<DOC>
[109th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:24248.wais]
ASSESSING PUBLIC HEALTH AND THE DELIVERY OF CARE IN THE WAKE OF KATRINA
=======================================================================
JOINT HEARING
before the
SUBCOMMITTEE ON HEALTH
and the
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
of the
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
SEPTEMBER 22, 2005
__________
Serial No. 109-50
__________
Printed for the use of the Committee on Energy and Commerce
Available via the World Wide Web: http://www.access.gpo.gov/congress/
house
__________
U.S. GOVERNMENT PRINTING OFFICE
24-248PDF WASHINGTON : 2005
_____________________________________________________________________________
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COMMITTEE ON ENERGY AND COMMERCE
JOE BARTON, Texas, Chairman
RALPH M. HALL, Texas JOHN D. DINGELL, Michigan
MICHAEL BILIRAKIS, Florida Ranking Member
Vice Chairman HENRY A. WAXMAN, California
FRED UPTON, Michigan EDWARD J. MARKEY, Massachusetts
CLIFF STEARNS, Florida RICK BOUCHER, Virginia
PAUL E. GILLMOR, Ohio EDOLPHUS TOWNS, New York
NATHAN DEAL, Georgia FRANK PALLONE, Jr., New Jersey
ED WHITFIELD, Kentucky SHERROD BROWN, Ohio
CHARLIE NORWOOD, Georgia BART GORDON, Tennessee
BARBARA CUBIN, Wyoming BOBBY L. RUSH, Illinois
JOHN SHIMKUS, Illinois ANNA G. ESHOO, California
HEATHER WILSON, New Mexico BART STUPAK, Michigan
JOHN B. SHADEGG, Arizona ELIOT L. ENGEL, New York
CHARLES W. ``CHIP'' PICKERING, ALBERT R. WYNN, Maryland
Mississippi, Vice Chairman GENE GREEN, Texas
VITO FOSSELLA, New York TED STRICKLAND, Ohio
ROY BLUNT, Missouri DIANA DeGETTE, Colorado
STEVE BUYER, Indiana LOIS CAPPS, California
GEORGE RADANOVICH, California MIKE DOYLE, Pennsylvania
CHARLES F. BASS, New Hampshire TOM ALLEN, Maine
JOSEPH R. PITTS, Pennsylvania JIM DAVIS, Florida
MARY BONO, California JAN SCHAKOWSKY, Illinois
GREG WALDEN, Oregon HILDA L. SOLIS, California
LEE TERRY, Nebraska CHARLES A. GONZALEZ, Texas
MIKE FERGUSON, New Jersey JAY INSLEE, Washington
MIKE ROGERS, Michigan TAMMY BALDWIN, Wisconsin
C.L. ``BUTCH'' OTTER, Idaho MIKE ROSS, Arkansas
SUE MYRICK, North Carolina
JOHN SULLIVAN, Oklahoma
TIM MURPHY, Pennsylvania
MICHAEL C. BURGESS, Texas
MARSHA BLACKBURN, Tennessee
Bud Albright, Staff Director
David Cavicke, Deputy Staff Director and General Counsel
Reid P.F. Stuntz, Minority Staff Director and Chief Counsel
______
Subcommittee on Health
NATHAN DEAL, Georgia, Chairman
RALPH M. HALL, Texas SHERROD BROWN, Ohio
MICHAEL BILIRAKIS, Florida Ranking Member
FRED UPTON, Michigan HENRY A. WAXMAN, California
PAUL E. GILLMOR, Ohio EDOLPHUS TOWNS, New York
CHARLIE NORWOOD, Georgia FRANK PALLONE, Jr., New Jersey
BARBARA CUBIN, Wyoming BART GORDON, Tennessee
JOHN SHIMKUS, Illinois BOBBY L. RUSH, Illinois
JOHN B. SHADEGG, Arizona ANNA G. ESHOO, California
CHARLES W. ``CHIP'' PICKERING, GENE GREEN, Texas
Mississippi TED STRICKLAND, Ohio
STEVE BUYER, Indiana DIANA DeGETTE, Colorado
JOSEPH R. PITTS, Pennsylvania LOIS CAPPS, California
MARY BONO, California TOM ALLEN, Maine
MIKE FERGUSON, New Jersey JIM DAVIS, Florida
MIKE ROGERS, Michigan TAMMY BALDWIN, Wisconsin
SUE MYRICK, North Carolina JOHN D. DINGELL, Michigan,
MICHAEL C. BURGESS, Texas (Ex Officio)
JOE BARTON, Texas,
(Ex Officio)
(ii)
Subcommittee on Oversight and Investigations
ED WHITFIELD, Kentucky, Chairman
CLIFF STEARNS, Florida BART STUPAK, Michigan
CHARLES W. ``CHIP'' PICKERING, Ranking Member
Mississippi DIANA DeGETTE, Colorado
CHARLES F. BASS, New Hampshire JAN SCHAKOWSKY, Illinois
GREG WALDEN, Oregon JAY INSLEE, Washington
MIKE FERGUSON, New Jersey TAMMY BALDWIN, Wisconsin
MICHAEL C. BURGESS, Texas HENRY A. WAXMAN, California
MARSHA BLACKBURN, Tennessee JOHN D. DINGELL, Michigan,
JOE BARTON, Texas, (Ex Officio)
(Ex Officio)
(iii)
C O N T E N T S
__________
Page
Testimony of:
Blakeney, Barbara, President, American Nurses Association.... 86
Cappiello, Joe, Vice President, Accreditation Field
Operations, Joint Commission on Accreditation of Healthcare
Organizations.............................................. 74
Dufour, Bob, Vice President, Pharmacy Services, Wal-Mart,
Inc. on Behalf of National Association of Chain Drug Stores 79
Gerberding, Julie, Centers for Disease Control, Department of
Health and Human Services.................................. 25
Hoven, Ardis, Member, Board of Trustees, American Medical
Association................................................ 70
Kirsch, Thomas, American Red Cross........................... 59
Peters, Mark, President and CEO, East Jefferson Memorial
Hospital, on Behalf of American Hospital Association....... 64
Simmons, Bernard, Chair, National Association of Community
Health Centers, Inc........................................ 72
(v)
ASSESSING PUBLIC HEALTH AND THE DELIVERY OF CARE IN THE WAKE OF KATRINA
----------
THURSDAY, SEPTEMBER 22, 2005
House of Representatives,
Committee on Energy and Commerce,
Subcommittee on Health, and the
Subcommittee on Oversight and Investigations,
Washington, DC.
The subcommittee met, pursuant to notice, at 9:35 a.m., in
room 2123, Rayburn House Office Building, Hon. Nathan Deal
(chairman of the Subcommittee on Health) and Hon. Ed Whitfield
(chairman of the Subcommittee on Oversight and Investigations)
presiding.
Members present, Subcommittee on Health: Representatives
Deal, Hall, Bilirakis, Upton, Gillmor, Shimkus, Shadegg, Pitts,
Ferguson, Burgess, Barton (ex officio), Brown, Waxman, Gordon,
Rush, Eshoo, Strickland, DeGette, Capps, Allen, and Dingell (ex
officio).
Members present, Subcommittee on Oversight and
Investigations: Representatives Whitfield, Stearns, Ferguson,
Burgess, Blackburn, Barton (ex officio), Stupak, DeGette,
Schakowsky, Inslee, Baldwin, Waxman, and Dingell (ex officio).
Staff present: Bud Albright, staff director; Chuck Clapton,
chief health counsel; Brandon Clark, policy coordinator;
Melissa Bartlett, majority health counsel; David Rosenfeld,
majority health counsel; Nandan Kenkeremath, majority health
counsel; Mark Paoletta, chief oversight and investigations
counsel; Andrew Snowdon, oversight and investigations counsel;
Chad Grant, health legislative clerk; Jonathan Pettibon,
oversight and investigations clerk; Michael Abraham, oversight
and investigations clerk; Edith Holleman, minority professional
staff; Voncille Hines, minority research assistant; Jessica
McNiece, minority research assistant; John Ford, minority
professional staff; Chris Knauer, minority professional staff;
Amy Hall, minority professional staff; Bridgett Taylor,
minority professional staff; Purvee Kempf, minority
professional staff; and Chris Treanor, minority intern.
Mr. Deal. Good morning. The subcommittees will come to
order.
As everyone is now aware, Hurricane Katrina devastated the
lives of countless thousands of people living along America's
Gulf Coast and decimated much of the public health structure in
the areas that were hit by the hurricane.
The purpose of today's hearing is to focus on the current
situation on the ground in terms of public health and the
health delivery infrastructure, and to focus on how we can
improve our preparation and response to similar natural
disasters in the future.
A broad list of public and private sector organizations are
working together in efforts to improve the lives of people
affected by Hurricane Katrina, and I am proud to say that many
of these groups are represented here today on our panels.
We have two panels of witnesses appearing before us, and I
believe they certainly can help shed light on the current
situation in the affected areas and on the direction we need to
take in the future to lessen the impact of similar natural
disasters.
We look forward to hearing the testimony of both panels,
and on behalf of the American people, we applaud you and the
efforts that you have made in light of the Katrina disaster.
I would also like to thank my good friend from Kentucky,
Mr. Whitfield, and his staff on the Oversight and
Investigations Subcommittee, for joining me and my staff in
preparing and conducting today's hearing; and we will
alternate. Since this is a joint meeting of both subcommittees,
I'll be presiding over the first panel and then I will turn the
gavel over to Mr. Whitfield at that time for his presiding over
the second panel.
We, of course, are all aware that Hurricane Katrina is not
maybe the last on our list of hurricanes to be concerned about
today. We originally, of course, had scheduled to have Stewart
Simonson, the Assistant Secretary of the Office of Public
Health Emergency Preparedness, with us, but in light of the
fact that as of about 6:50 last night the National Weather
Service announced that Hurricane Rita was the third most
intense hurricane on record and was apparently headed for the
Texas and Louisiana coast, and had been categorized as a
Category 5 hurricane. And warnings had been issued, and I
think--my understanding is, approximately 1.3 million people in
the States of Louisiana and Texas have been ordered to
evacuate.
Certainly in light of that and in light of his capacity in
that regard, he has asked that he be allowed to attend to that
emergency rather than a hearing here before these
subcommittees; and certainly we have consented to that. We want
him to be where he needs to be to do his job, and that is the
reason for his absence.
But we are pleased to have Dr. Gerberding, who is the
remaining panel member for the first panel.
[The prepared statement of Hon. Nathan Deal follows:]
Prepared Statement of Hon. Nathan Deal, Chairman, Subcommittee on
Health
The Committee will come to order, and the Chair recognizes himself
for an opening statement.
At 6:50 p.m. last night, the National Weather Service announced
that Hurricane Rita became the third most intense hurricane on record.
As a storm-weary Gulf Coast braced for another hit, Rita grew in
strength with frightening speed, becoming a 165-mph, Category 5
nightmare in a matter of mere hours. A hurricane warning has been
issued from Port Mansfield, Texas, to Cameron, Louisiana, prompting
more than 1.3 million people in the states of Texas and Louisiana to be
ordered to evacuate by authorities who have learned painful lessons in
the wake of Hurricane Katrina.
Hurricane Katrina devastated the lives of countless thousands of
people living along America's Gulf Coast and decimated most of the
public-health infrastructure in the areas hit by the hurricane. The
purpose of today's hearing is to focus on the current situation on the
ground in terms of public health and health delivery infrastructure and
to focus on how we can improve our preparation and response to similar
natural disasters in the future.
A broad list of public and private sector organizations are working
together on efforts to improve the lives of the people affected by
Hurricane Katrina, and I am proud to say that many of these groups are
represented here today. We have two expert panels of witnesses
appearing before us this morning that I believe will help shed some
light on current situation in the affected areas and on the direction
we need to take in the future to lessen the impact of similar natural
disasters. We look forward to hearing your testimony, and on behalf of
the American people, we applaud you for your efforts.
I would also like to thank my good friend from Kentucky, Mr.
Whitfield, and his staff on the Oversight and Investigations
Subcommittee for joining me in preparing and conducting today's
hearing, and I now recognize him for five minutes for the purpose of
making an opening statement.
Mr. Deal. At this time I will turn to my colleague from
Ohio, the ranking member of the Health Subcommittee, Mr. Brown,
for his opening statement.
Mr. Brown. Thank you, Mr. Chairman.
Welcome, Dr. Gerberding, back to our subcommittee.
Hurricane Katrina has left Americans with more questions
than answers. We want to know how to respond, we want to know
what happened, we want to know what could have been done
better, we want to know how to prevent such catastrophic
effects in the future.
The public health arena is no exception. We see the images
emerging from the Gulf Coast, we hear the stories and watch the
death toll grow, we wonder what we could have done to save
people trapped by illness or by infirmity.
As policymakers, we must temper our grief with the firm
resolve to understand what happened and correct our mistakes.
That will no doubt prove a challenge. It is not enough to be
ready for another Katrina. Preparedness for one type of
disaster does not translate into preparedness for another; we
learned that the hard way. It is not enough to look at short-
term needs; we must look at long-term investment.
This Nation has not only witnessed the traumatic effects of
Katrina, we've witnessed--if only for a few days, we've
witnessed the insidious effects of poverty. We're paying a
steep price for neglecting basic government functions, for
ignoring the hardships around us.
Public safety is not an option; it's an imperative. When
tax cuts trump public safety, when tax cuts trump public
safety, government is shirking its most basic responsibility.
That is short-sighted.That's reckless. We need to invest in CDC
and FEMA and HRSA and other agencies that promote public health
and safety. This Congress learned that the hard way.
Impoverished communities in a wealthy nation are not an
inconvenient reality; they are a failure of government. We need
to invest in the services that help Americans bounce back after
a crisis and build better lives, services like Medicaid, like
food stamps, like public education. It would be easy to ignore
that piece of the Katrina puzzle; it would also be unethical.
I hope this hearing answers a number of questions about the
response to Katrina and what needs to be done before the next
disaster strikes. And the resources that we've allocated in the
past, for example to HHS for bioterrorism preparedness, proved
useful in responding to Hurricane Katrina. What did Katrina
teach us about preparedness for other disasters, not just from
floods of another hurricane, but from a pandemic flu outbreak,
from a bioterror nuclear attack.
What is a realistic timeframe for crafting an effective
disaster response, one flexible enough to accommodate a range
of possible disasters in our Nation's geographic, demographic,
and socioeconomic diversity?
As we consider these questions, it is important to remember
the other public health issue left unconsidered. We can't
ignore Medicaid and claim--not to mention cut Medicaid--and
claim to be stewards of the public health. Public health rests
in prevention, it rests in detection, it rests in treatment.
Medicaid means treatment for Katrina victims and for millions
of others in need.
What are we going to do to ensure access to Medicaid for
Katrina's victims when their home States were already in crisis
prior to Katrina, and their host States were overwhelmed prior
to Katrina? The Bush administration has graciously agreed to
ensure that Mississippi and Alabama and Louisiana pick up the
tab if one of their residents seeks health care in a host
State. Coupled with the President's desire to cut Medicaid $10
billion and continue to pursue more tax cuts, that's not
hurricane relief, it's a collection service.
In a democratic society, every member is equally important.
The government's role is to promote society as a whole by
protecting and empowering every member. Katrina forced us to
acknowledge that government is not doing its job.
I am pleased the Energy and Commerce Committee is taking a
step to move in the right direction.
Thank you, Mr. Chairman.
Mr. Deal. I now recognize the chairman of the Oversight and
Investigations Subcommittee, Mr. Whitfield from Kentucky, for
his opening statement.
Mr. Whitfield. Mr. Chairman, thank you very much. And I
want to thank you and your staff for proceeding with this
hearing with Oversight and Investigations. We welcome the
opportunity to work with you on this critical issue.
The extent of Katrina's devastation has been truly
unimaginable, and the impact of the storm, we know, will be
felt for years to come.
Just as Katrina's winds and floodwaters tore apart homes
and lives, they also exposed numerous vulnerabilities that must
be identified and remedied so that the next disaster does not
have such tragic consequences.
The Oversight and Investigation Subcommittee has a long
history of tackling important public health issues. We've had
oversight work on such issues as bioterror preparedness, the
safety of the U.S. Blood supply in the wake of 9/11, readiness
questions posed by the SARS outbreak, and the availability and
safety of vaccines, among others.
Unfortunately, the devastation wrought by Katrina has
spawned an array of public health and health care issues that
are unprecedented in their scope and magnitude. Our Federal
public health authorities face an enormous task and complex
task not only with this vital step to deliver care and supplies
to those in need, but the equally important task of rebuilding
infrastructure and ensuring the future habitability of New
Orleans and the devastated Gulf Coast communities.
Many aspects of this undertaking will require congressional
oversight, and we intend to embark upon an ambitious schedule
of hearings, examining key public health and emergency
management issues involved in the Katrina response and
rebuilding effort. For example, we will seek to learn about the
evacuation of health care facilities, as well as the public
health and cleanup problems presented by environmental
contaminants.
We will also be focusing on how departments and agencies
within the committee's jurisdiction plan to spend and monitor
their respective portions of the billions of dollars going to
the Gulf Coast region, in order to ensure the money be spent as
efficiently and effectively as possible.
Today's hearing will focus on the critical issue of
Katrina's catastrophic impact upon the health care
infrastructure of the Gulf Coast. Hospitals, clinics and
community health centers throughout the region have been
severely damaged or destroyed. Moreover, contaminated flood
waters, toxic mold, an incalculable amount of debris are just a
few of the public health problems that confront the devastated
region both today and for the foreseeable future.
Our witnesses today will speak to these issues and to the
state of affairs on the ground as well as what we might expect
in the months and years ahead. At the outset, I want to thank
Dr. Gerberding for taking the time to be here in the midst of
what must be an exhausting schedule, and we look forward to
your testimony and those of all the witnesses.
And I yield back the balance of my time.
[The prepared statement of Hon. Ed Whitfield follows:]
Prepared Statement of Hon. Ed Whitfield, Chairman, Subcommittee on
Oversight & Investigations
Thank you, Mr. Chairman. The Oversight and Investigations
Subcommittee certainly welcomes the opportunity to work with you on
this critical issue. I would like to express my deepest sympathies for
all of the individuals in the Gulf Coast region affected by Hurricane
Katrina--a disaster of epic proportions. The extent of Katrina's
devastation is truly unimaginable, and the impact of this storm will be
felt for years to come.
Just as Katrina's winds and flood waters tore apart homes and
lives, they also exposed numerous vulnerabilities that must be
identified and remedied so that the next disaster--and there will be a
next disaster--does not have such tragic consequences. Katrina should
serve as a wake-up call to all agencies and departments at all levels
of government, and I have no intention of allowing this call to go
unanswered.
The Oversight & Investigations Subcommittee has a long history of
tackling important public health issues. In recent years, it has been
at the forefront of efforts to ensure the nation's public health
infrastructure can manage emerging threats--with oversight work on such
issues as bio-terror preparedness; the safety of the U.S. blood supply
in the wake of 9/11; readiness questions posed by the SARS outbreak;
and the availability and safety of vaccines, among others.
Unfortunately, the devastation wrought by Katrina has spawned an
array of public health and healthcare issues that are unprecedented in
their scope and magnitude. Our federal public health authorities face
an enormous and complex task, not only with the vital steps to deliver
care and supplies to those in need, but the equally important task of
rebuilding infrastructure and ensuring the future habitability of New
Orleans and the devastated Gulf Coast communities.
Many aspects of this undertaking will require Congressional
oversight. It is our obligation to make certain that people are getting
the care and help necessary to put their lives back together.
Accordingly, over the course of the next several weeks and months, this
Subcommittee intends to embark upon an ambitious schedule of hearings--
examining key public health and emergency management issues involved in
the Katrina response and rebuilding effort.
For example, we'll seek to learn more about the evacuation of
healthcare facilities, as well as the public health and clean up
problems presented by environmental contaminants. We will also focus on
how departments and agencies within the Committee's jurisdiction plan
to spend and monitor their respective portions of the billions of
dollars going to the Gulf Coast region, in order to ensure the money is
spent as efficiently and effectively as possible.
Today's hearing will focus on the critical issue of Katrina's
catastrophic impact upon the healthcare infrastructure of the Gulf
Coast. Hundreds of thousands of people have been displaced, a great
many of whom have been separated from their medicines, healthcare
providers, and medical records. Hospitals, clinics, and community
health centers throughout the region have been severely damaged or
destroyed. Moreover, contaminated flood waters, toxic mold, and
incalculable amounts of debris are just a few of the public health
problems that confront this devastated region both today and for the
foreseeable future. Our witnesses today will speak to these issues and
to the state of affairs on the ground, as well as what we might expect
in the months and years ahead.
At the outset, I would like to thank Dr. Gerberding for taking the
time to be here in the midst of what must be an exhausting schedule.
While we certainly do not want to do anything that might interfere with
the relief effort, it is essential that we hear from those who are most
knowledgeable about the situation on the Gulf Coast and in New Orleans
in a timely manner.
With that, let me welcome all the witnesses. I look forward to an
informative hearing and yield back the remainder of my time.
Mr. Deal. I thank the gentleman.
I now recognize the ranking member of the Oversight and
Investigations Subcommittee, Mr. Stupak, for his opening
statement.
Mr. Stupak. Well, I thank both of the chairmen for holding
this hearing on health care and Hurricane Katrina. I also want
to thank all the witnesses for testifying today, many of them
on very short notice.
This is a critical issue, both in terms of what went wrong
in preparing for and responding to the hurricane, and how the
health care infrastructure of the affected areas of the Gulf
Coast is going to be rebuilt and who is going to pay for it.
I am, however, very disappointed that the Department of
Health and Human Services yesterday, at the last minute, pulled
Stewart Simonson from testifying in front of us today. Mr.
Simonson is a lawyer, who is head of the Office of Public
Health Emergency Preparedness within HHS. His office, on paper
at least, is responsible for putting in place a health care
system that would work during a major disaster.
Mr. Simonson could be called the Michael Brown of HHS
because, like Mr. Brown, he has scant experience in public
health and emergency preparedness. He was legal counsel for
Governor Tommy Thompson in Wisconsin, and then worked for
Amtrak before receiving an appointment to serve in HHS as
counsel to the Secretary, and then to his current role.
He is best known to the public for two recent faux pas: his
attempt this summer to stop publication of the paper on the
insecurity of the milk supply, and his statements to Senator
Grassley about the effectiveness of an untested Anthrax
vaccine. Senator Grassley later forced a public retraction of
that statement. His lack of experience showed in his office's
actions during Hurricane Katrina.
For example, I would like to have asked Mr. Simonson if he
was the HHS official that held up for several days a FEMA
contract with Kenyon International Emergency Services to
recover bodies in New Orleans because he wanted a chaplain to
retrieve each one of them. As a result, body retrieval was
further delayed. And I would have liked to ask him why HHS was
unable to mobilize 40 250-bed emergency medical shelters,
called the ``Federal medical contingency stations,'' that were
promised to the Gulf Coast.
