accounts and full deductibility of health insurance premiums; patient access to limited specialist care; and extended hospital stays for women undergoing mastectomies.           Debate over the patients' bill of rights leads a list of topics scheduled for next week's July SCMA board meeting in Columbia. The mood is expected to be spirited.          The SCMA represents physicians and specialists from other medical specialties and subspecialties throughout 46 counties around the state. Since organized medicine, SCMA has supported its own version of the patients' bill of rights.    In July 1998, Gov. David Beasley signed into law the Patients' Insurance and Benefits Protection Act which addresses specific statewide health care concerns.   “For South Carolina physicians, our aim will be to seek consensus by finding a common ground as it applies to taking care of our own,” Johnson said. “Its all about taking care of sick people.” SCMA Patients’ Bill of Rights 1. The patient should be given a full explanation of benefits offered by the managed care  organization, as well as an explanation of restrictions and limitations in the plan. 2. The managed care and insurance industries should develop plan descriptions that detail benefits available under the plan in language easily understood by the average patient. Additionally, patients should be made aware of plan restriction on choosing their physician  or hospital and limitations on treatment options, hospital stays, and financial incentives employed by the managed care organization.  3. The patient should be given full disclosure about the relationship of the managed care  organization, physicians, and hospitals. Managed care and hospitals for limiting care  provided patients should fully disclose these financial rewards to the patient. 4. There should be no restrictions on the ethical obligation of the physician to fully discuss the availability of diagnostic and treatment options as well as providing information to the patient about medical specialists. Restrictions on medicine are unethical and cannot be tolerated. Any attempt at gagging the physician’s duty to advocate the patient’s best medical interests should be immediately stopped. 5. The patient should be given a choice of an affordable point-of-service option at the time of enrollment. Ethically, a patient’s choice is an inalienable right. Patients should, at the time of enrollment, and for 30 days thereafter, be given the privilege of purchasing, with their own funds, a point-of-service option that allows patients to see the physician of their choice. 6. The patient should be provided a procedure to appeal decisions by a managed care organization that deny access to services, and there should be no retaliation against a patient for utilizing this process. Disagreements between managed care organizations and patients concerning access to treatment should be resolved through an appeals process, and there should be a guarantee of no retaliation against a patient who chooses to utilize this process. 7. Patients should be given sufficient notice when their physician is dismissed from the managed care organization. Patients develop trust in physicians and hospitals and  interruption of this trust is a serious matter. Patients should always have ample notice of a disruption of the physician-patient relationship. 8. Patients should be given names and addresses of regulatory agencies capable of interceding when disputes between managed care organizations and patients cannot be reconciled. The names and addressed of regulatory agencies, such as the South Carolina Department of Insurance and the Department of Health and Environmental Control, should be made available to patients seeking redress of their complaints about their managed care organization.