ITTLE ROCK, Ark. - Continuing his attack on the Republican Party leadership, Vice President Al Gore yesterday wagged an accusing finger at opponent George W. Bush, holding the Texas governor accountable for Congress's failure to pass a patients' bill of rights.
''If he is willing to pick up the phone and call the leadership of Congress, he can help us pry loose that one last Republican vote'' to approve the legislation, Gore told doctors, nurses and health care professionals at the University of Arkansas for Medical Sciences.
With the Senate having come as close as one vote to passing the Democrat-sponsored patients' bill of rights, Bush, as the ''titular head'' of the Republican Party, can make it happen, Gore said in an appearance on NBC's ''Today'' show in New York yesterday morning.
Bush campaign spokesman Dan Bartlett countered that Gore was refusing to take responsibility for ''his own failure to provide leadership in Congress.''
Gore listened to several stories from doctors about cases in which patients did not get the care the doctors thought was needed because a health maintenance organization or insurance company refused coverage. Gore was clearly familiar with the details of the stories he heard from the physicians.
In one case, recounted by Denise Greenwood, a breast cancer surgeon, a low-income patient had to have her entire breast removed, instead of just a localized mass, because her insurance company wouldn't pay for the test needed to determine how far the cancer had spread.
Without that knowledge, Greenwood said, she was forced to remove the entire breast - only to find out later that the cancer was, in fact, localized.
''Had I been able to confirm to the woman that she had a localized disease, she would have her breast today,'' Greenwood said.
The legislation would give patients and doctors greater power to challenge decisions made by their HMOs. Republicans on Capitol Hill have backed a less sweeping bill, which Gore called ''phony.'' The Republican bill would not protect people from financial penalty for using emergency care services, Gore said, and it would not guarantee patients access to specialized care.
''That is not a patients' bill of rights,'' Gore said. ''It is a blank check for the insurance industry to keep on doing what's wrong.''
The HMO horror stories follow a theme that Gore has been pushing for the past few weeks. He has been painting himself as a populist fighting the ''special interests'' he says are bankrolling the Republican Party.
The vice president's campaign has been methodical in getting out that message, moving from an attack on pharmaceutical companies to a denouncement of the oil industry to the recurring theme of HMO administrators concerned more about finances than first-rate patient care.
Rarely does the meticulously scheduled Gore campaign lapse into the unplanned. That protects Gore from unwelcome surprises, but also leaves him vulnerable to an image as stiff and scripted.
The vice president's campaign staff was clearly pleased yesterday at a spontaneous Gore moment, when the vice president presented muffins to no-nonsense Judge Judy, the television jurist.
The judge, whose full name is Judy Sheindlin, appeared after Gore on ''Today'' yesterday morning and complained to host Matt Lauer that she didn't get her breakfast muffins because Gore had ''taken over the green room,'' the waiting area for guests.
''Nobody's ever taken over the green room before,'' bellowed Sheindlin, who was promoting her new book, ''Keep It Simple, Stupid.''
''I think the vice president ought to get me a muffin,'' Sheindlin insisted, her words blaring through a loudspeaker to the street outside the studio, where Gore was shaking hands with a crowd of people. ''I think he ought to get me a dozen muffins if he wants my vote.''
Gore went back into the studio, had a staff member retrieve a tray of muffins from the green room, and approached the set, behind the still-complaining Sheindlin.
Lauer noted to Sheindlin that her words carried a lot of power. As if on cue, Gore then strode in front of the cantankerous judge, bent down on one knee, and offered her the muffins.
''Does he have your vote?'' Lauer asked.
''We're going to have to talk about that later,'' Sheindlin said.