On August 30, after Katrina hit land and the levees were
breaking, Mr. Simonson told health care leaders, and I quote,
``We do not have all the assets and supplies which are needed
to stage up these facilities; and so we are, at this very
moment, in the market purchasing necessary supplies,
medication, consumables, cots, IV poles, all the things like
that to go into health care,'' end of quote. What have we been
doing with all this preparedness money and training if HHS had
to purchase supplies after the hurricane hit?
Mr. Chairman, let me conclude by saying that there are many
other issues involving Katrina that the Oversight and
Investigations Subcommittee needs to look at. Mr. Dingell and I
sent you a letter listing a number of them, but none is more
important to our Nation than the energy supply for the coming
winter.
Yesterday, CNN cited experts that said any further refinery
damage resulting from Hurricane Rita could result in $5-to-$6-
a-gallon gasoline.
Mr. Chairman, the U.S. Energy Information Administration's
dire predictions of an increase of up to 77 percent in natural
gas prices, as well as a 33 percent increase in home heating
oil, and an additional 43 percent for propane costs in the
Midwest has many of my constituents wondering how they will be
able to afford to keep their homes heated this winter. Many of
them are already living paycheck to paycheck or Social Security
check to Social Security check.
These constituents have already been forced to decide
between buying food, buying medicine or gasoline for their car.
Many are breaking their medications in half and not receiving
the proper medical treatment. Now, with skyrocketing home
heating costs, their finances will be spread even thinner, and
I fear many will be pushed over the brink. All of this will
occur while big oil companies continue to post one record
profit on top of another.
The impending increases in heating costs will surely force
many in my district to turn their heat down to dangerously low
temperatures, which will, in turn, result in increased
illnesses among the elderly and poor. This will then place
additional burdens on the Medicaid and Medicare systems, which
are already overburdened.
Cooler fall weather is already settling into my northern
Michigan district. In some places, we will receive well over
200 inches of snow this winter. I had a constituent call my
office earlier this week after he was told that he could not
receive assistance with his electric bill because the money in
the Low Income Home Energy Assistance Program--LIHEAP, as we
know it--had been reprogrammed to the Gulf area due to
Hurricane Katrina. In fact, $27.25 million was sent to
Louisiana, Mississippi, Alabama and Florida.
Mr. Chairman, my district is not unique; every district
faces significant energy price increases. I hope that we will
truly begin to investigate some of these more pressing areas
and hold necessary hearings. These hearings cannot merely be
briefings where witnesses come with little notice and prepare
testimony about what they are going to say very late into the
night the day before the hearings. Our hearings must be based
on real investigation with in-depth field work and interviews.
I have directed the Oversight and Investigations Democratic
staff to start talking to oil and pipeline companies and
refineries, so that we can understand and prepare for what may
be ahead. I would hope that your staff would join me in this
effort.
I am hoping that this general briefing that we're having
here today on health care will signify a starting point and not
an end to an active, aggressive effort by the Oversight and
Investigations Subcommittee. We owe it to our constituents and
the American people.
I yield back the balance of my time.
Mr. Deal. The gentleman's time has expired.
It is regrettable that we've already deviated from the
purpose of this hearing today and are getting into politics. As
I said in my opening statement, Mr. Simonson is doing his job.
I think it would be regrettable if we had someone who was here
testifying before this subcommittee today in the wake of the
third largest hurricane about to hit our coast, instead of
doing his job of preparedness; and that is what Mr. Simonson
should be doing. He shouldn't be here; he should be doing his
job, which is what he's doing.
If the gentleman wishes to submit the questions he said he
wanted to ask, certainly with the permission of this
subcommittee chairman, he may do so in writing. And I am sure
Mr. Simonson and his department will respond accordingly. But I
would keep in mind for all of us that the purpose here is a
legitimate inquiry as to where we are on the ground and what we
can do to avoid these incidents in the future.
We will now begin with opening statements from other
members of the two subcommittees. I would remind everyone that
if you choose to waive your opening statement, you get 3
additional minutes with regard to questions of the witnesses on
the panels themselves.
I believe Mr. Bilirakis would be our next person for an
opening statement.
Mr. Bilirakis. Thank you very much, Mr. Chairman. I am also
pleased you are holding this hearing.
Certainly, it will take some time before we fully realize
Hurricane Katrina's true human and economic impact. We must
not, however, delay assessing the health of those impacted by
this storm and ensuring that its victims get the care they need
in as timely and appropriate manner as possible. The residents
affected by this tragedy, those who remain in damaged areas, as
well as those who have been relocated elsewhere, including my
State of Florida, must be informed of the possible health risks
they face and given increased access to corresponding health
and medical services.
I believe it's imperative that we learn from our response
to Hurricane Katrina, so we can both help its victims and
improve our disaster preparedness in the future, especially
since another massive hurricane is bearing down on Texas's Gulf
Coast. It seems that we are always reacting to something that
happens, rather than being ahead of the curve, and I would hope
that maybe we will learn our lessons one of these days.
I also want to highlight, Mr. Chairman, legislation that
I've talked with you about, that I introduced to better
coordinate health, human services and other relief efforts
which I believe would be helpful in the aftermath of disasters
such as Hurricane Katrina. Congresswoman Eshoo and I introduced
this legislation which we're calling the Calling for 211 Act,
which would establish a Federal grant program to help States
implement 211 telephone service for their residents. This
service has proven to save time, money and improve the delivery
and coordination of help and other services vital to
communities around the country.
I believe enactment of that bill, H.R. 896, will also
expand the essential role that 211 service can play in crisis
preparedness as a response to it.
I would hope that given the fact that the bill has
bipartisan support from members of this committee, we would
consider including the Calling for 211 Act as an essential
element to any Hurricane Katrina or Hurricane Rita, or whatever
the case might be, relief package that this committee may
consider in the coming weeks.
Thank you, Mr. Chairman. And I again commend you for
calling this very timely and critically important hearing.
Mr. Deal. I thank the gentleman.
We are pleased to have the ranking member of the full
committee, Mr. Dingell, with us, who is recognized at this time
for his opening statement.
Mr. Dingell. Mr. Chairman, thank you, and thank you for
scheduling this hearing.
All of us have been shocked by the destruction, human
suffering and loss of life brought by Hurricane Katrina. The
full toll in terms of physical and mental illness and premature
death attributable to those events is yet to be known, but it's
clear it's considerable.
What brings us here today is the virtual universal
acknowledgement that some of the death and destruction wrought
by Hurricane Katrina was avoidable. Some of her victims could
have been spared if adequate local, State and Federal
preparedness and response programs had been in place and
executed in a timely and competent fashion. We have now seen
that the human costs of inadequate funding and incompetent
management are severe.
Today, we lack final information, but in these hearings and
in future hearings this committee should be examining what
happened and what the Federal Government and others can do
better next time.
That brings us to the fact that today we must assess the
current and future health care needs of the people in areas
affected by the storm and its aftermath. None of us wants to
compound the problem with ineffective or inadequate measures to
rebuild the public health infrastructure or by skimping on the
true costs of delivering health care to a displaced and needy
population.
I note that it is at times like these when we have a chance
to see how efficient the Medicaid program can be and how
critical it is to the people's health. Every hour of every day
there is someone having trouble getting access to medication,
to a doctor or health care because they lost their job, their
income, their identification, their assets and more. Providing
100 percent Federal Medicaid reimbursement for people in States
devastated by Katrina will result in immediate relief delivered
in an efficient fashion. These people need to know today that
they will have access to basic health care, not tomorrow or
next week, while the Federal Government tries to work out a new
and more complex system.
I welcome this hearing as a good start in the process of
examining what went wrong. We need to look at what needs to be
done now and how we can do better in the future.
I look forward to the testimony of our witnesses, and I
commend you for holding this hearing, Mr. Chairman.
Mr. Deal. I thank the gentleman.
I recognize Mr. Shimkus for his opening statement.
Mr. Shimkus. I will pass, Mr. Chairman.
Mr. Deal. I thank the gentleman.
I recognize Mr. Upton for an opening statement.
Mr. Upton. I will pass.
Mr. Deal. I thank the gentleman.
I recognize Mr. Ferguson for an opening statement.
Mr. Ferguson. Thank you, Mr. Chairman. Thank you for
holding this hearing. I thank both of the chairmen for holding
this hearing, and Dr. Gerberding and others for being with us
to provide testimony and share their thoughts and expertise.
Another monster hurricane is bearing down on the Gulf Coast
as we speak, and it is necessary, of course, that we review and
revise our response procedures to better serve the areas of
devastation after a disaster, both those wrought by nature or
at the hands of a terrorist or some other disaster.
In Baton Rouge, several days after the hurricane struck, I
was able to see firsthand some of the response, particularly
the medical response to Hurricane Katrina and the medical care
that was being administered to many of the evacuees from New
Orleans and around that area. In the River Center, the biggest
shelter in Baton Rouge, I saw health care professionals and
volunteers and Red Cross personnel and so many others working
to help their fellow Americans who were in need.
I even saw one of our own colleagues, Dr. Phil Gingrey, who
was there volunteering as well, who was administering care and
helping to coordinate response efforts with organizations like
the Red Cross and others. It was amazing to see the response of
health care professionals from all around the country who were
making sacrifices to provide health care to those who were in
such need.
It is crucial, though--and that's the point of this hearing
today--it's crucial that as we look forward to any kind of an
emergency like this in the future, that we learn lessons from
what has happened over the last several weeks. Obviously, we
have another hurricane bearing down on the Gulf Coast right
now. There is always the possibility of another terrorist
attack, and certainly, representing northern New Jersey, it is
something that is constantly on our minds.
There are issues like pandemic flu, which we need to always
be thinking about and concerned about; it's something that you
and I have talked about in the past.
There are always situations that we need to be preparing
for, and I am pleased today that we will have an opportunity to
hear from Dr. Gerberding and our other witnesses to hear about
what lessons we are learning from the past several weeks and
what actions we're taking to better prepare for emergency
situations in the future.
I thank both the chairmen for putting this hearing
together, and I again thank our witnesses.
I yield back.
Mr. Deal. I thank the gentleman.
I recognize the gentlelady from California, Ms. Eshoo, for
an opening statement.
Ms. Eshoo. Good morning, Mr. Chairman. Thank you for having
this hearing. And to the witnesses that are here today, thank
you for coming.
There are so many things that I want to say. I am, more
than anything else, extraordinarily frustrated.
I know, Mr. Chairman, that you've worked hard to put this
together. Our first distinguished witness, Dr. Gerberding--most
frankly, her department is not the problem at all, at least not
in my view. The Secretary of HHS should be here. If we are
going to examine what fell apart in terms of health care and
the entire system for our fellow citizens, in my view that
should--HHS should be here to answer those questions.
But be that as it may, they are not, and so we have got to
direct our questions, I think, toward that department, and also
to see what happened--to ask good questions about what happened
on the ground of people that are representing the organizations
and the institutions that were there.
I can't help but think that, No. 1, volunteerism is just as
much a part of America as our flag is. When I watch the news
and see where doctors that went in to volunteer on an emergency
basis were turned back by the military and others, we have to
find a way to integrate them into our emergency response
system.
There was a program last night on CNN where doctors
actually had come in and all of these human beings that were so
fragile and being shipped to the airport, they wanted to help,
and there wasn't any way for them to enter the system. So I
hope that we can address ourselves to things like that because
they are important.
And I think that no matter what we do in the future, there
is always going to be a need for the medical professionals to
be able to come into the system. And they are not always going
to be the ones that--you know, that we think of in a very set
way, when there isn't a catastrophe. Remember that there are
professional volunteers that need to be integrated.
I want to call attention to--and my friend and colleague,
Mr. Bilirakis did--to the 211 system. We're inviting people to
be a part of that. I think that it's an important step.
We are all frustrated. We want to launch something that is
good. Only 40 percent of the Nation has access to this; we
should make it 100 percent.
Now this is going to be a little tough, but yesterday the
Republican Study Committee came out with a summary, an
explanation of offsets to the spending for--I think for what is
projected the Congress needs to do on the heels of Katrina. One
of the most disturbing items in this is to reduce funding for
the CDC, and it's $25 billion over 10 years.
So what I would like to ask Dr. Gerberding to do is to tell
us what $25 billion, in terms of cuts, is going to do to the
CDC. I mean, if these things--I hope these things are brought
to the floor of the House, because the American people should
see, you know, what some of these choices or suggestions are.
I think $25 billion, if we really value the CDC, is--we
think communities have been gutted? Watch CDC being gutted. But
I want Dr. Gerberding to comment on that.
So, Mr. Chairman, what I hope will come out of this are
some very practical things that the Congress can do. And I hope
that you will consider bringing in the representatives from
HHS, because again, you know, we value highly what Dr.
Gerberding does and the CDC. They're not the problem; we've got
problems elsewhere, and I think that they need to answer for it
and help us come up with some of the ideas to address them.
So thank you for having the hearing, and I look forward to
the witnesses. And I hope in the future--I understand that Dr.
Simonson--is that his name, or Simons--couldn't be here today.
But invite him back.
He is doing what he is doing and has to do, I can
appreciate that, but he is a valuable person for us to hear
from, so I hope you will invite him back. Thank you.
Mr. Deal. Thank you, gentlelady.
We recognize now the chairman of the full committee, Mr.
Barton, for his opening statement.
Chairman Barton. Thank you, both chairmen, for holding this
hearing.
Today, we're here to talk about some of the health impacts
of Hurricane Katrina, and it's a very important hearing; and I
am going to ask unanimous consent to put my statement into the
record on that.
We are now dealing--gearing up to deal with another major
hurricane. It's almost biblical, like the seven plagues; and if
we knew who the Lord wanted us to let go, we would let them go
so we wouldn't have these hurricanes hitting our country. But
Hurricane Rita is headed into Texas, and the aftermath, what is
going to hit the southern part of my district if it hits in the
Galveston area; as we try to learn lessons from Hurricane
Katrina, hopefully, we can apply some of those very quickly to
Hurricane Rita.
And on the health consequences, there are lessons to be
learned.
So I want to thank both my subcommittee chairmen for
holding this hearing and ask unanimous consent that my full
statement be put in the record.
[The prepared statement of Hon. Joe Barton follows:]
Prepared Statement of Hon. Joe Barton, Chairman, Committee on Energy
and Commerce
Thank you, Chairmen Deal and Whitfield for holding today's hearing
on health care issues raised by Hurricane Katrina. When Katrina smashed
into the Gulf Coast, it uprooted hundreds of thousands of people and
destroyed much of the health care infrastructure across an entire
region.
People were up to their necks in water, but had none they could
drink. Sometimes the water and the air around them were poisonous. And
among the precious property that Katrina washed away were thousands of
critically important personal medical records.
Right now in the Gulf of Mexico, another monster storm threatens to
inflict more of the same destruction, danger and misery on new victims
in Texas.
The challenges are daunting, but America is responding. Our people
opened their homes and their hearts to help those who lost everything
to Katrina. The outpouring of government, corporate and individual
assistance runs into the billions of dollars, and it has barely begun.
The greatest challenge we now face is how to get the most help to those
who need it most. We cannot permit red tape to slow the flow of aid,
and we'd better be sure that none of it is wasted or stolen. Today we
will hear first-hand accounts of what is being done to provide care and
meet the medical needs of those in the devastated region. We will learn
about the efforts of private doctors, hospitals and pharmacists who are
volunteering their time to assist the victims of Katrina. We will also
hear about the efforts of public health officials from the Department
of Health and Human Services, who are working to assess health risks,
coordinate care and rebuild the health infrastructure in the areas
worst hit by the hurricane.
We should all applaud these efforts, and in particular, the
leadership shown by HHS Secretary Mike Leavitt. I hope this hearing
will highlight these efforts and also help us identify what more needs
to be done.
Regrettably, we won't have much time to learn the lessons of
Katrina before Hurricane Rita hits the Texas coastline. As I told the
governors of Louisiana and Mississippi last week, the Energy and
Commerce Committee stands ready to do everything in its power to help.
This morning, I say to my home state's governor, Rick Perry,
whatever you need that is within our jurisdiction to provide, count on
it. I also want to ask that everyone who hears these words take a
moment today and say a prayer for the people who are in the path of
Hurricane Rita. Thank you.
Mr. Deal. I thank the gentleman.
I now recognize the gentlelady from California, Ms. Capps,
for an opening statement.
Mrs. Capps. Thank you, Mr. Chairman. I want to thank all of
our witnesses for being here today, and especially welcome to
the second panel, the President of the American Nurses
Association, Barbara Blakeney.
These committees need to devote considerable time to
reviewing what happened when Hurricane Katrina hit the Gulf
Coast. This is the first, but should certainly not be the last
hearing on this topic.
The response of the Federal Government was uneven at best.
The Coast Guard was, and is, admirable, the CDC also has done
well. But the response, as we all know, of FEMA was pathetic,
and it cost lives; and there is no one here to speak for them.
As we analyze what went wrong, we do so to be able to change
what we are doing now for the future.
Many of the failures that surrounded Katrina came because
of inadequate funding and misplaced priorities. The majority
insists that we need to continue on with the budget
reconciliation process as if nothing has happened; this would
be, if it happens, irresponsible, incompetent and immoral.
Hurricane Katrina has shown us the true face of poverty. It
has shown us exactly what we're talking about when cutting
safety net programs like Medicaid is proposed. We can talk all
we want about protecting the victims of Katrina from these
cuts, but what about the people just like them living in
poverty in other States? And what if the victims of Katrina are
forced to remain on Medicaid for years to come? The simple
truth is that we must learn from this disaster and abandon the
heartless notion that $10 billion can be chopped from Medicaid.
I am also stunned by the complaints surfacing now by many
about paying for the emergency relief that Congress has
dispersed and is committed to dispersing. For 5 years the
majority has stacked tax cut upon tax cut to create the biggest
deficit in the history of our Nation. Nearly $200 billion has
been spent on the war in Iraq which, while claiming the lives
of 1,900 brave Americans, shows few signs of improving
America's national security.
Through it all, many of us have urged restraint in order to
keep our fiscal house in order and to prepare for times like
these. We have been ignored by the majority, but now that real
people need real help, many of whom have had little to start
with and now have less than nothing, we have Members of
Congress's leadership demanding that we cut other safety net
funding to pay for it. Apparently, deficits are acceptable when
we are paying off the wealthy, but unacceptable when we are
helping the neediest in society.
As has been mentioned, one of their proposals is to cut $25
billion from CDC. We need to address that in our hearing this
morning. CDC is a major player in this recovery effort, and we
still have the threat of avian flu, pandemic, AIDS,
tuberculosis and, of course, the threat of bioterrorism.
Cutting CDC by $25 billion is as absurd as asking the poorest
of the poor to pay more for the limited health care that they
get.
The majority needs to rethink it is priorities.
I yield back the balance of my time.
Mr. Deal. I recognize Ms. Blackburn for an opening
statement--Dr. Burgess for an opening statement.
Mr. Burgess. Thank you, Mr. Chairman. And I want to thank
both of my subcommittee chairmen for holding this hearing
today.
The witnesses, I also appreciate you being here. I know
there are plenty of other important places you could be, and I
commend you for your courage in having worked in the--many of
you, in the disaster area, and for your perseverance of almost
historic proportions.
I think all of us can agree that this has been a disaster
that has put a challenge on the American people and on this
Congress. And it's already been presented to us as a
substantial public health challenge in the disaster area. In
areas like my State of Texas, it has absorbed a significant
number of people who have been displaced by the first hurricane
and are now directly in the path of the second hurricane.
Hospitals are working short staff, doctors have been displaced,
infectious disease outbreaks are a risk, and the funding
structure for patient care has been thrown into chaos.
Today, I hope this committee is able to learn the current
safety and health status of the areas impacted by Hurricane
Katrina and those due to be impacted by Hurricane Rita. I would
specifically like to hear how the Federal Government has
interacted with providers, the providers that remain behind and
continue to serve their community. I would also like to
determine what it would take, in terms of manpower and money,
to get the public health system of this area back to a pre-
Katrina and a pre-Rita level.
The lives of so many Americans will never be the same
because of this disaster, and the residents of the Gulf Coast
can look to rebuild their homes, schools, businesses and
families, but our public health system needs to be ready to
meet their needs in the future.
I am pleased that we have members here from the Joint
Commission on the Accreditation of Hospitals. I would very much
like to hear from you.
We had a terrible Tropical Storm Allison in Houston 4 years
ago. We lost our generators in Herman Hospital, one of the
first casualties of that storm, when the hospital basement
flooded. I would like to know if you have incorporated in your
hospital inspections the fact that the generators need to be
located on a floor that will not flood, particularly for a
hospital that's located below sea level.
I would like to hear from the people involved with the
evacuation of those hospitals. Evacuation, medical evacuation,
is one of the things this country does extremely well.
I have been fortunate enough to visit the country of Iraq
several times, I have been to Bilad Air Base right in the
center of Iraq; I've seen the air and medical contingency
staging facility load our wounded soldiers onto air transports,
stabilize them in the field, load them onto transports, send
them to Germany, and then on to Walter Reed Hospital here in
Washington, 27,000 patient transfers from a war zone, with one
injured transfer death.
We know how to do this. What happened to us in New Orleans
when we couldn't get those patients off the roof of a parking
garage in New Orleans?
Evacuation works, that's the one lesson we did learn from
the last hurricane; and from what I see on the television this
morning, it appears that the people of Galveston and Houston
are taking that to heart. But those who are poor, those who are
frail, those who are medically compromised must receive the
attention they deserve to get out of harm's way.
The short-term reciprocity of medical and nursing
licensure, why can't this happen? Why are providers not allowed
into the zones after they've been hit and hit hard? Why are
there not doctors allowed in for respite care for those doctors
who are literally working on their last fumes?
Mr. Chairman, again I commend you for holding this hearing.
There are a multitude of questions that are going to have to be
asked, and I hope answered this morning. And I also hope that
this is only the first in a series of such hearings that we
will hold.
Traditionally, the Committee on Energy and Commerce has had
the obligation to--the constitutional obligation for oversight
and investigations into things that happen in this country,
within our shores; and I hope our committee and our two
subcommittees take this very seriously.
I yield back.
Mr. Deal. I thank the gentleman.
I recognize Ms. Baldwin now for her opening statement.
Ms. Baldwin. Thank you, Mr. Chairman.
I join my colleagues in expressing shock at what we all saw
in the Hurricane Katrina aftermath; and like my colleagues, our
first thoughts were all of the victims of this tragedy. But now
that we have had some additional time to reflect, my reaction
turns more into one of frustration, and this frustration stems
from many of the unanswered questions.
Why in our age of technology were officials unable to
communicate with each other? Why was the Federal response so
slow? Why was disorder so pervasive? And from a public health
standpoint, why were hospitals left to fend for themselves,
especially in terms of evacuation, with only late or minimal
evacuation assistance?
And why were we unable to get insulin to diabetics in the
Convention Center or Superdome? And why were dead bodies left
amidst evacuees? And why were volunteer nurses and doctors from
my State and others unable to reach those in need in the South,
especially the health care workers who had worked hours and
hours and days on end without relief?
To have an experience like Hurricane Katrina and then not
to learn from it would be the biggest tragedy of all. It's why
I thank the chairmen for holding this hearing. And I associate
myself with comments of others that we must not have this be
the only hearing.
We need to ask and have answered a lot of questions. We
must thoroughly evaluate our preparedness and our reaction. We
must learn from this experience and work toward improvement.
So in looking forward and moving forward I ask, what steps
can we take to better protect the public health in the face of
emergencies? What proactive measures can we institute? What
changes can we make in order to safeguard our health? And in
light of Hurricane Rita's approach, what immediate improvements
must we make?
In my opinion, one of the most immediate and obvious steps
we can take to protect the public health is to preserve the
Medicaid program and ensure that Katrina victims and any
victims we may see of Hurricane Rita are able to access health
care through Medicaid; and I hope that we will put aside our
plans to slash funding to this program in this time of need.
I also want to join with my colleagues who have voiced
their concerns over a Republican Study Committee recommendation
to cut CDC funding in order to pay for Hurricane Katrina. I am
also aware of that recommendation and feel that it would be
very ill advised.
I look forward today to hearing the testimony of our
witnesses, especially as it relates to the many questions that
we have collectively posed in our opening statements. And I
thank all the witnesses for coming today.
I yield back.
Mr. Deal. The thank the gentlelady.
I recognize Mr. Shadegg for his opening statement.
Mr. Shadegg. Mr. Chairman, other than to commend you for
holding this hearing so we can get some real facts on the
record in light of a lot of hysteria and a lot of
misinformation that's been reported, I will waive my opening
statement.
Mr. Deal. I thank the gentleman.
Mr. Stearns for an opening statement. Mr. Stearns, do you
wish to make an opening statement?
Mr. Stearns. Thank you, Mr. Chairman.
I would like to just start out by saying that we've been
pretty negative here and indicated that what happened in New
Orleans and Louisiana and blame the--in many respects, the
Federal Government.
But in my State we were through, Mr. Chairman, four
hurricanes. We didn't have this problem; we didn't have the
criticism that we are hearing this morning because the local
officials--Governor Jeb Bush, the legislature, as well as the
mayors and the police force and everybody--got organized early
and evacuated. And you saw that in Miami and you saw that in
the Keys. So I think we should concentrate also on remembering,
there's a lot of States who have handled this well, and we
should learn from those States and not just continue to dwell
on what perceives to be the negative aspect.
You know, for example, a lot of the pharmaceutical
companies have provided drugs free of charge, almost $100
million and getting those drugs down to the pharmacists--and
the pharmacists are using these drugs and dispensing them free.
So a lot of people complained about there was no insulin, but
the pharmaceutical companies provided it free of charge.
A question comes up that I hear people, doctors
particularly, who were ready to go from my home county from
parts of Florida to go into the State, but they could not get
in. So to rapidly deploy professionals into a State, one State
to another, how can we expedite this? This is perhaps one of
the keys we should talk about today, this reciprocity
arrangement.
In our State, we had--from Ohio, through the Midwest and
the Northeast, we had power companies into the State ready to
go before the hurricanes, to take down the trees. That's the
kind of early response that was done in Florida.
So there are some success stories across this United
States, and we shouldn't overreact at this hearing or with our
legislation and think that just throwing a lot of money at this
is going to solve the problem.
I think if we had the administrative procedures that we've
had in States that have been successful, and we adopt those,
Mr. Chairman, I think we will go a long way toward solving this
problem without a huge Federal intervention and a huge amount
of criticism of Federal officers who, they say, supposedly
didn't react.
I've seen even in local States, in Maryland, Virginia,
where they have sent physicians down into Louisiana to help
out. So there are clearly some success stories here across the
board. And I look forward to exploring these as well as
criticism, Mr. Chairman, on how we can improve.
Thank you.
Mr. Deal. I thank the gentleman.
I recognize Mr. Allen for an opening statement.
Mr. Allen. Thank you, Mr. Chairman, for convening this
hearing. I look forward to hearing from our expert witnesses on
the status of current relief efforts and the medical needs of
the affected citizens.
This tragedy has tested our Nation's ability to deal with
widespread devastation, placing a tremendous burden on first
responders, hospitals and other health care facilities. Many
medical professionals worked in hospitals without electricity
or running water or in makeshift shelters without proper
equipment. In many cases, these professionals continued to work
even though their own homes were destroyed and their families
evacuated.
We have witnesses today representing many of these first
responders--doctors, nurses, community health centers and the
American Red Cross. Our Nation owes a tremendous debt of
gratitude to those members who served during the storm and to
those now traveling to the Gulf Coast to volunteer their
services.
I also want to acknowledge another group of health care
professionals who successfully evacuated thousands of sick and
disabled people from hospitals and nursing homes: air ambulance
providers. Although flight operations were challenged by
limited electricity, communications, ground support and access
to fueling stations, civilian air medical programs such as Air-
Evac Lifeteam from West Plains, Missouri; THI Air Medical from
Lafayette, Louisiana; Angel One Transport from Little Rock; and
Baptist LifeFlight from Pensacola, Florida, worked around the
clock evacuating patients from local hospitals in the areas
hardest hit by Katrina.
These efforts were largely informal and voluntary; there
was no organized Federal plan to rapidly deploy nonmilitary
medical aircraft in the case of medical disasters such as
floods and hurricanes. Organized deployment of specialty team,
critical care, medical aircraft to moving the critically ill
and injured out of hospitals and nursing homes would allow the
Coast Guard and military aircraft personnel to concentrate on
search and rescue and material support for affected areas.
We do not have witnesses from HHS or FEMA with us today to
discuss this issue, but I hope that the role of air ambulance
providers in emergency preparedness and disaster relief will be
considered in future congressional hearings.
In closing, this natural disaster bore most heavily on the
working poor, many of whom had no health insurance. This
Congress should abandon planned funding reductions to the
Medicaid program and, instead, direct its efforts to rebuilding
and strengthening the health care infrastructure and addressing
the health care needs of those devastated by Hurricane Katrina.
Mr. Chairman, I yield back.
Mr. Deal. I thank the gentleman.
Ms. Blackburn is recognized for an opening statement.
Ms. Schakowsky is recognized for an opening statement.
Ms. Schakowsky. Thank you, Mr. Chairman. And I thank both
chairmen for holding this hearing and beginning what I hope
will be an ongoing committee effort to understand what went
wrong in public health preparedness.
I very much look forward to hearing from Dr. Gerberding
about the CDC's efforts to protect the health of those
evacuated from the Gulf Coast, as well as those working on
reconstruction efforts and returning home to cities and towns
that present serious health threats because of contamination.
The lack of a functioning health care infrastructure makes the
task even more difficult.
I do have two issues of particular concern, but first I
have to comment on what has--what is a blueprint, in my view,
for another disaster: a document presented by the Republican
Study Committee that really is the meanest proposal I have ever
seen, an intentional attack on the poor, billions of cuts in
Medicare, increases in--Medicaid; increases in Medicare
premiums; new home health care copayments; elimination of loans
to graduate students, which would include, I presume, health
professionals; cuts in the CDC. And I hope that the Republican
leadership will reject this cruel and counterproductive
proposal.
My two issues are, though: I hope we can explore the
response and needs surrounding the New Orleans public
hospitals. Many reports suggest that Charity Hospital's
patients were not evacuated as promptly as patients in other
hospitals. It appears as if the health care disparities that
existed before Hurricane Katrina may have resulted in
disparities in emergency response.
I am also interested in hearing from Dr. Gerberding and the
other witnesses how patients who rely on the public hospitals
receive care once they return home.
Second, I hope this committee will look into the tragic
treatment of nursing home patients.
Dr. Gerberding, I know that the CDC does not have authority
in this area, but as the administration's only witness here
today, I hope you will pass along my concerns to your
colleagues. There is nothing more horrifying than hearing
Jefferson Parish's President, Aaron Broussard, tell America
about the elderly mother of one of his employees, a mother who
drowned in her nursing home waiting for rescuers. He said every
day she called and said, Are you coming, son? Is somebody
coming? But nobody came.
We need to know why nursing home residents were not
evacuated in time. Was it a question of inadequate staffing or
neglect? Were residents too frail to be removed? If so, were
they left to die on their own? What can we do to provide better
emergency care for the frailest among us?
Fortunately, it looks as if nursing home residents are
being properly evacuated in advance of Hurricane Rita. What are
they doing that was not done in New Orleans?
And we're also beginning to hear about nursing home
residents who were evacuated, but may have been sent to
substandard nursing homes. I recently learned about one long-
term care ombudsman coordinator who had expressed serious
concern. She wrote, quote, I have to tell you that I am dealing
with another side of the story, and I am really feeling sick as
I see what's happening. I received word in the past few days of
one adult home and one nursing home that are getting ready to
accept evacuees. They are both for-profit facilities that had
have empty beds because they have been penalized for providing
poor care. Neither staff has the facility to be able to provide
consistent and good care to their own residents, along with
evacuees in need of lots of TLC.
I know I'm out of time, but I hope, Dr. Gerberding, that
you will pass on this very important concern about decisions
that are made, how and where to send nursing home residents.
Thank you.
Mr. Deal. I thank the gentlelady.
Mr. Rush for an opening statement.
Mr. Rush. Thank you, Mr. Chairman. And I want to thank you
also for holding this hearing.
I hope that we will have a hearing on the environmental
hazards that Katrina has imposed on the citizens of Louisiana
and Mississippi as we have additional--contemplate having
additional hearings. Given this committee's vast jurisdiction,
we should have numerous hearings on the subject from many
different policy angles. Given that Hurricane Rita has now
developed into a Class 5 storm with the same devastating power
of Katrina, I think it's now more important than ever to hold a
hearing like this in our committee.
From this hearing I want to learn not just what the Federal
Government is doing now for the affected populations along the
Gulf Coast, but I want to know what went wrong and why so many
people needlessly died.
Mr. Chairman, the public health emergency infrastructure
and system failed the victims of Hurricane Katrina, and this
committee needs to determine what went wrong and why it went
wrong. I say this not because I'm a Democrat and am looking to
score points against my Republican friends on the other side of
the aisle. We need to be retrospective and determine what went
wrong so that we can learn from history.
As I said, Hurricane Rita is now bearing down on Texas, as
we speak, and we need to learn how we failed in the aftermath
of Katrina if we are going to assure the people of Texas that
they will not suffer from the same incompetence and
indifference that the people of Mississippi and New Orleans
suffered from.
Too many lives are at stake, and if we want to call it the
blame game, so be it. I hope my Republican colleagues do not
get defensive and engage in a full-fledged combative posture to
protect an incompetent bureaucracy.
To my Republican friends I say, we need your inquisitive
and critical minds, too. So forget dogmatically defending every
aspect of this administration, and let's find some real answers
to some real questions.
To my Democratic colleagues, I would ask that we engage in
a thoughtful and deliberative investigation without needlessly
accusing the administration of wrongdoing. Let's hold
accountable those who were incompetent and indifferent, but
let's not try to score political points by exploiting the
suffering of the poor people of the Gulf Coast. We are all
better than this.
That said, I too am deeply disappointed and profoundly
perturbed that Mr. Simonson is not present today. Frankly, I
was looking forward to hearing his agency's justification for
his action, or lack thereof, during Hurricane Katrina. Let us
get him in here, pronto.
And, Mr. Chairman, I would just like to address a couple of
comments from my colleague from Florida. The hurricane was a
necessary and sufficient condition for the compromise of the
levee system in New Orleans, which is and continues to be a
Federal responsibility. I might remind my friend from Florida
that Florida does not share New Orleans' geographical
configuration, nor does it share its levee system.
So you can't compare Florida to New Orleans. Thank you and
I yield back.
Mr. Deal [presiding]. The Chair recognizes the chairman.
Mr. Barton. Thank you. I didn't give my full opening
statement and use all my time because I thought we were trying
to get to the witnesses. But I have sat here and listened to
some of the opening statements, and I just want to make a few
comments on the process. I think it is very important that
committees of jurisdiction act in a timely fashion. And we have
had one catastrophic hurricane, and we are in the process of
possibly, hopefully not, but possibly of having another. So I
want to tell my friends on the Democrat side we're not trying
to whitewash anything. We want the facts before the American
people, and we want them in timely way.
And hopefully, we want to put them forward in a nonpartisan
way. The easiest thing to do right now would be to hold no
hearings at all and let this select committee that hasn't yet
been established do whatever it's going to do and then us come
back next spring after the fact. But I don't think that's
right. And I'm in close contact with Congressman Dingell as we
try to prepare these hearings. This is our second one. I've
instructed every subcommittee to hold a hearing in its
jurisdiction as soon as possible.
Mr. Gillmor is going to have a hearing on some of the
environmental consequences next week, hopefully. But in the
process of doing that, sometimes some witnesses are not
available because they are down in the area, either dealing
with the aftermath of Katrina or preparing to soften the blow
of Rita. But I assure everybody on this committee, at the
appropriate time, there is no witness in the executive branch
of this government, if there is a legitimate reason for them to
appear before this committee, they will appear. We are not
whitewashing or protecting anybody. But when you have an
administration official who has the responsibility not just
retroactively, but prospectively, you want them doing their job
right now, hopefully to save lives and protect public health of
potential victims of this second hurricane. But I have
instructed the staffs and I have, you know, I have told very
senior administration officials that they can't hide behind
some pseudo reason that they can't be here. You know, we will
have everybody before this committee that needs to be before
the committee.
But we also want to make sure that we allow them to do
their jobs while there's a job that of immediacy that needs to
be done. And I have conveyed that to Congressman Dingell and he
has assured me that he is supportive of that. I hope he will
have enough faith in my chairmanship and the subcommittee
chairmanship to know that the one thing we are about on this
committee is getting the facts, getting the truth and doing it
in a way that bring credit on the institution of the Congress
of the United States. Lord knows we need some credit, given the
general public opinion of the entire Congress. So there are
times we need to be partisan. I understand that. But partisan
statements, while within 3 weeks of one major hurricane, with
another hurricane that I'm told is three times as powerful as
the first, make it difficult to move the process forward. And
with that I yield back.
Mr. Brown. Mr. Chairman.
Mr. Deal. Mr. Brown Mr. Brown. Yeah. I only used 3\1/2\ of
my 5 minutes. I just wanted to say one thing. I don't think
it's partisan when members on our side hold up this document,
signed by half the Republican members of this committee and a
third of the Republican members of this Congress, which cut CDC
$25 billion, which cuts Medicaid tens and tens of billions of
dollars, I don't think it's partisan. I think it's something we
want to put on the table to discuss.
Mr. Deal. Well, the chairman didn't use his time either. I
would simply remind Mr. Brown that's not the purpose of this
hearing today. As we have a saying in the South of gone with
the wind. We're looking at what happened in the result of what
was gone with the wind and what was left and what we are going
to focus on. So we will try to keep the hearing and the
comments hopefully directed in that fashion. Ms. DeGette is the
next one for an opening statement.
Ms. DeGette. Mr. Chairman, I'll waive my opening statement
in order to have additional time for questions.
Mr. Deal. I thank the gentlewoman. Mr. Strickland.
Mr. Strickland. Thank you, Mr. Chairman. Mr. Chairman I
would just like to say at the beginning that I continue and I
hope we all continue to be troubled by the fact that Americans
died while they were waiting for water and food and emergency
medical care in the United States of America in the year 2005.
And we need to know why and how that happened and we need to
make sure it never happens again. I would like to say a few
words this morning about making Medicaid available to the
survivors of the Hurricane Katrina. As you know, several States
are delivering health care to survivors, including my State of
Ohio. And in order to guarantee these evacuees continue to
receive their care, we need to make sure that we are properly
reimbursing the States. The National Governors Association has
come out strongly in favor of the Grassley-Baucus relief
package that provides 100 percent Federal funding for the
health care needs of Katrina survivors. I hope that the
witnesses will talk a little bit about that today and what this
disaster relief package would mean to them and the importance
of reimbursing the States in this way. I would also like to
talk about the health care of our first responders, namely, our
National Guard personnel. Immediately after Katrina hit,
national guardsmen from across the country deployed to the Gulf
Coast to begin relief efforts. As they return to their home
States, it is my hope that we will monitor their conditions and
adequately respond to any health concerns that arise. The
Governors of this country have lent us their most precious
resource, the men and women serving in their Guard. We must
take care of them and we should honor their service. And that
is why I will soon be introducing legislation to ensure that
the health conditions of these guard personnel are
appropriately monitored and that they will be able to receive
care if they develop a health condition as a result of their
service in response to Hurricane Katrina. Mr. Chairman, I want
to thank you for this hearing and I look forward to hearing
from our witnesses. I return the balance of my time.
Mr. Deal. Thank the gentleman. Mr. Waxman is recognized for
an opening statement.
Mr. Waxman. Thank you, Mr. Chairman. In Katrina, we saw our
national emergency response system fail. We witnessed a
horrifying delay in access to basic medical care for tens of
thousands of people. Hospitals had no electricity, light, water
and medication for days. Thousands of people were stranded
without even minimal medical attention in the Superdome, the
New Orleans Airport and the Convention Center. Chronically ill
patients died in their homes or on the streets. For a Nation
that spends more money on health care than any other in the
world, that has invested millions of dollars in medical
emergency response, this failure is difficult to comprehend.
In the wake of Katrina, we are told that dozens of health
centers serving the areas most medically underserved were
devastated. These centers provide care to thousands of people
who, in the absence of these facilities, will have to travel
great distances to receive card or worse, will simply go
without. The emergency and trauma care facilities in these
areas have also sustained significant damage. Big Charity
hospital, the larger hospital in New Orleans and the only level
one trauma center in the Gulf Coast region, was forced to shut
down completely.
It is imperative that we immediately provide the funding to
rebuild these facilities and restore access to critical medical
care in these areas. An immediate priority has to be to provide
health care coverage for people affected by or displaced by
Katrina. Medicaid is the program on the ground. That program
can provide coverage and payment for care. Every State taking
in evacuees has a Medicaid program in place that can
immediately extend coverage to those in need. Our job is to
give them the certainty that the Federal Government will
provide full funding for the costs they incur by extending the
Federal matching rate to 100 percent for those displaced by
Katrina. The affected States that are taking in the people are
already some of the poorest States in the Nation.
With their economies in shambles they must have a temporary
assurance so that they can maintain services to their Medicaid
patients and reimbursement to their health care facilities
already reeling from the effects and demands of Katrina. This
is not something that ought to be approached on a waiver basis
dependent on possibly arbitrary Federal decisions with no clear
source for the promised funding. Changing the law to assure
Medicaid full Federal payment is a simple and most certain
approach. Affected States and providers deserve this assurance.
There is a bipartisan bill introduced by Senators Grassley
and Baucus in the Senate that would do just that. I hope our
committee will do the same thing so the House can move in the
same direction. The destruction resulting from Hurricane
Katrina is unprecedented. Rebuilding health care infrastructure
is unfortunately just one of the many tasks before us. I am
looking forward to the testimony of the witnesses and I want to
thank them for being here today.
Mr. Deal. Well that concludes the opening statements of
both subcommittees.
[Additional statements submitted for the record follow:]
Prepared Statement of Hon. Barbara Cubin, a Representative in Congress
from the State of Wyoming
Thank you, Mr. Chairman, for calling today's hearing. Today, we
will have the opportunity to investigate one of the most important
issues involved in the aftermath of Hurricane Katrina. The inherent
necessity of adequate public health care is essential in the wake of
any disaster, and today's hearing will clarify the current state of
America's ability to react to these emergencies.
I'd also like to thank the two panels of expert witnesses who have
joined us here today. Many of you have been on the ground, working
directly to assist the victims of this terrible tragedy. I thank you
for these efforts and look forward to hearing what my colleagues and I
can learn from your experiences.
Hurricane Katrina is perhaps the most devastating natural disaster
our nation has ever seen, and has presented the medical community with
challenges of a magnitude we never could have predicted. The scope and
variety of difficulties facing the public health care system in the
Gulf States are staggering: there is a lack of health care providers,
inadequate facilities, medical supply shortages, and infectious disease
outbreaks, just to list a few. In addition, I have grave concerns
regarding the administrative difficulties of delivering medical care to
individuals who have no proof of insurance coverage and no medical
records, many of which have been destroyed forever.
Though we hope and pray we never again see a disaster of similar
magnitude, we are here today to ensure America learns as many lessons
as possible from this tragedy. Natural disasters have the potential to
strike unpredictably and without mercy, in any area of the country. It
is my hope that today's hearing will generate discussion on what steps
must be taken to insure that health care assistance could be quickly
dispatched to even the most rural areas of America, which tend to be
medically under-served even in the best of conditions. I am also
particularly interested in hearing how individuals with immediate and
ongoing health care needs, such as chemotherapy or dialasis patients,
are being assisted.
Again, I look forward to hearing an honest assessment of the public
health care system's response to Hurricane Katrina, and to hearing how
Congress may help correct the inadequacies that persist. People across
the country have opened their hearts Katrina's victims, and I hope this
hearing will yield a practical work agenda for those who continue to
serve the health care needs of their fellow Americans. Again, I thank
the Chairman, and I reserve the balance of my time.
______
Prepared Statement of Hon. Ed Towns, a Representative in Congress from
the State of New York
Good morning. Today we are talking about a very important public
health issue that has massively impacted the poor. The devasting effect
of hurricane katrina destroyed the lives, families and homes of some of
the most vulnerable American citizens. Likewise, businesses and
infrastructure were also dealt a lethal blow. The tragedy of the
situation is the unncessary loss of human life stemming from poor
coordination and the lack of planning at the local, state, and federal
levels. The government's delayed response to this public health
emergency was unacceptable and unsatisfactory.
Today, I implore congress on behalf of our fellow Americans whose
lives were devasted by hurricane Katrina to not allow any of our
countrymen to undergo such a horrific experience because of the Federal
Government's lack of preparedness. We have the resources and means to
ensure this for all American citizens. What we need is the political
will and heart. This is about our country and us coming together as
Americans to rebuild lives. Because when we rebuild the lives of the
Americans that survived hurricane Katrina we fortify our own. Thank
you.
Mr. Deal. We will now move to the first panel and I am very
pleased to have Dr. Julie Gerberding, who is the director of
the CDC and certainly not a stranger to our committee and our
committee processes here. We thank her for her presence. Since
this is a combined hearing of the Health Subcommittee and the
Oversight and Investigation Subcommittee, and since the policy
of that latter subcommittee under chairmanship of Mr. Whitfield
is to swear the witnesses, I would ask him at this time to
swear in Dr. Gerberding.
Mr. Whitfield. Thank you, Dr. Gerberding. I'm assuming you
have no objection to testifying under oath. And I would like to
advise you that the rules of the House and the committee, that
you are entitled to be an advised by counsel if you so choose.
Do you desire to be advised by counsel during today's
testimony? In that case I would ask you to raise your right
hand.
[Witness sworn.]
Mr. Whitfield. You are now under oath and may give your 5-
minute summary of your opening statement.
TESTIMONY OF JULIE GERBERDING, CENTERS FOR DISEASE CONTROL,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Ms. Gerberding. Thank you. Thank you, Mr. Chairman,
Chairman Deal. I'm very pleased to be here this morning. We are
sitting in the middle of two of the largest hurricanes that I
think any of us could imagine. This is my 23rd and 24th public
health emergency since becoming part of the leadership team at
CDC, and I can assure you that we have learned something every
time we have had an emergency operation. This is also the
largest national natural disaster our country has faced, and I
think the scalability of our preparedness and response
capabilities are really a part of what we need to be looking at
in terms of lessons learned as we go forward. In order to deal
with a disaster this large, a network of response capability at
every level, at the Federal level, the State level, the local
level, the private level, the public level and in particular in
this case, the citizen level of all the volunteers who have
done so much, and not just the affected States, but the States
that are receiving evacuees, all of these elements need to work
together in a synergistic fashion to get each of their roles
and responsibilities accomplished.
But a response also requires a command and control
environment. It needs leadership. It needs clear strategies and
accountability for what's going on. And I feel very strongly
that within the Department of Health and Human Services, we
have had effective leadership on the part of Secretary Leavitt.
We have been addressing four priority areas during this
operation. Those include health care services, mental health
services, the delivery of human services to the many
disenfranchised people to require them immediately, and for the
long run, and from my particular perspective, public health
services. I wish I could provide more perspective and
information about the overall departmental roles and
responsibilities in this regard.
I'll have to limit my remarks to the public health sector
because that's my area of responsibility and expertise. But I
just do want to acknowledge a few remarkable contributions that
my colleagues have made. Secretary Leavitt put the whole
commission corps of the United States public health service on
early alert. That involves more than 6,000 clinicians and other
experts for response. And we have engaged in the largest
deployment of the commission corps since the Korean War. More
than 1,200 commission corps officers have been staffing the
shelters and providing medical services to people in evacuation
centers across the south.
In addition, we have deployed the strategic national
stockpile in the State of Mississippi and provided more than 30
tons of medical equipment and materials in the State of
Louisiana. We've also conducted the coordination of the vending
operations to assure a supply line of medical materials and
vaccines. And CDC has also used the authorities that Congress
has provided us in terms of our aircraft to, on short notice,
deliver anti microbials, intravenous supplies, and I believe
save lives by being able to get those materials into Louisiana
very, very quickly.
The Department has also taken the leadership team to many
of the shelters. Secretary Leavitt has actually been three
times now to visit shelters and understand firsthand what the
needs of the sheltered individuals are. But we have also
visited our Federal medical contingency stations where we
deployed more than 2,500 emergency equipment for 2,500
emergency beds in that regard, and deployed large contingencies
of the commissioned corps as well augmented services from other
medical centers across the United States to staff these
shelters and provide these medical services. These and many,
many other activities, I think, have been going on largely in
the background of the lens of most of what's been discussed.
In terms of the Centers For Disease Control, currently, our
operational mission is summarized here. We have 61 people who
are doing surveillance for the emergence of disease and
investigating those diseases with teams across the south. The
largest force is in Louisiana at the moment. But we've had
overall since the operation began more than 300 people
supporting public health functions in the field. Again, I want
to emphasize, these are broad spectrum of activities, including
occupational health screening, environmental health services,
vector control for mosquitoes, rodent control for the
anticipated rodent and pest problems that will emerge and a
variety of other public health functions to support and
augment, in my opinion, some of the unsung heroes, the State
health officials in the various regions, in particular, Dr.
Kevin Stevens, the health officials from the city of New
Orleans who spent time in the Superdome.
And I traveled with him to various shelters as he tried to
locate his staff and figure out ways to get them back to New
Orleans to begin the recovery and reconstruction
responsibility.
I'm just going to present three very brief snapshots of
what the medical experience has been. These data are provided
by hospitals in the greater New Orleans area. These are just
snapshots. These data haven't been elevated or confirmed. But
what you can see here in terms of injuries and chronic
diseases, yes, the hospitals are requiring services for people
with their regular medical attentions. But injuries have
emerged in all of the different environments as a consequence
of people rescuing and cleaning up the debris. We also have
noted several cases of carbon monoxide poisoning, which is
something we anticipate after any disaster that involves the
use of generators and we are working hard to try to get
information and education to people to avoid that.
I have to emphasize the importance of mental health issues.
The incredible immediate impact on people with pre-existing
mental health conditions as well as long term mental health
conditions is something that has engaged the entire department,
and particularly SAMHSA, that has the lead for this activity.
And last, in terms of infectious diseases, we have not seen
widespread outbreaks of anything unusual. We anticipated
intestinal diseases and respiratory diseases in the shelter
context and we have seen some problems with an organism called
vibrio, which is associated with the brackish water and some
serious infections and death from that, but not the scale of
infectious disease problems that one might anticipate.
Environmental assessments are ongoing.
I'll be happy to answer questions about the environmental
impact as it pertains not just to the city of New Orleans where
there was flooding, but also in other regions of the south.
And last, let me just conclude by remarking on the
incredible heroism that I've seen, not just among all the
people in the country who are working hard to mitigate the
consequences of this, but particularly to the survivors of this
catastrophe, the stories that people tell about their own
family heroism as well as the efforts that they made on behalf
of others are heart warming, and I think what really leads us
to have some hope, particularly as we look at Rita, but also as
we go forward and try to strengthen our Nation's overall
preparedness capacity. Thank you.
Mr. Deal. Thank you, Dr. Gerberding. And I will begin the
questions as this point. Before the hearing today, you and I
had an opportunity to talk briefly about an issue that is of
concern, I think, to all of us. We've heard it surface in
several of the opening statements here today. And that is with
regard to volunteer professionals, doctors, nurses, et cetera,
from outside the affected region and their ability, or
inability, as the case may be, to access and be able to be of
service in the affected area. You outlined for me the program
that is in place and the procedure for certification and
verifying that. Would you be kind enough to do that briefly
right now?
Ms. Gerberding. Sure. I'll be happy to give a summary and
provide additional background on that as we go forward. The
overall health care service delivery in the context of
preparedness is a modular program that relies on the
commissioned corps of the public health service which has been
engaged and relies on the national medical disaster system,
which are teams of people from the civilian population who move
into an area as a unit with the equipment and the materials
necessary. Those are the people who, for example, worked out of
the New Orleans Airport to support the evacuation efforts. Then
there's an augmentation. We have a reserve corps in the
commissioned corps of the public health service.
And importantly, in all of this are the health care
personnel in the affected regions. They are providing the vast
majority of the care. Beyond that, if the need is larger than
those people can provide and importantly in this context,
sustain, it is possible for voluntary health care workers to be
temporarily licensed in the affected States. And that can
happen by providing them status as temporary Federal employees.
If you're a Federal employee, your license can apply in any
jurisdiction in which you're working as a Federal employee
providing medical services as long as it's within the scope of
your license. Credentialling that is something that has
happened. We've had more than 30,000 people volunteer. The
credentialling is in progress for those people. And depending
on the decisions by Governors and the involved health officials
in the State we can Federalize volunteers. What we don't want
is for people to flood in a discoordinated way because then we
end up having health care workers doing everything they can to
help, but we don't have a comprehensive approach, leadership,
management, supplies and communication that really allows us to
take the best advantage of this volunteerism.
So, it's an important component. And I know it's hard
sometimes for people who really want to help to feel that their
help is not being accepted. Believe me, there will be
opportunities to help, and I think we can anticipate this
volunteerism in the future and do a better job of planning for
it ahead of time so that the step of credentialling is
happening in advance, and perhaps people could be trained and
offered the opportunity to prepare before they're actually
requested to serve.
Mr. Deal. Well, I thank you for that. And I would simply
echo that last comment, that I think in light of what we learn
here is that there are many people willing to help and willing
to volunteer. And if we make the information available to them
so that we can get the credentialling done in advance of a
disaster, I would encourage movement in that direction, and I
think this will make everyone more aware of the fact that there
is a process, because as I understand it, licensure and
credentialling carries with it the Federal Government giving
protection from a liability standpoint and obviously, you do
need to have some degree of say-so about who you extend that
protection to. But I would hope that we would see that effort
of credentialling continue and expand greatly.
Let me go to another subject. And the CDC Foundation that
works in conjunction with the CDC, would you explain briefly
what that foundation does and how it augments what you do at
the CDC, and what has that foundation done in conjunction with
Hurricane Katrina?
Ms. Gerberding. Thank you. The CDC Foundation is a
Congressionally authorized nonprofit foundation that exists to
help CDC do more and do it faster. Beginning with the World
Trade Center attacks, the Foundation has taken a special
interest in supporting and augmenting our preparedness and
response capabilities by creating special funds that allow us
to make resources available at the front line. So in the
context of Hurricane Katrina, we've had remarkable
contributions from several foundations and individuals across
the country that have allowed us to do things like provide
housing for the public health workers in the city of New
Orleans who wanted to work but couldn't afford to pay a hotel
bill for their stay, provided laptops for front line people,
eventually they will be able to have some of these services,
but they need them right now and we don't have to go through
the government procurement process.
The Foundation can put those tools in the hands of people
on the front lines. It's been absolutely important. We've used
it do get vaccine supplies in places where we needed to make an
immediate buy and a number of other things that really have
solved problems for the front line public health officials
without having to go through a lot of red tape. So it's been a
wonderful, wonderful support for all of us.
Mr. Deal. And you multiply the dollars that the Federal
contribution is. You multiply them many times over by the
contributions from the private sector.
Ms. Gerberding. Oh, absolutely. Absolutely. The Federal
Contribution Foundation is very small compared to their overall
ability to help.
Mr. Deal. Thank you. Mr. Brown is recognized for questions.
Mr. Brown. Thank you, Mr. Chairman. And welcome again, Dr.
Gerberding, and thank you, Chairman Barton, and Chairman Deal
for putting together this hearing. In the general sea of
Federal incompetence that we saw in New Orleans and along the
Gulf Coast the CDC really stood out as an agency that
represents what the Federal Government should be, and we thank
you for that. I think people on this subcommittee, or on the
Health Subcommittee, and I think Mr. Stupak and Mr. Whitfield's
subcommittee also are not surprised at the effort that the
CDC's good work, not just in response to Katrina, but generally
because most of us, I think probably on the subcommittee, have
visited Atlanta and seen the CDC and seen the professional way
that you carry your work out and not just you, but your entire
top staff and mid-level and rank and file workers, and I think
that's a lesson to us that when you hire competent professional
people to run agencies, it means that those agencies carry out
their work in competent professional manners. And that's
something that we should remember whether, whenever we would
both judge and evaluate what our Federal Government is doing.
Ms. Eshoo, and then Ms. Schakowsky and Capps and Baldwin,
all mentioned the cuts, the proposed cuts to CDC. And I think
they speak for themselves certainly, but my concern is not that
this was one person proposing a huge cut in CDC, there are 435
Members of Congress and people do what they do. But when a
large swath of a political party or a large swath of Members of
Congress, 80-some members, put out a document that says we
should cut CDC $25 billion over 10 years, that's something we
need to understand better and respond to and prepare for, in
case they are able to keep tax cuts in place and make these
huge cuts to CDC.
So I would like, if you could, Dr. Gerberding, tell us what
these cuts, what they actually mean. What they would mean in
terms of your day-to-day operations and what you do, everything
from lead-based paints to obesity to health disparities to
response to preparedness and what it would mean to your agency,
those kinds of cuts in response to another Katrina or an
attack, terrorist attack or something like that.
Ms. Gerberding. I respect and appreciate the dilemma that
Congress faces in terms of how to pay for these disasters. I am
not a party to the discussions about the CDC budget cuts. This
is really the first I've learned about them sitting here in
this hearing today, and it is a sobering prospect. But I
believe what probably happened, and I hope I have a chance to
talk to the people who have considered cutting CDC, is that in
our House budget this year, there is, on paper, the appearance
of a $1.8 billion increase in our budget because the
Appropriation For Terrorism Preparedness that used to go to the
Department of Health and Human Services is now in this budget
directly appropriated into CDC's line.
So if you're just looking at last year's line compared to
this year's line, it looks like we got a proposed $1.8 billion
increase. And I suspect that the proposed reduction was a
misunderstanding that that $1.8 billion was an increase for
some purpose, when in fact, it was a movement of money from one
line item in the Department back to our own line item. So I'd
like to have a chance to check on that and to get back to you
if that's the explanation.
Mr. Brown. I don't know if it is a misunderstanding. I look
at other parts of this document and the cuts are huge in all
kind of service areas, increase in Medicare premiums, cuts in
Medicaid, even though the demands of Medicaid are greater and
greater prior to Katrina and Rita, prior to, but because of
layoffs and all that's happening and more people need Medicaid
and all of that. So I don't know if that's the case. Talk to
me, if you would, about--I mean, even if the $1.8 billion is
considered that way, $25 billion cut over 10 years, by any
multiplication factor is a significant cut. I really do want
you to talk about what the demands on--I mean, I know you're a
``political appointee,'' but I also know you're a professional
and I trust you and I've watched you in all kinds of venues.
What would that mean to this country's public health if we
have these kinds of, whether it is a--no matter what percent
the cut is if you include or exclude the $1.8 billion, it's
still a significant reduction in a funding stream for a very
crucial public health agency. What does that restrict you? What
can you not do?
Ms. Gerberding. I'm not prepared to answer that with
accuracy right now. Obviously, it would be a very sobering set
of decisions about prioritizing or reprioritizing our work and
we would have to----
Mr. Brown. Okay. I accept that. But would you, after
consulting with the authors of this and after they clarify to
you what you meant, would you respond in writing to me and to
Mr. Stupak about what, in fact, that would mean to your agency?
Ms. Gerberding. Absolutely.
Mr. Brown. Thank you.
Mr. Deal. I'll recognize Mr. Barton for questioning.
Mr. Barton. Thank you, Mr. Chairman. Doctor, you've
testified before this committee before and I appreciate you
coming again. I want to ask, just for the record, what your
role is in the overall hierarchy at health and human services
in terms of setting some of the larger policy goals that HHS is
responsible for. Do you participate in those discussions on
Medicare and Medicaid and things like that? Or is your role
strictly Centers for Disease Control and running that part of
HHS?
Ms. Gerberding. My primary role is public health and the
Centers For Disease Control in prevention. There are many
important intersections between the work we do at CDC and other
parts of the department, including Medicare. For example, the
fact that the new Medicare Modernization Act includes
prevention benefits that never before existed in Medicare is
something that CDC has worked very hard to encourage for a long
time. And we feel that the Medicare modernization process is an
excellent opportunity for us to do what we do, which is to
protect health through prevention services.
Mr. Barton. So you do have some input and some interaction
with the secretary and some of the other assistant secretaries
and the people at CMS and some of the larger policies, is that
fair to say.
Ms. Gerberding. It is fair, and in areas where our
expertise is complementary or helpful.
Mr. Barton. Okay. So now while we couldn't have some of the
witnesses that we had initially hoped to have today, one in
particular who had to go down to Texas, and I know some of
these questions are not directly in your jurisdiction, but
since you just said that you have some input, I want to ask a
few questions on some of the larger issues. What is considered
within HHS right now, the No. 1 health issue as a consequence
of what's happened with Katrina? If there was one issue that
the Secretary and the other assistant Secretaries and yourself
are most concerned about, that directly, as a cause of Katrina,
what would that be?
Ms. Gerberding. I don't want to speak for the Secretary.
But I believe the restoration of health services is the big
picture here. We need those systems to support the delivery of
services, whether it's care for chronic medical conditions,
care for mental health conditions that are present or emerging,
or the sort of support services that people need to get their
feet back on the ground.
Mr. Barton. So there's not a concern, I mean there is a
concern, but it is not as high a priority, some sort of an
infectious disease because of contaminated water supplies, or
environmental damage, some of the petrochemicals leaking into
the groundwater, those are serious issues. But the No. 1 issue
is just restoring the basic health services. Is that fair to
say?
Ms. Gerberding. I would say that would be at the top of the
list. The other acute problems that you've mentioned are things
that are certainly very important issues for the CDC and we are
very vigilant about doing what we can to prevent infections,
prevent exposures to these toxins, prevent vector borne
diseases and help restore the public health infrastructure
which was fragile in many of these areas before the hurricane
and is going to be a challenge to restore after the hurricane.
Mr. Barton. So within the No. 1 issue of restoring health
services, what is the discussion right now about the Federal
role, and should we--should the Federal Government come in as a
providers of last resort and put money and manpower, regardless
of the profit, nonprofit State-Federal-local relationship? Is
it the feeling that we should just go in and do whatever needs
to be done and have the Federal Government pick up the tab for
it? Or is there some feeling that there should still be some
sort of a partnership and we should look at the historical
relationships and try to provide immediate short-term
assistance while trying to maintain some balance of the
historical relationships?
Ms. Gerberding. No, my understanding from the participation
in these discussions that I've had is that we all recognize
that, again, sort of that network concept, that we're going to
have to work effectively in partnership with a wide variety of
enterprises, including the private sector, and that no agency
or no government or no individual is really going to be able to
affect a solution here standing on their own. I would be happy
to get more information and clarity on this point from
Secretary Leavitt for your record.
Mr. Barton. Well, I understand that we didn't get some of
the witnesses and some of these questions I'm asking you would
be better directed to somebody that had a direct policy role
day-to-day in these areas. But we're dealing--what should we do
on Medicaid? Should the Federal Government step in and provide
100 percent Medicaid assistance for everybody in the affected
regions, or should we provide short-term Medicaid assistance in
the historical Federal-State sharing relationship? What should
we do with for profit hospitals? Should we rebuild a for-profit
hospital right now or should we provide this assistance only to
nonprofit hospitals? These are the kind of policy questions
that honorable people can disagree on what the, you know, what
we should do.
The humane short-termed compassionate response is let's
just do it. Let's don't worry about who pays for it. Let's just
do it. When you look at the financial consequences long term on
the American taxpayer, the Federal Government just stepping in
and doing all right now, some of the numbers get to be pretty
big pretty quickly.
So you know we'll do some other hearings on this as soon as
we can get the right people to come forward. I want to thank
you for your, first, for your work in the current situation. I
want to echo what Congressman Brown said. You've done an
outstanding job.
And I encourage you to do that good work as this second
hurricane gets ready to hit our coast. I've just been told that
my hometown, which is 320 miles from the coast of Texas, is
now--the interstate Highway 45 is one way all the way from
Galveston through Ennis, Texas. That's amazing. That's over 300
miles, one way getting out of there. Thank you, Mr. Chairman.
Mr. Deal. Thank the chairman. Mr. Stupak.
Mr. Stupak. Thank you, Mr. Chairman. And Doctor, if the No.
1 goal or No. 1 issue in your eyes is the restoration of health
services to these people, many of them are displaced, then
would the bipartisan legislation introduced by Senator Grassley
and Senator Baucus, which is a bill which really provides
immediate health care assistance to Katrina survivors through
Medicaid and 100 percent Federal funding to any State that
enrolls survivors in their program, in other words, the money
would follow the person no matter where they ended up, whether
it's Texas, New York, Washington or Michigan, this approach is
simple. It's immediate. It's equitable. It will not require the
complexity of negotiating separate deals or Medicaid waivers by
the administration with over 25 States that have taken in
Hurricane Katrina survivors.
Also the bipartisan Senate bill would also guarantee full
funding for all low income Katrina survivors. And it does so in
a program that States already know and work with. So would this
legislation then meet the needs of your No. 1 issue, the
restoration of health services?
Ms. Gerberding. Thank you. I'd like to make a couple of
statements of principle that we are planning on in the
Department. One is that we want people to be able to access
their services quickly in the most synergistic and customer-
friendly way possible, wherever they are when they need them.
And the second principle is that whenever possible, to use
existing programs and services to be able to provide things in
a familiar environment with people who are already expert in
administrating those program. But we are all looking for
flexibilities in authorization and ways to make these programs
work more rapidly. I can't comment on the specific legislation,
and I'm not familiar with the details. But I'm sure others in
the Department can respond to your question.
Mr. Stupak. But with those goals the approach is simple,
it's immediate, equitable. If you start going through waivers
it's going to take time to deliver these services, right,
because those all have to be----
Ms. Gerberding. I can't, I just can't comment on that.
Mr. Stupak. All right. Let me ask you this. Were there
areas in New Orleans and throughout the Gulf area, not
hospitals, but were designated as evacuation sites for
individuals who had medical needs?
Ms. Gerberding. There were evacuation plans that the city
had put forward, and I believe had even had a recent exercise
of those evacuation plans to account for people with special
needs. I'm not sure the plans adequately addressed some of the
concerns that were raised earlier about long term care patients
and others that would find it difficult to avail themselves of
an evacuation services.
Mr. Stupak. Well, was CDC then aware of these other
designated areas as evacuation sites for people with medical
needs? Were you aware of it before Katrina hit?
Ms. Gerberding. The CDC is not responsible for that
specific activity, and I would have to make a determination
whether or not we in the Department had that information.
Mr. Stupak. So you didn't know then that like the
Superdome, which was one of those evacuation sites for people
with medical needs. You wouldn't have known that?
Ms. Gerberding. Superdome is what is known as an evacuation
center of last resort. It was never designed or intended to be
a medical center. It was a place where, if everything else
fails, if people are at risk of drowning, it was known to be
able to survive a category 4 hurricane. But it was never
intended to be----
Mr. Stupak. Here in the city plans, it says some will be
housed at the Superdome, the city plan, the designated shelter
in New Orleans for people too sick or infirm to leave the city.
So I would see it more as just a--that's what we are trying to
get at and those were people who were sick. If we knew they
were at evacuation sites, whether it's the city plan, the
Federal plan, or the State plan, our question then is why, if
everyone knew about it, they were in these plans, how come the
medical supplies weren't there.
Ms. Gerberding. Again, it was not in the pre-event planning
intended to be a medical center. We wouldn't think of a large
auditorium like that as being a place where we would have the
kind of medical capability that turned out to be required.
Mr. Stupak. Sure. But as you indicated it was in the city's
plan.
Ms. Gerberding. I can't comment on the mayor's plan.
Mr. Stupak. Okay. Let me ask you this. What changes have
been made in the way--I'd like to ask HHS, but again they're
not here. Well the CDC, what changes have been made in light of
Katrina to get you ready for Rita?
Ms. Gerberding. Thank you. We are doing several things.
I'll just give you a couple of concrete examples. In addition
to forward deploying personnel which we did prior to Hurricane
Katrina as well, we have just done an inventory of the
communications system that we are responsible for. CDC owns a
wavelength of the high frequency communications system. We have
14 bands in there. We know that, we have tested in Texas
frequently, prior to the hurricane, the activity of that high
frequency communication system that allows us to communicate
with public health officials. In the past, it was up to public
health officials to be able to connect with the relevant care
providers in their community. But we are reaching forward to be
sure that we deploy antenna, batteries, and other equipment to
make sure that our back up communications system is intact in
the State of Texas.
Mr. Stupak. Well, did you have that communication system in
New Orleans?
Ms. Gerberding. As a matter of fact it did exist in New
Orleans, but they didn't have gasoline for the generator and
they didn't have the battery supplies to be able to reliably
use it.
Mr. Stupak. Who is they? You or CDC?
Ms. Gerberding. We are just in the process of understanding
what the failure was in that high frequency communication
system in that jurisdiction.
Mr. Stupak. Thank you, Mr. Chairman.
Mr. Deal. Mr. Whitfield next.
Mr. Whitfield. Thank you, Mr. Chairman. Dr. Gerberding,
obviously, this hurricane did expose some vulnerabilities from
the health care systems, even in the area that you're
responsible for. And in your opinion, what are the major
vulnerabilities that were exposed?
Ms. Gerberding. I think there were issues around the
anticipation of the predictable surprises. For example, we knew
that any disaster would bring a requirement for rescue and
relief workers to go into environments that weren't necessarily
safe and that infectious diseases could be a problem there. We
could have prepared our guidance for who needed what
immunization prior to the event and not during the event so
that we could have eliminated--nothing that caused a problem,
but just one extra element of working one extra element the
communication.
Those kinds of anticipatory recommendations under disaster
circumstances are something that we're going through right now.
We also learned that we were able to stand up 20 public health
teams of 20 people each, excuse me, 12 public health teams with
20 people each with multi disciplinary support to be able to
move in as a team into a region and we have used those teams
across the south. The rostering of those teams revealed to us
that our bench is not broad in some specific areas.
For example, we don't have a deep bench in risk
communication. And in order to assure that we can scale up to a
disaster this size, we need to not only be able to augment our
own personnel, but we need to identify people from other parts
of the country who would be willing to come in and volunteer or
donate their time to be part of our teams. So we're already
figuring out how top reach outside of CDC to link into a
broader bench to help us when scalability is really the
challenge.
Mr. Whitfield. You sent 12 teams of 20 people each into the
New Orleans area?
Ms. Gerberding. We comprised 12 teams. We also are sending
people in without request, and so in some, for example early on
in Mississippi, they needed 35 environmental health experts to
help deal with things like water quality and food quality in
the shelter environment, so we rostered 35 environmental health
people there as a team. We have a full complement of public
health experts right now in the city of New Orleans, sitting
literally next door to the city health director, along with the
Department of Defense and the Army Corps of Engineers and
others.
They are really working on restoring the public health
system in the city in a wonderful collaboration, actually a
visionary collaboration of what really would be a better
solution to the public health system in a community that's long
had the challenges of health disparities and underinvestments.
Mr. Whitfield. And do you have the authority to just send
these teams in without a request from local or State
government?
Ms. Gerberding. No. CDC cannot send personnel into
anybody's State without permission. That is not part of our
authority. We have to be requested by State health officials or
local health officials for assistance.
Mr. Whitfield. And how timely was that request for
assistant?
Ms. Gerberding. It was, in my opinion, right on time. We
are using our own command and control structure, which at least
preliminary evaluation has revealed a much better system than
some of our strategies in the past. We have a senior management
official in each of affected States that is there with the FEMA
task force, but also with the State health official. And they
are the point of contact and the leader for all of the other
CDC activities in that environment, so all of our field teams
report back to our senior management official who's working
with the overall disaster leadership.
And that allows us to know immediately when there's a need
and to relay that need up and down the system. So I think the
timeliness of our deployments has been exemplary. And again,
not to harp on the CDC aircraft, but we were able to get people
in and out of these areas at a time where we could never have
been successful in the past because we could use the CDC plane.
Mr. Whitfield. So from your perspective, just the
infrastructure that you had in place and the management team
that you had in place was able to respond in a timely fashion.
But you were weak in that you did not have adequate expertise
in particular areas that you needed in these teams.
Ms. Gerberding. I would not describe it as a weakness or
deficiency. We just realized that if we were asked to do more
than we were already doing, that we were going to be cutting
into other important public health functions that are part of
our agency's overall mission. We're not only a preparedness
agency, we have other responsibilities like avian influenza and
other key issues on the horizon. So for us, given that this
operation is not short-lived, and we are seeing it followed on
by another hurricane, we have to get the balance right between
being able to provide an effective and sustainable response,
and at the same time, continue our important public health
mission.
Mr. Whitfield. So there was no weakness, but just not
enough people in this particular area.
Ms. Gerberding. A recognition that future planning will
need to assure that we have a back up to the system.
Mr. Whitfield. Just one other question. On September 8, in
an interview at CNN, you indicated that you were relieved at
that point because you did not see any major disease outbreak.
From your perspective, is that still the case or----
Ms. Gerberding. We have seen outbreaks of expected problems
in the shelters in Texas. There was a problem with a common
viral gastroenteritis, the same thing that causes the outbreaks
in cruise ships, sometimes called noro virus. CDC, along with
local and State health officials, brought that problem under
control remarkably easily, probably more easily than we have
seen on cruise ships through extraordinary measures to help
people improve hand hygiene and hand washing. We have seen this
vibrio infection outbreak. Vibrio is a bacteria. One member of
that family causes cholera. We certainly don't expect cholera
in this area, but organisms in that family can also cause other
very serious skin and bloodstream infections, and there have
been some deaths associated with vibrio from people being
injured, wandering in the water, and then getting infected.
Our most important public health focus right now in
addition to just avoiding drinking the contaminated water in
the greater New Orleans level is the concern that we have
tracked down people with pre-existing infectious disease
problems like tuberculosis that need to be treated even in this
context, and we have accounted for the vast majority of
patients with tuberculosis who were being cared for by their
public health programs, but we haven't found all of them, and
so we are very eagerly working across the United States to make
sure that we have identified every single person who is
supposed to be on tuberculosis medication and assure that they
are on their treatment.
Mr. Deal. Ms. Eshoo is recognized for questions.
Ms. Eshoo. Thank you, Mr. Chairman. I have a series of
questions, but before I start on this much referenced report,
``budget options summary and explanation of offsets by the
RSC,'' the Republican Study Committee, under reducing funding
for the Centers For Disease Control. It States under the House-
passed appropriation level, the CDC's funding increased 25
percent over last year, a significant infusion given the
current fiscal situation. Savings, $25 billion over 10 years,
$9.7 billion over 5 years. So that gives you a taste of where
they're going. All right. And----
Ms. Gerberding. I would like to have a chance to understand
this proposal. I have--it's obviously sobered my----
Ms. Eshoo. Well, certainly. And I understand your
discomfort of commenting on something you haven't read. But I
just wanted to read that into the record so that--because we've
just been using the figures, and I'd like to ask that after
having read this, that you send a letter to each member of the
committee with your analysis of what these cuts would
represent. I'd like to request that and I can't make you do it,
but I think that it would be an important document relative to
the health, the overall health of the Centers For Disease
Control. Let me ask you this: Of whose left in New Orleans,
have they received vaccinations?
Ms. Gerberding. The people who are--the rescue and relief
workers have been advised to receive vaccinations into the----
Ms. Eshoo. What about the population, any population that's
left there?
Ms. Gerberding. People who are presenting for care are
evaluated to determine whether or not their specific
environment puts them at risk.
Ms. Eshoo. Individuals have to make the determination as to
whether they're at risk and then step forward?
Ms. Gerberding. No. The vaccines that were especially
recommended in those areas because we were concerned about
people being in the water and rescuing and taking care of
people, the people in the evacuation centers.
Ms. Eshoo. I understand. But both the search and rescue and
from residents----
Ms. Gerberding. The evacuees immunizations were based on
the fact that they were in crowded conditions where they could
transmit----
Ms. Eshoo. Not in water?
Ms. Gerberding. The evacuees we were focusing on,
particularly the children, the vaccine preventable diseases
that they should have had as well as their tetanus shots. So
there are really no special vaccines for regular people that
are necessary. But a lot of these people were behind on their
regular immunizations and so we want to catch them up. And
that's really been the focus for the average person who is not
putting themself at special risk.
Ms. Eshoo. I am feeling less and less confident the more
you try to explain this to me. I want to get it straight.
Residents of the affected area that are still there, is there a
team of people, whether it's CDC or any other organization that
is making sure that they receive the kind of vaccines that
search and rescue people have gotten?
Ms. Gerberding. The people who, let's say the people who
refused to be evacuated, is that who you're talking about?
Ms. Eshoo. Well, the people that are left there. People
that didn't get out. People that are still there, whatever you
want to call them.
Ms. Gerberding. The people who are still there or who are
returning are at no greater risk for special infectious
diseases----
Ms. Eshoo. Not returning. There are some people who didn't
leave. They're the ones that I'm asking about.
Ms. Gerberding. It's not a one-size-fit-all answer. The
purpose of the immunizations in the context of a disaster are
to provide protection against special circumstances that
emerge. If individuals are in an environment where they're----
Ms. Eshoo. Let me just go on, because I have two more
questions. When did the teams that you referenced, these 12
teams of 20, when did they arrive in the area?
Ms. Gerberding. They arrived at different times throughout
the deployment, depending on the request of the State health
officers. But generally, they arrived on the day they were
requested.
Ms. Eshoo. Which was when?
Ms. Gerberding. I can give you the details for all of
various departments.
Ms. Eshoo. I think that we need to have that.
Can you explain to us how the planning that takes place at
FEMA and Homeland Security includes you, so that there are
not--I think if there is anything that we've learned from this
is that we have separate smokestacks. Each agency is talking
about what their team did or didn't do and how they planned. I
don't have a sense that there was coordination that was so
meaningful that they arrived at a time with the breadth and
depth of teamwork from across agencies in order to address this
catastrophe. So can you describe for us how you, how CDC is
integrated in that.
Ms. Gerberding. Under the current National Response Plan,
and something called the National Incidence Management System
and its annexes, right now CDC is not directly linked into
Homeland Security or----
Ms. Eshoo. Do you think you should be?
Ms. Gerberding. I think that is one of the things that I
would like to look at, was there adequate health input into the
decisions that were being made. The Department----
Ms. Eshoo. Dr. Gerberding, I mean, with all due respect, I
mean we pick up the newspaper and we see bodies wrapped in
white sheets on the front pages of our Nation's newspapers. So,
you know, if we need to think out of the box, this isn't fault
or blame, we've got to come up with a better way to respond,
and this is--I don't want to pit a terrorist attack against a
natural disaster. We are a great and wealthy and decent nation,
so something is wrong here. And if you're left out of that, if
CDC is left out of that--we see people going through these
contaminated waters. I think that CDC needs to be part of the
overall response team that hits the ground. I might be wrong,
but since you're here, you're included and you're the lead
witness in this hearing. We are going to need some real
professional thinking coming out of the agency to help us do
what we need to do. It seems to me that you should be
integrated in those teams. I may be the only know that thinks
that, but I think that should be a consideration. I really do.
Ms. Gerberding. I think I misunderstood your question
because I thought you were asking me about sort of the planning
process and the kind of high level government process. On the
ground we're very much integrated in the team. And we do have a
desk in the operations center and we are there side by side
with the other responders on the ground. So I apologize for
misunderstanding.
Mr. Deal. The gentlelady's time----
Ms. Eshoo. So are you satisfied with how your agency was
able to do what it is supposed to do in this emergency?
Ms. Gerberding. I'm never satisfied, and we can learn.
Ms. Eshoo. Neither am I, I'm never satisfied with myself or
all kinds of things, because anything we can do we can always
do better. But I'm asking you are you satisfied that what your
responsibilities were----
Mr. Deal. The gentlelady's time is expired. Can we conclude
within 3 minutes over time, please?
Ms. Gerberding. I believe that all of us should and could
do much better, including the CDC and the health sector
response. I'm just as horrified by some of the things that
happened in these areas as you are, and I am very committed to
making sure that my agency will do better next time, and I'm
very committed to doing my part within our department to
improve.
Mr. Deal. We have a vote going on on the floor. The
committee is going to stand in recess pending the completion of
the votes, and I would encourage the members to come back as
soon as possible so we can finish because we still have a
multi-member second panel. We stand in recess.
[Brief recess.]
Mr. Deal. The subcommittee will come back to order. We will
resume with the hearing at this time, and Dr. Gerberding is
still the first witness on the first panel. It is now in order
to call on Mr. Bilirakis from Florida for his questions.
Mr. Bilirakis. I thank the Chairman, and I know that many
of the folks who have been talking about this Republican Study
Committee plan are not in the room. CQ Today, ``Conservatives
offer $1 billion offsets plan but GOP leadership won't bite.''
And those of us who were in the caucus yesterday morning heard
the GOP leadership not biting on this, so I think that should
be a part of the record.
Doctor, you've heard a lot of frustrations up here today,
and they're all with merit. There is no question about that in
my mind. And yes, we are frustrated regarding what has happened
or what hasn't happened or what hasn't happened exactly the way
it should have, and things of that nature, and it's important
that we learn from the past, we learn what has happened or
hasn't happened so we can prepare better in the future. There
is no question about that either. But my frustrations go more
toward, you know, it's like I said in my opening statement. We
seem to react. A disaster takes place, and we decide to hold
hearings and react and what not, and when are we ever in really
the richest country on the face of the earth, with all the
intelligence we have here and what not, ever going to be
prepared, really adequately prepared when these things happen?
Sort of like the Medicare bill for years and years didn't have
any provisions in it to keep a disease from taking place, it
was just providing to take care of a person when they got sick.
And you heard me talk about 211, and as I understand it, it
played a role down in the States of Louisiana and Mississippi.
There are areas there apparently 911 went down and people went
to 211. And I don't know whether 211 is available in all of the
areas of those two States. Like in Florida there's neighboring
counties that have 211 and other counties that can't afford it
and don't have it and that sort of thing. That's why it's so
critical--in my opinion, it's so critical to get it into place.
But maybe--I don't have that much time left, but maybe if
you can address 211 and its significance. And then expand upon
that if you can in the short time available, what would you do
if you were king and you're frustrated too with the fact that
these things happen and we're never adequately prepared. What
should we do? Who is responsible? Who should be responsible?
What would you put into place if you could do this and say that
this has to be done?
Go ahead. Please proceed.
Ms. Gerberding. I would like to answer the if-I-was-king
question first.
Mr. Bilirakis. Queen, queen.
Ms. Gerberding. The one thing that we have learned at CDC
in our emergency operations is that you learn most in
operation, but the second best way to prepare is to exercise.
And there is nothing better than getting out there and rolling
up your sleeves and either doing it or role playing the doing
of it to inform you where your weaknesses are.
We learned from the 9/11 Commission about the failure of
imagination. I think one of the things that CDC is learning in
this operation is the challenge of scalability. So in order to
prepare we have to be able to think of the scenarios that we
are preparing for, and in our society and in our culture that's
very challenging.
I've observed that people are resistant to imagining things
that are really hard problems to solve, and so instead we
pretend like they're not really going to happen. We have known
for a long time a hurricane of this nature would be devastating
in New Orleans, we've known for a long time that parts of our
country are prone to earthquakes, and now we have the
additional dimensions of emerging infections like a food
pandemic or a terrorism attack.
We have to come to grips first with the fact that bad
things happen, and the government is going to have to be
providing a significant part of the leadership in that, but not
the only leadership. So if I were in charge, I would exercise
often, I would exercise without notice, and I would exercise
repeatedly.
Mr. Bilirakis. But are the plans--Mrs. Eshoo said it all so
very well. You talked about lack of coordination. As far as she
was concerned it looked like there was a lack of coordination.
So when you talk about exercising and that sort of thing
without notice, et cetera, but there's got to be something in
notion, there's got to be a structure there. Your folks--you
can exercise within the realm of your jurisdiction and
responsibility, but the way if it jives in with all of the
other agencies and departments, et cetera, et cetera, is out of
your hands.
So we have all this emphasis on some sort of a commission
to find out what happened, and that is significant, I'm not
belittling that, but should we be talking about maybe some sort
of a nonpartisan commission to sit down once and for all and
try to really work out, with the proper people like yourself,
work out some sort of a structure, of a national structure so
we can be better prepared and everybody knows where all the
pieces will fit when it happens?
Ms. Gerberding. I'm not sure that that would be the first
step. We actually have a new structure that is just in the
process of being implemented, something called the National
Incident Management System, which by law this September was
supposed to be finalized and in operation in various Federal
agencies. This is the first time we've ever operated under this
structure, and I think it's a great platform. We will either
learn that it could work but didn't for various reasons, or we
will learn no, that's not the right structure and we have to
reinvent it. I think it is too soon to say which of those
answers is correct. But CDC is operating in the context of that
structure. It's an incident management module that's been used
for a long time, but----
Mr. Bilirakis. Is everybody else operating within the
content of that structure?
Ms. Gerberding. Everyone is supposed to be. I'm pretty sure
they're not at every level because many people haven't
exercised it and it is just brand new. But the concept of
knowing who is in charge, who is responsible, what the roles
and responsibilities are, all of the important components of a
response, that's critical.
One place where we've gone--and obviously there is a big
difference between public health and the Department of Defense,
but we've gone to look at how does the military conduct such
complicated operations involving many disparate parts and
sometimes working with many different nations like they did
with the tsunami and they're able to make it work. But two
things; one is you have a strategy and everyone knows it and,
second, you exercise and you learn how to make these
connections go.
A third thing that we have----
Mr. Bilirakis. My time is up. I don't know, Mr. Chairman,
whether----
Mr. Deal. Could you summarize right quick, please?
Ms. Gerberding. I was just going to say, the third issue is
leadership. And I would say that in order to effectively lead
in this complex environment with multiple agencies and
jurisdictions requires a set of leadership skills that are
beyond those necessary to run an organization. You have to
learn to work between organizations and really how to lead a
network, and that's a new set of skills.
Mr. Bilirakis. Well, I would think maybe ONI, Mr. Chairman,
it wouldn't be a bad idea to maybe look into that; or Mr.
Whitfield coming here now, but we ought to learn a little bit
more about that and whether that might turn out to be the
ultimate solution.
Mr. Deal. To make that DOD analogy, you probably need a few
first sergeants. That might solve part of the problem.
Ms. Capps, you are recognized for questions.
Mrs. Capps. Thank you.
Dr. Gerberding, you had an agency that's respected
throughout the world for the epidemiology you provide to many
nations, and you are appreciated by the public health community
I represent, and that every community owes a debt of gratitude
to the CDC for the local support services that you provide, and
I thank you for being here today.
I have three topics in my brief time, so I don't expect
lengthy answers from you, but I want to focus on the emergency
responders to Hurricane Katrina who have been and will continue
to be exposed to extremely dangerous environments since the
first day of rescue operations. Example, wading through
contaminated waters filled with sewage and hazardous materials.
Now following 9/11, the Federal Government created a
medical monitoring program for responders to the World Trade
Center tragedy, and I'm wondering if the same long-term
monitoring program for responders to Katrina, and now maybe
Rita, is being set up.
Ms. Gerberding. The program is not set up as a long-term
program right now; we're concentrating on preparing people to
protect themselves, is the first priority, with the equipment
and the immunizations that are necessary. We are assessing the
hazards as we go. And we have NIOSH teams as well as the
environmental health teams onsite to assist with those
assessments. If that perspective indicates that yes, this is
going to be issued for long-term health concerns, then I'm sure
we will be getting recommendations about what and how we would
go about them.
Mrs. Capps. So you could set up something to monitor as
well?
Ms. Gerberding. Yes, we could.
Mrs. Capps. And what about the population that moves back
into New Orleans as the cleanup continues, would they also fall
under this category?
Ms. Gerberding. Well, different set of issues but a lesson
learned from the World Trade Center. As people return they will
have concerns about the environment. The first thing is to do
everything possible to improve the environment so that there
aren't exposures. The second is to try to assess what the
hazards may be, and that work is ongoing as we speak with
various people in the field. And then the third is to identify
what, if any, are the long-term consequences of that, and to do
what we need to do to address them. I think this is early in
that process, and so we will be----
Mrs. Capps. You are just sitting it out there?
Ms. Gerberding. Yeah. Mrs. Capps. Adults who move back in--
or people who move back in and begin cleaning up their own
property face a variety of health risks as they do that. I'm
wondering if there is the capacity to vaccinate them in the
same way that relief workers are being vaccinated.
Ms. Gerberding. Yeah. I didn't have a chance to give a
complete answer to this question before. There are two
categories of immunization in play here. One is to catch people
up with the vaccines that they should have had, and that is
just part of providing health care services to people. Most of
the evacuees are going to fall under that category.
There are special immunizations that we've recommended for
people with special exposures. And some of the States have
recommended even more than we at CDC feel is in evidence based
on the approach right now. But for the majority of evacuees
returning, their hazard that is relevant to immunizations is
tetanus. And if they haven't had a tetanus shot in the last 10
years they need to get one. So that's the emphasis there.
Mrs. Capps. Good. Another topic, in 2002 this committee
worked in a bipartisan way to produce bioterrorism legislation,
and we deliberately made sure that that legislation covered all
public health emergencies. Now we're seeing whether it works or
not. The legislation created a program to assist cities and
communities to plan and prepare for public health emergencies,
and you were asked as one of those agencies to set benchmarks.
In fiscal year 2003 this program, Bioterrorism Prevention
Program, was decently funded, but the next year it was cut by
$100 million and then in fiscal year 2005 it was cut again by
another $10 million, and now the administration has requested
another cut in the budget of $130 million for next year.
I want to ask you, in the 3 years since this legislation
was passed, would you say that every major city in the country
has met the benchmarks that you established for planning
appropriations?
Ms. Gerberding. No.
Mrs. Capps. So I'm wondering if you have the funding, or
what is the blockade for doing that, what is the barrier?
Ms. Gerberding. It will be hard for me to give an accurate
short answer, but I will try to hit the highs.
First of all, we're starting in the hole. The public health
structure----
Mrs. Capps. The hole?
Ms. Gerberding. In the hole. The Public Health System was
neglected for decades, and so in order to bring it up to
anything even closely resembling contemporary needs is taking a
lot of investment.
Second, while--from the line item that says ``money to
States in the grant'' there have been some reductions, there
have been increases in other line items at CDC. So we learned
that it wasn't making a lot of sense to put money out into 50
States to do everything 50 times. Some things we just needed to
do and create a tool or a resource or a package and do once.
And so the total investment has not been cut, but it's been
moved out of Cooperative Agreement Program to be made available
to States through other means.
Mrs. Capps. Thank you. And Mr. Chairman, if I could direct
to you, this is legislation that we fairly recently--well, in
2002--passed, starting in this committee and through the House,
that we find some opportunity to follow up, if we are finding
this situation such as she was able to say just in the very
brief time.
Thank you.
Mr. Deal. Thank you.
Mr. Shimkus.
Mr. Shimkus. Thank you, Mr. Chairman. And I appreciate your
waiting, and patiently, for us to get through opening
statements and then in asking the questions. This is obviously
an interesting time for our country in many aspects.
I'm involved with the NATO Parliamentary Assembly, and we
had a strategic exercise last fall called Black Dawn put on by
Sam Nunn and some think-tank, and it basically said what
happens if a weapons of mass destruction--this case it was a
small nuclear bomb went off in Brussels, and what happened was
catastrophe: Overwhelmed first responders, no first responders,
people fleeing, and very similar to Hurricane Katrina. They are
very linked. And we, as a country, really need--you hit it in
your last question that my friend, Mr. Bilirakis, asked about
what do we need? What we need is the ability to respond; i.e.,
the military. I'm very biased, I'm a military guy, and when the
military got on the scene things changed. The Coast Guard was
on the scene for a long time, no one knew it. They were pulling
people off 3 hours after the hurricane went through, and they
have a military structure to be able to deploy assets. They're
the only ones.
So in your look, as being suggested, as we try to get a
handle on how are we going to respond to mass evacuations and
mass casualties, we'll have to integrate our agencies in sync
with probably a military response, maybe change the focus of
the National Guard to make sure--the military hospitals are in
the Army Reserves right now, and the Army Reserves has a
different deployment aspect than the National Guard does. Maybe
we need to get National Guard away from flying fighter aircraft
and back to infantry so they can roll trucks into an area and
deploy.
So this a the very important debate. And your agency, along
with others, we want to make sure that you've got your foot in
the door so that you're not left out, because there is--and I'm
going to follow up with questions that highlight your important
role. Many of us, because of all the interconnections we have,
either because of family or friends or--my pastor was down
there--we're getting a lot of just firsthand information or
secondhand information from visitors.
So I want to ask about the voluntarily first line
responders who went down there, some at the request, some
because they just packed up and went down. And one such group
is the fire fighters. And so they've been working as long as
they've been down there. And the question that I've been asked
to ask, they have the ability to even inoculate themselves.
What they have difficulty in is receiving the vaccinations they
need to protect the first line responders who are there now
from disease. What do I tell them?
Ms. Gerberding. I would need a few more specifics, but I
can say that first of all CDC has put forward with a fairly
massive distribution what we recommend people do. We are
bringing vaccine into the regions, and we are assisting with
the administration of vaccine at any place that needs our
place. So if there is a gap----
Mr. Shimkus. If we can follow up with you and point to
someone in my staff and--my staff or theirs, Mo--and we can
help coordinate with this particular--and there's probably
disparate groups all over the place that--I mean, I think
people--this is a huge disaster. And we keep beating up on
FEMA, and to some extent FEMA is a check-writing agency. They
go to disasters and they find a truck company and they give
them a check to haul out, you know, the refuge that is just--
but if you don't have a truck company any more, you can't hand
a check to them. If you find a truck owner, he can't find his
trucks. If he can find his trucks, they've been flooded. So
that's why when the military came in, as we talked about
before, and leadership, the deployment of assets, that's our
real challenge on a major disaster, and we've got to figure out
how we do that internally.
The other question deals with--it's kind of with the
bioterrorism question. What is the status of Federal and State
preparedness planning activities for vaccine and antiviral
stockpiling, which was part of the issues that we've been
trying to address? And if there is stockpiling in the area,
unless it's been destroyed, are we drawing upon other
stockpiles? Or where are we at as a nation in this whole issue
of stockpiles of vaccines?
Ms. Gerberding. Let me talk about the stockpile concept
generically and then specifically. We have 12 locations around
the country where we have something called a push pack, which
is a very large cache, a 747 cargo hold full of medical
equipment that was designed primarily to provide emergency care
in the context of a setting like the World Trade Center or the
day after the hurricane. It was not really designed to provide
sustainable health care for long periods of time, the kinds of
requirements that have emerged during this particular disaster.
Mr. Shimkus. Well, was the plane--once the air field was
available, did the plane ever get deployed?
Ms. Gerberding. We leaned forward----
Mr. Shimkus. Leaned forward in the foxhole, good.
Ms. Gerberding. We leaned forward, and when it was clear
that the State of Mississippi needed it, we brought the assets
to the location where they were needed. We put it on trucks,
the trucks were ready to roll. It was all right there.
In Louisiana we predeployed, before the hurricane hit,
about 37 pallets full of anticipated medical resources to a
zone outside of where we expected the hurricane damage, and
then those assets were made available, primarily at Baton
Rouge, but at other locations throughout the State.
So in terms of the planning, I think one of the questions
we'll need to look at is, is the content of the stockpile
that's designed now adequate to meet all of the range of
disasters that we would be required to support?
The second element of stockpile specifically relates to
drugs, vaccines and other supplies that have a half-life that
expire. And so instead of having them sit in a warehouse
somewhere, generally those supplies are in the process called
vendor managed inventory where there is a holding tank of them
at the vendor. They rotate them or use them so that they don't
expire, but when we need them, they have a cache place to
instantaneously get our hands on.
With the vaccines per se, independent of this, we have a
separate small vaccine stockpile, particularly vaccines for
children as well as some flu vaccine. We have tapped into that
replenishable resource. Also, we have looked for vaccine in
States that have extra and so forth. So we've brokered the
movement of a lot of vaccine around the country. I think you
will hear more about that on the next panel.
Mr. Shimkus. And let me follow up real quickly on the
issue, since there have been some public statements about
seniors and the ready access for them to being first in line
for the flu vaccine. Where are we at based upon the problems we
had last year?
Ms. Gerberding. So far the news this year is good. We have
anticipation of four suppliers of flu vaccine. If Chiron is
able to license the lots of vaccine coming off its shelves, as
we expect, there will be able to be--we are not anticipating a
shortage. But we have learned how unpredictable the vaccine
supply is, and therefore we have made a very firm decision that
we will immunize the people who need the vaccine the most
first, and on October 24 we will then open it up for everyone
else who wants a vaccine.
Mr. Shimkus. Thank you very much. Thank you, Mr. Chairman.
Mr. Deal. Thank you.
Ms. Baldwin.
Ms. Baldwin. Thank you, Mr. Chairman.
I have been intrigued with the last few series of questions
relating to planning that has gone on, planning that will
hopefully follow this hurricane efforts to integrate. I have a
couple of questions along those lines.
First of all, my understanding is that FEMA conducted a 5-
day exercise involving a hypothetical hurricane named Pam. As I
understand it, Pam was projected to bring sustained winds of
120 miles per hour and up to 20 inches of rain in southeastern
Louisiana, with a storm surge that topped the levees in the New
Orleans area. It seems like the exercise used realistic weather
and damage information to help officials develop response plans
for a catastrophic hurricane in Louisiana. I'm wondering, did
CDC participate in the Hurricane Pam simulation?
Ms. Gerberding. The way these exercises run is they are
designed to exercise the National Incident Management System,
and there is a component of the National Response Plan called
the ESF-8, which is the set of responsibilities that are
health, and Health and Human Service has the lead for those
responsibilities. Under that there are a set of activities that
we are expected to be able to perform, and CDC has specific
responsibilities under them. So in that particular exercise, I
did not play in that exercise, but representatives of the
health desk did play in conjunction with HHS.
Ms. Baldwin. So CDC, but not you specifically, did
participate in the simulation?
Ms. Gerberding. I would be happy to define specifically for
you who participated in which exercise.
Ms. Baldwin. Okay. Can I ask you if you are able to, given
your limited participation, answer whether public health
threats were--well, were there public health threats that were
encountered with Hurricane Katrina that were not projected in
the simulation that was done with Hurricane Pam?
Ms. Gerberding. I would like to get back to you with those
specifics.
Ms. Baldwin. Okay. Let me move on to then follow-up
planning. And perhaps I think some of the other members of the
panel share my frustration that we have heard both anecdotally
and certainly seen the images on television that suggest that
there were many, many problems. And we have you here today to
ask questions to, and I think if you were to look at the
organizational chart of who had responsibilities, you probably
represent one of the agencies that responded most effectively,
and I know you have room for improvement, et cetera. So I want
to get answers to some of the questions I have. And I know
you're not necessarily the appropriate person to ask them to,
but what sort of follow up plans--you just said few minutes ago
that you learn most in operation and second by role play,
simulation, the role of imagination, realizing and following up
on the challenge of scalability. Who will do follow-up
planning? Who will be at the table, who will convene this
group, and what recommendations will you make when you sit at
that table?
Ms. Gerberding. I will speak for CDC first. We have, as I
said earlier, this is--Rita is our 24th emergency operation.
And since anthrax, we have developed an activity called Team B,
which is a set aside group of experts, scientists,
knowledgeable people who aren't supposed to be participating in
the operation, they're supposed to be watching us. And it's
their job to challenge our dogma, it's their job to
troubleshoot things that we are overlooking, it's their job to
reach out to the community and see if what we are thinking, we
are doing is making sense to the people that we're working with
and so forth. And we bring those Team B perspectives into our
operation as we go forward.
This time last week we invited three people from the
Department of Defense who do exactly this kind of operational
learning support for the military to CDC. They spent a couple
of days with us, explaining to us how they work--and they
actually work by embedding their people in the operational
field so that they're out there cycling the learning on a real-
time basis instead of waiting until everything is done, then
studying it and going back and trying to fix it in retrospect.
Both things are important, but what we are trying to do is
adjust as we go, get the learning in the same time that we are
doing it. It's fresher, it's more helpful, it's more immediate.
Sometimes it's very tactical, but it is the kind of continuous
quality improvement process that we think really, in the long
run, serves as a more efficient operational organization.
I also--at the end of our operations we do do more
comprehensive after-action reports for CDC where we try to
strategically change things that we really felt didn't go as
well as they should have and as we learn after every operation.
I think those same principles are exactly what other
governmental organizations do, learn as you go, but at the same
time also do a comprehensive retrospective look. And probably
there is a role for both of them as a government as well as the
State and local and private sector people who are engaged in
these operations. I don't have an evidence base for that, I
just have an experience, but that's been my perspective.
Ms. Baldwin. Thank you.
Mr. Deal. I thank the gentlelady.
Mr. Ferguson.
Mr. Ferguson. Thank you, Mr. Chairman.
I want to thank Dr. Gerberding for again appearing before
our committee. You've been here many times, and you provide
excellent testimony. You are extremely patient----
Ms. Gerberding. Not always.
Mr. Ferguson. Nor are we. But we certainly appreciate not
only your testimony with the committee, but your excellent work
at CDC. You provide a level of integrity and leadership there,
which is so important to our Nation and to the people of this
Nation, and we certainly appreciate both that work and your
frequent visits here to share your views on a whole host of
important topics with us.
Our discussion today has been centering around the
tremendously large coordinated response between Federal and
State and local officials that is needed to respond to a public
health crisis. And as you and I have discussed on a number of
occasions, I am particularly interested in obviously some of
the lessons that we can learn from Katrina and the other many
couple of dozens of crises that you have dealt with in your
tenure at CDC, public health situations, what we can learn from
those as we prepare for the future.
And when we talk about pandemic flu, it is really--everyone
who knows anything about pandemic flu tells us that it's really
not a matter of if, it's a matter of when, and we have to deal
with that eventuality. And the outbreak of pandemic flu, when
it happens, will almost certainly cross State lines, it will
cross county lines, it will cross many layers of government
jurisdiction, which will virtually require a federally led
response to that sort of crisis. Public officials were told for
many years that a hurricane with the force of Category 3 would
overwhelm the levee system protecting New Orleans, would cause
flooding, would wreak havoc in that region. The same warnings
are given to us frequently about the possibility and
eventuality of a pandemic flu, so I think it is certainly
within the scope of this hearing to talk about that a little
bit.
Can you tell us a little bit about where we stand with the
pandemic response plan--we've been talking about this for a
year or more--and when you believe it might be released?
Ms. Gerberding. Thank you. One of the things going on
behind the scenes of Katrina is an enormous amount of effort on
pandemic flu, Secretary Leavitt and I and Dr. Fauci and Dr.
Gallin and others from the Department have systematically been
briefing every Cabinet and every Cabinet secretary in
government on their role in preparing for pandemic. We are
working very hard to do the science to understand what our
vaccine capabilities will be, what are the limitations of our
antiviral treatment, investing aggressively internationally to
improve detection, and a lot more needs to be done.
In terms of--the Department's pandemic plan was, as you
know, put out in draft form a year ago, and what was missing
from the plan at that time were the really tough decisions
about how we would allocate scarce resources when we know no
matter what, right now if it happened tomorrow, we won't have
enough vaccine to go around for at least 6 months into the
enterprise, and that process of getting the public and the
public health community as well as the medical community and
others, including decisionmakers, to really articulate the
strategy for allocating those resources is tough. And we aren't
going to please everybody when we come out with these
recommendations, but the dialog has been time well spent. I
think we expect to have the plan within the next couple of
weeks finalized and ready for a final public review.
I would also say that the plan is important, but the
planning is much more important. In my experience, often plans
aren't what you take out in the middle of a disaster. What you
do take out are the relationships and the knowledge and the
connectivity that you have built as a part of the planning
process. And I think this time we've spent this year working on
this at State and governmental levels, and also international
levels, has been extremely helpful. Our plan is better because
of it.
Mr. Ferguson. And just very briefly, as my time is about to
expire. Are you satisfied, given the experience that we've had
in the last several weeks with Hurricane Katrina, are you
satisfied at this point, or do you think more work might need
to be done on the plan, the pandemic flu plan, with regard to
coordination between local, State and Federal officials and
responsibilities?
Ms. Gerberding. I believe that if we are facing pandemic
flu it will make Hurricane Katrina look very small. And while
we are certainly challenged with this disaster, we recognize
that a pandemicdisaster would encompass the whole global
community. So it is very difficult to anticipate proactively
whether your plan is going to have the capacity to solve and
anticipate every one of those problems, I doubt it will, but it
certainly creates a framework for decisionmaking and helps us
identify our governmental strategy.
It is remarkable to me how much clarity we have achieved by
simply defining that we are following a strategy of containment
first, if feasible, and then subsequent components of that
strategy that we are going to work on, building our vaccine
capacity, we are going to work on building our drug capacity,
and we are going to scale up the investments in our ability to
detect and respond to cases.
We have a remarkable challenge in front of us, and probably
one of my biggest concerns is that we are so easily distracted.
Our focus shifts from one disaster to another. So while we are
talking about hurricanes and natural disaster preparedness, I'm
pleased that you would even ask a question about pandemic flu
because it is very much on our plate. And we know it will be
difficult to keep it on the plate in the minds of the public,
but it's nice on know it's on the minds of the Congress, and I
really appreciate that.
Mr. Ferguson. Thank you again for being here. Thank you,
Mr. Chairman.
Mr. Stupak. Mr. Chairman, if I may. In light of that last
statement, we've asked a number of times for CDC to come and
brief us on pandemic because it is a major concern. And we've
been asking and we get no response. So I would hope, based on
your response here today, you would take our offer and come and
meet with us.
Mr. Deal. I'm not sure if the gentleman was aware, but
we've already had a hearing on that issue in which CDC was
present testifying.
Mr. Stupak. Right. We had one hearing, it was the shortage
of the vaccine that we're going to need, and that's why we want
more on pandemic flu. Specifically we've asked, specifically in
writing a couple of times, so I hope we can get this briefing
for our staff and the members because this is a serious issue.
Mr. Deal. Well, we will follow up with it from the
committee level, I'm sure, and the full committee, too.
Mr. Engel.
Mr. Engel. Thank you. Thank you, Mr. Chairman.
I have seen a series of articles which talked about the
medical nightmare of people who were being treated in various
New Orleans clinics, who needed a continuation of a treatment,
who went to Texas and other places and didn't really know, for
instance, if they had cancer, what stage the cancer was in. And
I'm wondering if you could comment. I mean, one of the obvious
ways to deal with this could be talking about the need for a
national data base of electronic medical records. I know that
it involves privacy issues and other things, but it would
certainly seem to me that this is something we ought to work
toward. I'm wondering if you could comment on that.
Ms. Gerberding. I think Secretary Leavitt will be very
happy you asked that question. One of our over-arching
priorities in the Department is the electronic health records.
And we said--every shelter we visited, oh, if there was ever a
case for an electronic medical record, this is it.
And one of the directions that we gave to our CDC team in
New Orleans yesterday when we got a briefing on the
redevelopment of the Health Department there is that your
planning assumption should be e-public health, e-medical
records. We have got to do this right. And now we have a chance
to make it very visible why not only is it a convenience, or a
patient safety issue, it's a life-saving issue in situations
like this.
In most of the hospitals that were flooded, the medical
records department was on the ground floor. Those medical
records will never be recovered. I know that Dr. McClellan and
his colleagues at CMS are trying to reconstruct chemotherapy
regimens by going back through billing records because it's the
only electronic resource available. That should never happen in
an environment where we have the technologic capability that we
have today.
I thank you for addressing that.
Mr. Engel. Thank you. And I really appreciate your answer
because obviously you said it, it's not just simply a matter of
patients not being able to get treatment, many medical records
were washed away forever, and it's a real problem.
I was speaking with a friend of mine who happens to be a
surgeon in the Miami area, and they're surrounded by water, and
he was telling me also, not only with records, but the
operating rooms in many of the hospitals are on the ground
floor, so it's also a very big problem in terms of weather-
related things. I suppose that new hospitals that are going to
be built will change that.
The other question I had involves the same line of
thinking, and I am told that an estimated 8,000 people with
HIV/AIDS have been displaced by Katrina. And the Federal--the
Department of Health and Human Services has not yet announced a
comprehensive plan to guarantee HIV positive evacuees access to
anti-retroviral medication and medical care. And I am wondering
if you could tell me that because I am also--tell me if that's
true because I've also been told that no provision has been
made for emergency release of Ryan White Care Act funds to
allow neighboring States to care for HIV positive Katrina
survivors. That is obviously a problem, so I'm wondering if you
can comment on that. And then I have two related questions.
Do you believe that HRSA or HHS should release these
emergency funds to the States accepting the evacuees? We
checked with HRSA this morning, and we were told there were no
plans to. So I'm wondering if you could comment on that, and
then I have another follow-up question.
Ms. Gerberding. I very early after the hurricane personally
received correspondence from the National Association of People
with AIDS that outlined a number of concerns related to the
disaster status of people with HIV/AIDS, and all very
thoughtful and appropriate, including access to medications and
relocation. And I don't know what decisions have been made at
HRSA or within the Department, but I certainly will try to get
that information back to you as quickly as we can.
Mr. Engel. Thank you, I appreciate it. And can you tell me
if the CDC is supplying an adequate supply of rapid HIV testing
kids to community organizations throughout the affected region
and around the country to ensure that counseling and testing
are available for evacuees near and far from the disaster, and
educate providers about how to recognize infections in immune
suppressed people? Because obviously if we are concerned with
infections based on the water and whatever, people who have
compromised immune systems are that much more at risk.
Ms. Gerberding. Yeah. I think there are a lot of people
with compromised immune systems for a number of reasons that
are in the special needs population. And I'm sorry, I don't
know if CDC is doing that, but I think it's a good idea and I
will go back and check.
Mr. Engel. Thank you very much. I appreciate your
testimony, thank you.
Mr. Deal. I thank the gentleman.
Dr. Burgess.
Mr. Burgess. Thank you, Mr. Chairman.
Dr. Gerberding, on the issue of preparedness, as we look at
Hurricane Rita poised just off the Texas coast, do you think
there are things that we are likely to do better as Rita comes
ashore as a consequence of having learned some things from
Hurricane Katrina?
Ms. Gerberding. I certainly hope so. I believe we see
evidence of that already in terms of the comprehensive
evacuation. I know from the people at CDC who are
prepositioned, as well as what I'm seeing on television, that
the vulnerable populations were among the first to be evacuated
so that there was special planning for those individuals there.
I also anticipate that the coordination of the services for
those people will have benefited from the fact that many of the
materials and utilities are already in the State of Texas since
that's been providing so much shelter and medical care to the
survivors of the previous hurricane. So I would fully expect
there to be some significant improvements in certain areas of
response.
I hope that the biggest improvement is that people really
do cooperate with the evacuation and leave because that is the
single most life-saving thing that people can do.
Mr. Burgess. Yes, I agree with you. Now many, many years
ago I was in medical school in Houston, and I remember back in
those days reading in the newspaper about the Houston-Galveston
Area Council of Governments and their disaster preparedness and
when the big one hits and what their plans were even back in
the 1970's. Obviously all of this preparation is not something
that's taken place in the last 3 weeks.
Do you feel that in any way that the Houston-Galveston area
has been better prepared over the long term than perhaps the
Louisiana Gulf Coast?
Ms. Gerberding. I can't make that comparison directly. I
have spoken with Dr. Eduardo Sanchez, who is the Health
Director, and I am well aware of his perspective that the
investments made in preparedness in the last few years have
definitely paid off in multiple ways in helping to support the
care and support for the evacuees that arrived in Texas
spontaneously.
I also spoke to the Deputy Director of Health in
Mississippi, who was adamant about how valuable the
preparedness investments assessments had been made and his
ability to support the public health functions and save lives
in Mississippi. Whether one State is more or less down that
path than another is a more complicated question.
What I will say from our perspective as an agency, as well
as our responsibility for administering some of the
preparedness dollars, all of our States can and will do more.
Mr. Burgess. But surely going forward from these two
historic storms, we'll develop some type of best practices,
what worked in planning, what didn't work in planning, where
were the weak spots, or at least I hope we do. That would be a
real tragedy to not learn those lessons.
It seems to me from where I sat in Texas a week before
Labor Day weekend--and I will reference most of my remarks
about Louisiana since they were--that was the State closest to
us--there are certainly some areas where there were pinch
points, as far as getting people in, getting people out,
getting aid in. I was very impressed with the private sector of
the Dallas/Fort Worth area. If I put a call into American
Airlines and said what are you doing, they said what do you
need, they were ready to go. And then very quickly we would run
into an obstacle that wouldn't let them participate. Same with
DFW Airport. We heard the stories about Wal-Mart and Ray
Pensley on the television on Meet the Press. What are we doing
overall, particularly in the health care community, to keep
those pinch points to a minimum and to make certain that,
especially in delivery of needed care, that it becomes seamless
rather than as rocky as it seemed in so many instances?
Ms. Gerberding. Thank you. We are actually very actively
looking at that as a department right now. And from a CDC
perspective, we are going back to even looking at the grant
programs and the expectations to see if we need to make
fundamental changes in our expectations based on this.
But the coordination necessary to get the government
agencies to work together is one piece of it. You're bringing
in then how do we take advantage of the private sector
opportunities, and that is a generic question that I believe
all of us are going to have to look at from our own individual
domain. It's a ying and a yang, because if you have an
unstructured approach, then you have people running all over
each other and you don't have that kind of command structure
that we need. But a properly managed incident command structure
should have allowances for inserts from the private sector to
perform specific functions, and I think it's primarily a matter
of communication more than it is of anything more complicated
to solve.
Mr. Burgess. But it is a problem that must be solved.
And finally, Mr. Ferguson brought up the flu epidemic. Have
we weakened our public health infrastructure with these two
storms or will we have weakened our infrastructure with these
two storms such that we have increased our vulnerability to an
outbreak or just regular flu or avian flu or any other easily
transmissible disease?
Ms. Gerberding. It's always a challenge to have a surge in
requirements in one domain, and you have to get that surge from
someplace. It's difficult to sustain a surge for a long period
of time without cutting into other needed programs.
At the moment, I feel, in part because CDC has exercised
for many, many public health emergencies in the last couple of
years, that we are able to sustain our mission and respond to
these hurricanes in following our own strategy, which includes
the concept of parsimony. We don't send everybody out. We try
to be very thoughtful and rigorous about who we send--we are
rotating people in and out. We're taking steps to try to
support our workforce in mental health by including mental
health counselors and resilience counselors on our teams to
recognize when people are at risk for burnout or unable to work
at their best.
So through a whole variety of personnel management issues,
as well as organizational strategy, I believe at the moment we
can continue our mission.
I mentioned earlier that there are specific capabilities we
have as an agency that don't have as much surge as we would
like to have, and we're going to have to go back as one of our
after actions and understand how can we access that surge
capability, those skills, those people when we need them,
through volunteers or through relationships with external
organizations, with academia, with the private sector in a
formalized way so that they are there when we need them,
they're trained and we can count on them. This is management,
but it's challenging.
Mr. Burgess. I will yield back, Mr. Chairman. Thank you.
Mr. Deal. Thank you.
Ms. DeGette.
Ms. DeGette. Thank you, Mr. Chairman.
Dr. Gerberding, I wanted to follow up on some of the
questions my colleagues asked you. First of all, about just the
regular flu. Here we are now in the fall season? Flu season is
approaching, and you talked about how you feel about--you
feel--I got the sense you are cautiously optimistic about the
flu vaccine supply for this season; would that be accurate?
Ms. Gerberding. I'm cautiously optimistic. I do remember
sitting in the House hearing on October 4 last year when I
learned that the supply had been cut in half. And so I have
learned my lesson not to project strong optimism. But what I am
optimistic about is that even if the worst case scenario occurs
and we lose unexpectedly some component of our supply, we have
what we need to get the high priority people vaccined and we
are starting out doing that first.
Ms. DeGette. And here's my question then; given the
hurricane victims, and now it looks like we might have even
more evacuees from this new hurricane, does the CDC have a
specific plan for vaccinating evacuees? And just briefly, what
kind of planning do we have for that?
Ms. Gerberding. First of all, Santa Fe Pastore donated
200,000 doses of the first flu vaccine this year for evacuees,
and it is included in the immunization programs going on
throughout the shelter system. So we put them in the priority
group so they could----
Ms. DeGette. Because they're clearly a high priority.
Ms. Gerberding. Absolutely. And they have gone through
enough. They don't need to have the flu this year.
Ms. DeGette. Yes exactly. And, also, given some of the
situations they're staying in, lots of people in one building,
they're at a much higher risk.
Ms. Gerberding. Absolutely.
Ms. DeGette. Okay. That makes me feel good.
Mr. Ferguson talked about the issue, as you know, that I
have been concerned for a long time, and that is the Avian flu.
I think it's more than just one or two people on this committee
that are worried about the Avian flu because that, as you said,
Doctor, this will make the hurricanes and all of the other
disasters just pale in comparison.
Just today, in the Washington Post--I don't know if you saw
this--there was an article about how now they have more cases
in Indonesia, and they're thinking that some of those cases
were human-to-human transmission, which, of course, is what
we're worried, that the Avian flu will mutate and then spread
around as a human-to-human pandemic.
But I wanted to follow up on Mr. Ferguson's questions,
because we have had hearings in this subcommittee, but I think
that we're really already so far behind the curve on Avian flu,
even though this hadn't hit, and the potential devastation
should be so great. You talked about how we're stockpiling
drugs now for the possible Avian flu pandemic. But, first of
all, I think the record needs to be clear. We don't have a
vaccine for the Avian flu right now, correct?
Ms. Gerberding. We have an H5N1 vaccine. We have less than
a million courses of vaccine for it. It's a very small
stockpile, but it was designed, first of all, to give us some
H5 vaccine to test to make sure that we could get an antibody
to; and, second, because the process of proving that you could
do it speeds up our ability to do it with exactly the right
strain should a new strain emerge that's easily transmissible.
Ms. DeGette. But since we don't know exactly what the
strain will be once the virus mutates we don't have a vaccine
that we know will be effective against a pandemic, correct?
Ms. Gerberding. We have strong reason to believe this
vaccine will be effective because we've seen it develop high
antibody titers. The difference between this vaccine and the
one that we used for regular flu is that it takes more of it to
get an immunological response, so it's going to be harder to
get an adequate number of doses.
Ms. DeGette. And that's my next question. A million doses
stockpiled is not even a drop in the bucket. It's such a
miniscule amount of what we would need. So what is the CDC
doing in conjunction with its various partners and allies to
increase that stockpile?
Ms. Gerberding. We don't really want a stockpile of the
vaccine because the virus is going to change. So, in other
words, the vaccine we have right now we made from the H5N1 that
was in Vietnam last year. Already this virus is evolving. When
and if it becomes transmissible to people, we're going to need
that virus to put that into the vaccine.
Ms. DeGette. Right. But we don't have the capacity to make
that virus, that vaccine.
Ms. Gerberding. That's why it would take about 6 months to
be able to get the supply we need for the United States if we
were starting from today.
Ms. DeGette. Right. So do you feel we have that capability
to manufacture that amount of flu vaccine? Because I didn't
have that sense after we had our last hearing.
Ms. Gerberding. What we do is we would have to turn off the
regular flu season vaccine and turn on the pandemic vaccine
production, and part of the government strategy right now is to
define exactly when would we make that decision. You know, if
we see a small outbreak, is that an indication to switch or,
you know, at what point do we say, yes, this is an imminent
threat; we've got to change our factories over to making the
new vaccine.
Ms. DeGette. The second question I have--I have more
questions about that, but I have less time. The second question
I have is there is an anti-retroviral drug that has proven--at
least it gives people that get the Avian flu some hope of
surviving, and that's the Tamiflu. And I understand that we are
way down on the list for shipment from the Swiss company that's
manufacturing this drug, is that correct?
Ms. Gerberding. There is a manufacturing bottleneck. The
company cannot make as much as people want right now, but they
are looking at new opportunities to do that.
Our current plan, meaning, you know, fiscal year by fiscal
year, is based on our understanding of what their bottleneck
is. What we would like to achieve is what we refer to as a 20/
20 approach for the first phase of our planning, and that means
we would like to have enough vaccine available for 20 million
people and enough antiviral for treatment of 20 million people,
knowing that that's not the end, but that is a significant
improvement over time.
Ms. DeGette. And, right now, how much Tamiflu do we have
stockpiled?
Ms. Gerberding. We have 2.3 million doses in our hands as
we speak, and we have another 2.1 doses that are arriving.
Ms. DeGette. And that's out of 20 million needed doses,
right?
Ms. Gerberding. Right.
Ms. DeGette. And of the vaccine we have a million, and we
would hope in 6 months to be able to ramp that up, is that what
you're saying?
Ms. Gerberding. We're not going to have a stockpile of 290
million doses of this.
Ms. DeGette. No. No. But what you're saying is we have a
million stockpiled now and what we would need to have is 20
million.
Ms. Gerberding. We'd like to have some additional doses.
Even though the vaccine that we're creating right now is not
likely to be a perfect match for what would emerge, it may give
some partial protection. So it's just an extra margin of safety
while we're waiting for the right vaccine to come out of the
factory.
I do want to emphasize a couple of things, though, because
there is such attention on the Tamiflu issues. There is kind of
the impression that this is the magic bullet solution, and we
need all of these things just for the record.
Ms. DeGette. Right. Mr. Chairman, I just have one more
question; and that question is, let's say we cut $25 billion
out of CDC over the next 10 years. How would that affect the
agency's ability to do things like stockpile the vaccines and
Tamiflu and to respond to possible issues like Avian flu that
are out there but that are not immediate right now?
Ms. Gerberding. My professional judgment, without
constraints, is the agency could not accomplish its current
mission with that level budget cut. But I also want to be clear
that I believe that the people who put that dollar figure on
the table were under the mistaken impression that it
represented an increase this year in CDC's budget.
Ms. DeGette. I understand. If we cut that money out, that
would really hurt your ability to plan for these future events.
Ms. Gerberding. I would be very sober looking at how we
would manage that cut.
Ms. DeGette. Thank you.
Mr. Deal. Well, I would just simply point out that the
likelihood of that is certainly not historically in the context
of what Republicans have done. Since 1995 through this year
you've actually had a 291 percent increase over the period of
time that we have been in control. So I think that this
suggestion by someone which has never been adopted is not in
keeping with the historical precedent of Republican funding of
your agency.
Ms. Gerberding. I'm glad to hear that.
Mr. Deal. Yes.
Mrs. Blackburn.
Mrs. Blackburn. Thank you, Mr. Chairman.
Dr. Gerberding, I think I'll change the subject from flu,
because everybody starts coughing and sneezing as we are
talking about it so we'll not spread that around. I do have a
couple of questions on that, but I want to go back to some of
the things that you have said regarding the response with
Katrina. I found it interesting that you've used military
analogy in saying that you all have some lessons learned from
the way the military responded and that strategy and exercise
are very important to an overall plan.
One of the things I would like to know from you is what you
would say were the most significant nondisaster-caused barriers
to your job. You've talked a little bit about workers without
immunizations. You talked a little bit about having
communications technology on the ground but somebody didn't
have the fuel to power the generators readily available. And,
as we all know, in that area, there was not fuel for a couple
of days because there wasn't electricity to run pumps. So if
you would elaborate on that for just a little bit. Or if you're
not--if you don't have what were the most significant barriers
in terms of like regulation, unnecessary regulation, poor
communication or whatever, if you would like to respond to that
later, as you look at your after actions, I would like to know
that.
Ms. Gerberding. Let me say, first, I mentioned the
logistical command and control capabilities of the DOD as
something that we learned from. But I think we also respect
that there were four hurricanes in Florida last year and that
there was a very fine emergency response to those hurricanes.
So we can learn from a lot of different places, not just the
DOD.
Some of the other things that we're concentrating on right
now are recognition that communication about medical supply
needs was not streamlined and efficient. I resorted at times to
calling the operations center directly and asking to speak to
the health officials at the combined emergency operations
center in Louisiana, and it was on one of those calls where a
desperate person said if we don't get IV fluids to this
facility within 2 hours, people will be dehydrated and die. You
know, fortunately, we had the capacity to load up two planes
full of IV materials and get them there within that timeframe.
But that is not a system that's working, and so those are the
kind of communication channels that we need to iron out.
Mrs. Blackburn. Okay. The responsibility for those supply
lines, would that be something at a Federal level or a State
level or do you see it as a shared responsibility?
Ms. Gerberding. I can't answer that in a simple way. We
were fortunate that the prime vendor of the medical supplies
for the functional hospitals in the areas were operational.
Most of the shelters that were providing medical services
reached back to their prime vendor and were not experiencing
supply disruptions, but, in some cases, such as pharmaceuticals
or vaccines, those lines were not adequate, and we were there
trying to augment and support them with materials.
I will also say that wasn't part of CDC's defined mission
in disaster response because, as I said before, our stockpile
was really designed to provide----
Mrs. Blackburn. But you stepped in.
Ms. Gerberding. Yeah, we stepped in to do that.
Mrs. Blackburn. Okay. So, again, we have that private-
sector/public-sector coordination that did not flow as smoothly
as it should have.
Let me speak for just a moment about a couple of things
relating to the evacuees that are in my State, and we have
many. I have had the opportunity to visit some of the shelters
and talk with some of the health care professionals, nurses and
physicians both, who are delivering some of the health care.
On your Web site, you've got a piece that is titled,
Medical Care of the Ill Evacuees: Additional Diagnoses to
Consider. So this directs the physicians to look for some
specific illnesses, and my question was this: With the evacuees
being in 48 States, what kind of communication network do you
have for those physicians that are working in those shelters?
Is this something that you are taking a proactive lead with?
Are you working with the medical associations? Do you expect
the physicians to go into your materials and find out on your
Web site? What's your interface?
Ms. Gerberding. We have two main strategies. One is, just-
in-case, you know, trying to provide materials before something
happens, and then the just-in-time approach. Our just-in-time
approach relies on our own distribution systems through the
Web, through things called health alerts or dispatches where we
fax or e-mail things directly to providers. We work through
State health agencies who are then sharing materials with the
evacuation clinicians, for example.
But we also have an extraordinary network of medical
associations, including the AMA that's on the next panel that
have taken on the role of we give them what we think people are
asking for and they use their extraordinary distribution
systems to amplify beyond that. So we--yes, to all of those
mechanisms. We, I think over the last 2 years, have greatly
expanded our ability to get information out. Do we get it into
the hands of every person who needs it when they need it?
Probably not yet. But much progress and opportunity from the
collaborations that we've established.
Mrs. Blackburn. One question on the flu, and I'll just hope
that nobody coughs or sneezes, you know, that we're not
spreading this around here. We've talked a good bit about that,
and we're coming up on flu season, and we still have
individuals that are living in shelters, and we know that with
Rita we're probably going to see that. Do you all have a plan
worked out, working with the State and local agencies, that
will be providing flu vaccines for those residents that are in
those shelters?
Ms. Gerberding. Absolutely. And you're reminding me to
emphasize that it's really the State health departments that
have the responsibility for this. But we have immunization
program staff in all of these centers, and our folks are there
helping deliver vaccine and plan for the vaccine program. We
made the decision not to do this in a crisis mentality of
saying, okay, people need varicella vaccine, let's run and do
that. Oh, no, it's flu. Let's do that. Rather, we are looking
at the individual and saying, first of all, what does this
individual need to catch up with? Often, we don't know. So, if
we don't, we err on the side of reimmunizations.
Mrs. Blackburn. Another case for e-records.
Ms. Gerberding. Well, that's right. And the second piece is
to include the flu vaccine in this comprehensive approach.
One really great thing that happened with kids is that the
State of New Orleans actually did have electronic immunization
records for most of their children; and, as those children got
redistributed across the shelters, special dispensation was
made so that health officials in other States could query that
electronic immunization record and would know, yes, this child
has had the measles shot; no, this child hasn't. It was
absolutely helpful for most of the children in that region. And
I think, again, that's a lesson on the importance of these
electronic records.
Mrs. Blackburn. Well, thank you for being here with us; and
thank you for your leadership in addressing the issue. We
appreciate that and appreciate your time.
Ms. Gerberding. Thank you. I have to be very clear that I'm
the spokesperson for CDC and all this, but I work for a
wonderful agency full of really, really fantastic people.
Mrs. Blackburn. Thank you.
I yield back.
Mr. Deal. I believe that completes our questioning; and,
Dr. Gerberding, again I would repeat what you have heard from
many of our members of the committee. We thank you for being
here today. We thank you for your professionalism and your
direction, and we also express our appreciation to those who
work with you and under your direction for the magnificent work
that they have done in this time of crisis. Thank you for being
here.
With that, I'll turn the gavel over to Mr. Whitfield, who
will preside over the remainder of the hearing.
Mr. Whitfield. Those of you on the second panel, if you
would come forward. You've been very patient, and we'd like to
give you an opportunity to testify and have ample opportunity
for questions. I do want to thank all of you for your patience,
and we do look forward to your testimony.
As you heard earlier, this is a joint committee meeting of
Health and Oversight and Investigation; and it is our practice
to take testimony under oath. I would ask any of you, do any of
you have any objection to testifying under oath this afternoon?
I would also advise you, as I did Dr. Gerberding, that
under the rules of the House and the rules of the committee
that you are certainly entitled to be advised by counsel. Do
you desire to be advised by counsel during your testimony
today? Does anyone here?
Okay. In that case, if you would please rise and raise your
right hand, I would like to swear you in.
[Witnesses sworn.]
Mr. Whitfield. You are now under oath.
Dr. Kirsch, we'll start with you. If you would give your 5-
minute opening statement.
TESTIMONY OF THOMAS KIRSCH, AMERICAN RED CROSS; MARK PETERS,
PRESIDENT AND CEO, EAST JEFFERSON MEMORIAL HOSPITAL, ON BEHALF
OF AMERICAN HOSPITAL ASSOCIATION; ARDIS HOVEN, MEMBER, BOARD OF
TRUSTEES, AMERICAN MEDICAL ASSOCIATION; BERNARD SIMMONS, CHAIR,
NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, INC.; JOE
CAPPIELLO, VICE PRESIDENT, ACCREDITATION FIELD OPERATIONS,
JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS;
BOB DUFOUR, VICE PRESIDENT, PHARMACY SERVICES, WAL-MART, INC.
ON BEHALF OF NATIONAL ASSOCIATION OF CHAIN DRUG STORES; AND
BARBARA BLAKENEY, PRESIDENT, AMERICAN NURSES ASSOCIATION
Mr. Kirsch. I'll try to keep my statement brief.
Chairman deal, Chairman Whitfield, Congressman Brown and
Congressman Stupak, I'm Dr. Tom Kirsch. I serve as a voluntary
physician advisor as the Medical Director for Disaster Health
Services of the American Red Cross. My professional position, I
work at Johns Hopkins Hospital as the Director of Operations at
the School of Medicine Department of Emergency Medicine as well
as in the School of Public Health as well as in some disaster
preparedness centers. I appreciate the opportunity to appear
before the subcommittees on behalf of the Red Cross and to
share with you some of the activities in public health that we
undertook following this extraordinary disaster of Katrina.
As an independent, nonprofit organization, the Red Cross is
part of the first response community, working with police and
fire personnel helping to move people out of harm's way and
providing primarily shelter, first aid and food. When the
National Response Plan is activated following a Federal
disaster declaration, Red Cross is the only nongovernmental
organization with primary agency responsibilities for mass care
such as feeding and sheltering, which is known as the ESF 6 of
this plan.
The Red Cross has been instrumental in providing over 12
million meals so far in this disaster and more than 9 million
snacks. We have provided services to more than 344,000 people
with mental health problems; and more than 156,000 volunteers,
including these trained public health professionals that we
organized for this disaster, have responded.
This was different for the Red Cross in that in the past we
have not ever really had a coordinated public health response.
For years, particularly following 9/11, we recognized the need,
that there were many issues in the shelters and within our
services that were affected by public health questions. We,
therefore, when this disaster struck, quickly assembled a team
of public health experts from Johns Hopkins and from Harvard
and began organizing a response.
The primary problems that we had identified in the past and
we knew were going to be a major problem in this disaster was
that many of the people who end up in our shelters have
absolutely no access to health care. They've lost their
records. They've lost their prescriptions. They've lost all
ability to meet their basic health needs. So one of the main
assessments that we were doing during our first preliminary
assessment was to look to see what was available with regard to
local health care access for the people in our shelters.
I'd like to just say that we went down there expecting that
these people would be cutoff, and I was amazed by the local
response by physicians and nurses in the areas. They had set up
clinics in the shelters. They had set up mobile teams. They had
really done wonderful things for the people in the shelters.
The second thing that we were concerned about was just the
basic health care needs of the shelters. Often in major
disasters the local, State and Federal agencies are really
unable to respond immediately to look at the basic needs of our
shelters, and there's some misunderstanding as to the functions
of the shelters. So we did a preliminary assessment along those
lines to see what we felt the major needs were.
Then, like everyone in this disaster, there were concerns
from the first day of the potential for outbreak and epidemics;
and so our primary mission was to look into that, also. We
deployed two teams, one to Mississippi, one to Louisiana, did
these preliminary assessments and, based on the findings and
recommendations, came up with a strategy.
The first strategy was that there is an obvious need for a
high-level coordination in public health and health response;
and we assigned team members to the EOCs in both of the States
to interact with FEMA, the Department of Public Health in the
State, the U.S. Public Health with CDC, et cetera.
Then we also began a surveillance-type system in our
shelters which were based more on symptoms than disease
specific. Because most of the people in shelters, those that
are directing the shelters, have little medical training; and
it's difficult for them to report disease-specific systems,
like they cannot diagnose dysentery. They are retired nurses or
even managers.
We have managed in even in the State of Mississippi,
working with the State, to set up a toll-free number so that
our shelter members can call into this number, speak to either
a State epidemiologist or one of our professional volunteers to
get information on cases and then have an investigation
conducted, if necessary.
The other things that we accomplished were developing
educational tools for the shelters. We developed posters on
hand washing, sanitation and recognition of symptoms that could
be transmissible; and we continue to have teams in the field
and, in fact, have deployed another team to--I guess they're
going to Austin now in preparation for Rita.
So, based on this experience, there were some specific
recommendations that we came up with that we feel are
important. And I think many of the Members, including Ms.
Eshoo, Dr. Burgess, Ms. Baldwin, Mr. Stern, had brought up the
issue of local volunteers or volunteers in general. This is a
huge issue. I think Dr. Gerberding touched on this.
Like I said, I was amazed--I was down there 4 days after
the event, and I was amazed at the ability of the local health
care system to absorb some of the blow, particularly in the
shelters. There were doctors and nurses in pretty much every
shelter I visited, and I visited some of the most remote ones
in the State of Louisiana. The team in Mississippi found the
same thing.
So I think that, based on that, there clearly needs to be--
the trouble with these people responding to shelters is that
they weren't credentialed. No one knew exactly who they were.
No one knew what their training was. No one had any formal
control or credentialing process over them. That is clearly a
need that needs to be addressed going forward.
The Medical Reserve Corps in the U.S. has been somewhat
tasked with that mission but has not been given the structure
of funding, is my understanding, to really conduct that
mission. I think that there needs to be work with the Medical
Reserve Corps to formalize that.
Another possible thing that I have found was the remarkable
response of particularly the LSU and the Tulane Schools of
Medicine. What they accomplished having their hospitals
destroyed and then setting up secondary hospitals in field
houses was truly amazing. I think there would be a significant
role for academic medical centers or medical schools to act as
a focal point for organizing local physicians and health care
response pretty much in every State in the Nation. Johns
Hopkins itself was tasked with forming one of these 40 medical
teams to respond to the disaster; and we had more than 250
volunteers ready to be deployed, physicians, nurses and other
support staff. So I thought that the coordination of the local
response is truly important both for the Red Cross as well as,
in general, the response.
It is not the role of the Red Cross to credential health
professionals. We don't have the ability to do that. So that
has to be looked at seriously.
Interestingly enough, people had commented on the laws
regarding volunteer health practitioners. There was a review
done by the Center for Public Health Law which is available at
www.publichealthlaw.net that specifically reviews the legal
issues. They were tasked by HRSA to do this, and the law is
called the ESAR-BHP. Many of the States have already signed on
to cross-credentialing capabilities for outside providers to
come into States.
The other issue that was tremendously important to the
people we found immediately and for weeks going on was the
access to medications, and I'm glad to see that there are
representatives here from pharmacy because that is a problem
with almost every disaster that we've encountered in the Red
Cross for decades now. People do not have their medications,
don't know what their medications are, don't have any access to
their medications, and so that is an issue that clearly there
needs to be some coordination moving forward.
Mr. Whitfield. Dr. Kirsch, if you could summarize. We
appreciate your testimony, but you're about 3 minutes over.
Mr. Kirsch. Okay.
Other thing would be that there needs to be, like Dr.
Gerberding said, further strengthening of the local public
health response. The public health in many of the States were
overwhelmed and didn't have the personnel to respond.
Finally, there needs to be a little bit more operational
control, I believe, at the ESC level in the States to
coordinate public health response between the different
agencies.
[The prepared statement of Thomas Kirsch follows:]
Prepared Statement of Thomas Kirsch, Medical Director, Disaster Health
Services, American Red Cross
Chairman Deal, Chairman Whitfield, Congressman Brown, and
Congressman Stupak, I am Dr. Tom Kirsch, and I serve in a volunteer
capacity as the American Red cross Medical Director for Disaster Health
Services. My professional position is Director of Operations,
Department of Emergency Medicine at the Johns Hopkins School of
Medicine. I appreciate the opportunity to appear before the
Subcommittee on behalf of Red Cross and to share with you the public
health efforts that have been undertaken following Hurricane Katrina.
As an independent, not for profit organization, the Red Cross is
part of the first response community, working with police and fire
personnel by helping move people out of harm's way and providing
shelter, first aid and food. When the National Response Plan is
activated following a federal disaster declaration, Red Cross is the
only nongovernmental organization with Primary Agency responsibilities
for Mass Care (feeding and sheltering), known as Emergency Support
Function #6.
In addition to being a primary agency for Mass Care, we serve as
support agency to the Department of Health and Human Services in the
provision of Public Health and Medical Services, as outlined under
Emergency Support Function #8 (ESF 8).
Our major responsibilities Under ESF #8 include:
<BULLET> Provision of emergency first aid;
<BULLET> Assistance for community health personnel;
<BULLET> Mental health counseling for individuals affected by the disaster;
<BULLET> Coordination with the American Association of Blood Banks
Interorganizational Task Force on Domestic Disasters and Acts
of Terrorism to provide blood products and services as needed
through regional blood centers;
As we focused on the public health issues that could arise in the
many congregate shelters needed as a result of the massive evacuation
following Hurricane Katrina, we assembled a team of public health
experts at Red Cross National Headquarters in Washington, D.C. on
Wednesday, August 31, 2005. Within 48 hours, we had two assessment
teams already deployed to Louisiana and Mississippi to assess our
sheltering operations in order to conduct an emergency assessment of
our shelters. As a Red Cross volunteer, I led the efforts with my
colleague, Dr. Courtland Robinson from the Johns Hopkins Bloomberg
School of Public Health. The purpose of the visit was to:
<BULLET> Assess the health and public health needs of the shelters;
<BULLET> Establish relationships with local hospitals and health care
practitioners; and
<BULLET> Begin liaising with other governmental and non-governmental agencies
providing aid.
Our teams visited the regional Red Cross headquarters in Baton
Rogue, Louisiana and Montgomery, Alabama as well as local chapter
headquarters and individual shelters throughout the two states. We also
coordinated activities and established relationships with local, state
and governmental officials through each state's Emergency Operations
Center (EOC) and by direct visits to these agencies. Based on these
preliminary assessments, an emergency public health response was
developed for each of the states.
We also developed a public health command center in the Red Cross
Disaster Operations Center in Washington, D.C. Along with two of my
colleagues, Dr. Gregg Greenough of Johns Hopkins and Harvard
Universities, and Dr. Ed Hsu of Johns Hopkins, the command center is
manned effectively. Not only have we been able to better coordinate our
public health efforts, but we have also developed assessment tools and
educational materials for use in the field.
To date, we have accomplished a great deal, including:
1. Emergency health and public health assessments in more than 35
shelters in Louisiana, Mississippi and Texas;
2. Medical and public health expert advice for the Red Cross at the
national and regional levels.
3. Ongoing engagement with FEMA, the CDC, Public Health Service, state
health departments, DMAT teams and local health facilities in
three states.
4. Deployment of 27 public health trained physicians, including the
Dean of the Johns Hopkins Bloomberg School of Public Health.
5. State-wide survey of all shelters in Louisiana in conjunction with
the CDC and U.S. Public Health Service.
6. Completed a state-wide shelter assessment in Mississippi and
implemented surveillance system using a toll-free number for
all shelters.
7. Developing and adapting health education handouts and brochures for
distribution to ARC shelters.
I am proud of the work that we are doing to ensure that shelters
remain safe for evacuees and survivors. I am also proud of the medical
community for their immediate support to these shelters. There was some
concern that an organization like the Red Cross would have to assume
responsibilities for coordinating local medical needs and medical
personnel. I am happy to report to you that this is not the case. There
was tremendous response from local physicians and nurses with providing
direct medical care throughout the state including in shelters.
However, there needs to be better coordination of these local doctors,
nurses, and other medical professionals so that credentials and skills
can be verified to ensure the highest possible care for those affected
by disaster. This type of oversight could be conducted by academic
medical schools, the Medical Reserve Corps, or other state agencies.
CONCLUSION
As the hurricane season continues, and the need for shelters is
still prevalent, it is imperative for the American Red Cross to
continue having a public health presence for the next 2-4 weeks or
until local, state and federal authorities can complete the
infrastructure needed to ensure public health safety.
My hope is that as we continue to assess the sheltering operations
that we will continue to work to mitigate any potential public health
crises. This will require long term public health expertise and advice
as the sheltering of these displaced peoples continues.
Thank you for the opportunity to appear before you today.
Appendix
Louisiana
In Louisiana, our team <SUP>1</SUP> initially met with the
leadership of the regional Red Cross response and reported through the
Disaster Health Services manager. Over the next four days we assessed
19 Red Cross shelters and three very large state shelters, established
relationships with the local emergency health facilities such as the
Pete Marovich Center in Baton Rogue, and met with multiple agencies
through the state EOC. Reports of possible infections at two shelters
were also directly investigated.
---------------------------------------------------------------------------
\1\ Thomas Kirsch, MD, MPH (Johns Hopkins), Hilarie Cranmer, MD,
MPH (Harvard), Alex Vu, MD, MPH, (Johns Hopkins), Joyce Sophle, MD
(private).
---------------------------------------------------------------------------
Major initial findings:
1. Initially there remained many logistic, communication and supply
problems but these rapidly improved.
2. There were no infectious disease issues identified at any shelter.
3. Every shelter had good access to medical care either through local
physicians providing care in the shelter, visiting medical
teams, DMAT teams or relationships with local hospitals.
4. There were no outside resources rapidly available to access public
health issues in Red Cross shelters or to begin surveillance
for infectious diseases.
Based on the preliminary findings plans were made to:
<BULLET> Create a full-time health liaison position to coordinate activities
with other agencies providing aid; and
<BULLET> Create four teams of public health experts to visit each ARC shelter
and assess public health needs, begin a passive surveillance
system and provide health education to shelter nurses.
Surveys and educational tools were drafted and more public health
experts were sent to the field. However, soon thereafter the Red Cross
health liaison found that the state, in association with the U.S.
Public Health Service and the Centers for Disease Control, was
interested in a similar survey and our efforts were combined. There are
now 24 teams conducting surveys of every shelter in Louisiana. Urgent
findings will be available immediately for operation purposes. Thus far
there are no reports of problems with infectious disease outbreaks.
Mississippi
In Mississippi, the team <SUP>2</SUP> initially met with the
leadership of the regional Red Cross response center in Montgomery,
Alabama. We then conducted assessments along with a regional physician
in 12 shelters in the Biloxi-Gulfport area. After these visits a health
liaison was sent to the state EOC in Jackson, Mississippi to begin
coordinating with other agencies.
---------------------------------------------------------------------------
\2\ Courtland Robinson, PhD, Margurite Kearney RN, PhD and Kellog
Schwab, PhD (Johns Hopkins), and Jonathan Spector, MD, MPH (Harvard).
---------------------------------------------------------------------------
Major initial findings:
1. There continued to be severe disruption in basic logistical support
and communications.
2. There were difficulties in staff availability.
3. There was reasonable availability of health care for the clients of
Red Cross shelters.
4. There were no infectious disease problems identified, although some
shelters were continuing to improve shelter services and
sanitation.
5. There was a need to begin disease surveillance and health education.
During meetings in Jackson, the Mississippi Health Department
requested that the Red Cross begin shelter assessments and disease
surveillance. The means chosen for this was to develop four health
intelligence teams, whose goals are similar to those in Louisiana but
will focus more on establishing a ``passive-active'' surveillance
system with county public health authorities and health education of
ARC staff and clients through the use of educational tools. These teams
will begin work on September 12.
Texas
A team <SUP>3</SUP> was sent to Houston on September 8 primarily to
liaise with other health and public health agencies to ensure the
safety of the shelters. Thus far they have been conducting planning
with the CDC and state public health officials to finalize surveillance
and education systems. They have also conducted assessments in more
than 10 shelters in conjunction with a team of epidemiologists from the
CDC.
---------------------------------------------------------------------------
\3\ Michael Klag, MD, MPH (Dean of the Johns Hopkins School of
Public Health), Alex Vu, MD, MPH (Hopkins) ans Sarah Tunebrtg, BSW
(Tulane).
Mr. Whitfield. Okay. Thank you. Dr. Kirsch, thank you.
Our next witness is Dr. Mark Peters, who is the President
and the CEO, East Jefferson Memorial Hospital in Metaire,
Louisiana.
Dr. Peters, we welcome you and look forward to your
testimony.
TESTIMONY OF MARK PETERS
Mr. Peters. Thank you.
Good afternoon, Mr. Chairman. My name is Dr. Mark Peters.
I'm president and CEO of East Jefferson General Hospital; and,
as you mentioned, I am in Metaire, Louisiana, which is a suburb
of New Orleans. I'm also a family physician by training.
I'm here on behalf of the American Hospital Association and
its 4,800 hospitals and health system members. We all
appreciate the opportunity to tell the committee about the
impact of the hurricane on our hospital and the hospitals in
the gulf region.
We are a 450-bed acute care hospital in Jefferson Parish,
which is adjacent to Orleans Parish. We employ more than 3,000
team members, and we have more than 900 medical staff members
on our staff. I think it is very important to point out that
the great majority of our medical staff are independent
practitioners with their own private practice. We are a full-
service, not-for-profit hospital that provides the full gamut
of services for our community.
Throughout the onslaught of Hurricane Katrina and its
aftermath, our hospital remained open all during the time of
the storm and remains open today. We are one of four hospitals
currently open in the New Orleans area, one of which is North
Shore, which is on the north side of lake Ponchartrain which is
a different area of the New Orleans region. The three of us on
the south side are--the area you're most familiar with--are
ourselves, the Oschner Clinic and West Jefferson Medical
Center.
I'd like to take a moment and tell you about our experience
at our hospital during the storm and also tell you what we're
doing right now to ensure that the continuity of care continues
in the greater New Orleans area.
Two days prior to the storm, we activated our disaster
plan. The medical staff members and employees came together,
followed the plan, decided who was going to be in the hospital,
made plans for continued stay in the hospital and really geared
up for what was coming. Our medical staff, who is independent,
did not have any financial obligation to stay. They chose to
volunteer their services, serve our patients and have continued
during these 3 to 4 weeks to work side by side with our
employees to assure that our patients receive care.
As the storm started, we made some decisions about our
patients. We made a decision to transfer all our babies out of
the neonatal unit. We felt that the risk to those babies
staying in our hospital was greater than the risk of transfer.
We were able to send them to a hospital in Baton Rouge. We sent
some other patients away. We also made some decisions to keep
some of our sick patients because we felt the risk of transfer
was greater than the risk of staying.
Quickly after the storm we lost power and ran on
generators. Our generators continued through the storm at times
were not at full strength.
We had to make decisions to minimize the use of power. We
had no air conditioning. We continued the power to run
ventilators and key medical equipment.
We did not have flooding in our hospital. The floodwaters
stopped about 30 yards prior in front of the front door. We did
have multiple leaks in our facility, and a few windows were
blown out.
Also, other factors that we dealt with were security,
communication and restaffing. I think everyone saw some of the
security issues as it related to the storm. We were fortunate
not to have a direct impact on our facility, but the fear and
the perception on our patients and our staff was very
significant. Fortunately for us, the Jefferson Sheriff's
Department and the National Guard responded to our needs and
helped secure our facility.
Communication was very difficult. Cell phones, as you've
all heard, were very, very difficult to get them to work. Our
own in-house phone system went down, and we had 2 or 3 days of
minimal communication with the outside. That was another factor
of how we had to assess the situation from our perspective,
make our best decisions with patient care No. 1, our No. 1
priority.
We also ran low on food. There were several days where the
staff and physicians ate once. We were able to maintain,
though, the food on a regular basis to our patients. We had
very, very fortunate cooperation with our vendors throughout
the southern region.
Patient safety and employee safety were our top priorities
through these 2 weeks. It was very difficult and challenging,
but I have to very much applaud the efforts of our staff in
very difficult times. You have to think about people who either
knew that they lost their home, did not have an idea of how
their home was, or their family relocated that stayed there,
provided health care when they were tired, when they were
fatigued, when they were stressed. And I think us, along with
the other two hospitals, are very proud of the fact that we
were able to continue through the storm and to be able to
continue our services as we provided care for the community.
We have some issues, though, now that I need to get out in
front of this committee. Three hospitals are left standing out
of many hospitals in the New Orleans area--we are it--to
provide hospital care for our region.
There are other hospitals in the future that are going to
look to get restarted. That will be challenging. Some have
facility issues. Some have lost their staff, and reopening and
getting back to where they were is going to be a process.
We will have health care needs in our community of people
coming back. You all have talked about the flu. You talked
about that a lot with the CDC. We anticipate this winter to
have extensive health care needs within our community.
Our issue right now is we're all at about a third capacity.
We're losing money on a daily basis. I can speak for East
Jefferson. We've lost $12 to $14 million through the storm,
through 2 weeks of the storm, and we are currently losing
approximately a half a million dollars a day. Why that's
happening is we have committed to being fully staffed, to being
prepared, to have that capacity that we feel is needed. That
being said, we have a financial responsibility to our hospital,
and we are running into some difficult decisions in the very
near future.
I'm also speaking on behalf of the Oschner Clinic in West
Jefferson. We three have been here this week talking to many
different officials, making certain that everyone is aware of
our current financial plight as we continue to try to serve the
community. It's a real issue. It's an immediate issue within
the next 7 to 10 days.
Can you imagine sitting in my chair, talking to somebody
who's worked through this storm, worked hard, worked double
shifts, worried about their home, and I may have to tell them
we don't have enough business, I need to send you home. We
might be able to use you later, but we can't use you now. How
would that make all of you feel? And what does that say to the
rest of hospitals that are going to face this issue and are
facing this issue today and tomorrow?
We also have housing issues for our staff, for our medical
staff. The other hospitals face this issue, also. That will
allow us to continue to provide the services that are needed.
I also would like to take a minute and point out issues
with our medical staff. A lot of times physicians get lumped in
with hospitals. In our case, in West Jefferson, that is not the
case. They run their own practices. It's their own business.
There have been no patients, no money coming in. They're facing
issues of survival, and we have a great risk of losing
physician manpower in our community. People can only tolerate
no income for a period of time. That will be a great strain on
the New Orleans area if we lose health care workers, and any
sign of instability in our systems can prompt that.
We also need economic support of our private practice
physicians, and we need some regulatory relief in what
hospitals can do with physicians. There are appropriate
regulations in place. These are unusual times that require some
interim relaxation of those regulations of what hospitals can
do for physician practices. It's imperative that we look at
that as we continue to support the health care needs of our
community.
I've also included in my written testimony a document
compiled by the American Hospital Association that identifies
critical legislative and regulatory issues that need immediate
attention to ensure that health care needs are met in the wake
of this storm. It is very unfortunate, with what is happening
with Hurricane Rita, and I've also been informed that that's
ticked a little bit to the north which does not bode well
potentially for Louisiana. Regardless of where it goes, it
heightens the three hospitals' need for financial relief.
Appropriately, some of the agencies that have helped us
have to direct their attention now to Texas or wherever this
storm hits. We need to be able to stand up to care for our
community and provide really the beachheads for the future
health care needs of our community. Rita has even accentuated
that further.
Mr. Chairman, I appreciate the opportunity to tell you of
the tremendous care that was given by all the individuals of
East Jefferson, Oschner and West Jefferson. Ours, we realize,
is just one of many stories throughout the gulf coast region
and throughout the U.S. We also appreciate everyone's help from
the outside, and we appreciate the opportunity of being able to
share our story.
Thank you.
[The prepared statement of Mark Peters follows:]
Prepared Statement of Mark Peters, President and Chief Executive
Officer, East Jefferson General Hospital, on Behalf of the American
Hospital Association
Good morning, Mr. Chairman. I am Mark Peters, M.D., president and
chief executive officer of East Jefferson General Hospital in Metairie,
Louisiana. On behalf of the American Hospital Association's 4,800
hospital, health system and other health care organization members, and
our 33,000 individual members, I appreciate the opportunity to speak to
you and your colleagues about the impact that Hurricane Katrina had on
hospitals in the Gulf Coast region.
I have been with East Jefferson since December 2000. Prior to that
I practiced family medicine and served in various medical leadership
roles with health care facilities in Ohio, where I earned my medical
degree from The Ohio State University.
East Jefferson General Hospital is located in Metairie, on the east
bank of Jefferson Parish, adjacent to Orleans Parish. We are a 450-bed
tertiary care facility with more than 900 professionals on our medical
staff. We employ more than 3,000 people, and are one of the largest
employers in the parish. Our publicly owned, not-for-profit hospital
offers the clinical expertise and cutting-edge technology that our
community expects and deserves. We offer a range of outpatient services
as well as numerous primary care services including cardiovascular,
rehabilitative, oncology, and women and child services.
Throughout the onslaught of Hurricane Katrina and in its aftermath,
East Jefferson General Hospital has remained open, caring for patients.
In fact, we are one of four hospitals open in the New Orleans area; the
others are West Jefferson Medical Center in Marrerro, Oschner Clinic
Foundation in New Orleans and North Shore Regional Medical Center in
Slidell.
When Hurricane Katrina hit the Gulf Coast, no one could have
prepared for the intense devastation it left in its wake. The wind and
the rain wreaked havoc across Alabama, Mississippi and Louisiana.
Knowing that the huge storm was headed their way, hospitals began
sending home ambulatory patients. Those in critical condition or
requiring special assistance, such as ventilator-assisted breathing,
remained in the hospital. When hospital staff reported to work on
Monday, they knew it might be a few days before they were able to
return home. When the levees in New Orleans broke, however, the
situation changed dramatically.
This morning, I'd like to tell you how my hospital prepared for and
operated during the storm, what we are doing to ensure the continuity
of health care delivery in the Gulf Coast region, what our facility as
well as the rest of the New Orleans medical community needs to ensure
that our doors remain open to provide critical health care services to
our community, and answer any questions you and your colleagues might
have.
Hospitals routinely plan and train to deal with disaster, whether
it's the derailment of a train carrying hazardous substances, a
multiple-vehicle accident on a nearby interstate, a plane crash, or a
natural disaster such as a hurricane or earthquake, depending upon the
region of the country. As they prepare for natural disasters and the
prospect of going without public services such as electricity and
water, they plan on being ``on their own'' for at least 72 hours, in
case it takes that long for assistance to arrive from the state or
federal government.
East Jefferson is no exception. The weekend of August 27, we
activated our disaster plan, which includes being self-sufficient for
72-96 hours following a disaster event; met with our hospital and
medical staff to ensure that we were able to care for patients
currently in our hospital as well as those who might come with injuries
as a result of the storm; and began moving our less-critical patients.
The physicians who comprise our medical staff are part of independent
practices, not employees of the hospital, and thus had no obligation to
remain with us in what looked to be a dangerous weather situation. They
did stay, however, and were tremendous in caring not only for our
patients, but also for our staff and others in the community who sought
shelter at our facility.
Before the storm hit and roads were closed, we moved our neonatal
unit to Woman's Hospital in Baton Rouge; many other patients were
transferred to facilities both in and out of state, though we did not
move patients that required ventilator-assisted breathing. We felt the
risk to their health during a transfer was too great.
While we quickly lost power and ran on generators, our building
weathered the storm fairly well. We reduced our electrical consumption
by shutting off the air conditioning and reserving our power for
ventilators and other key medical equipment. Our damage included quite
a bit of leaking throughout the building, but that did not hinder our
ability to care for patients. A few windows were blown out. Once the
levees broke, the flood waters came within 30 to 50 yards of our front
door. At that point, we evacuated the first floor, which is not used
for patient care.
Security, communication and restaffing became critical concerns as
we moved past the initial storm and began to look toward recovery. We
heard reports of looting and other unfortunate events in Orleans Parish
and were concerned for the safety of our patients and staff; the
National Guard quickly responded and provided us with armed security.
All phone service of course went down as well as cable connections, and
cell phone service was infrequent at best. This made it almost
impossible to ask other employees to come in and assist those who had
been working 12-hours shifts for days. It also made it impossible to
speak with other hospitals in our area and the public officials trying
to provide assistance. I was able to get to a Baton Rouge television
station, however, and announce that East Jefferson was still open and
operating, and that hospital staff were desperately needed. Help began
to arrive soon after.
A day or two after the storm, we ran low on food. We always were
able to feed our patients, and there were only two days when the staff
had to eat once a day, and in small amounts. After that, we were able
to contact various businesses and vendors to replenish our supplies and
food.
Throughout the storm, our first priority was patient safety, and
second--though only by a hair--was staff safety. Throughout the ordeal,
we received tremendous support from the men and women who work in our
hospital as well as from the independent private physicians who provide
care. In addition to caring for our patients, the physicians set up a
quasi-pharmacy with samples from their offices so that hospital staff
had access to needed prescriptions such as blood pressure medication.
It provided one little bit of comfort for staff who went above and
beyond their call of duty.
This is our story of how we maintained our commitment to serving
the residents of Jefferson Parish. Obviously, other hospitals in the
Gulf Coast region went much longer before relief arrived. They relied
on generators until fuel ran out, all the while trying to arrange the
means to evacuate patients and hospital staff. In New Orleans, of
course, the situation was exacerbated by the rising flood waters, as
patients were carried up flights of stairs to dryer floors, and
authorities tried to arrange air and water evacuations.
RESPONSE FROM AMERICA'S HOSPITALS
When the levees broke and the city of New Orleans flooded, the
immediate assumption was that all the hospitals would be inoperable in
the wake of a significant need for surgical and trauma care from the
many injured anticipated.
The AHA received countless calls from hospitals across the country
asking how they could help their colleagues in the south, with most
ready to send resources and health care teams at a moment's notice. The
AHA developed www.hospitalreliefefforts.org, a Web site through which
hospitals could sign up and volunteer for deployment by the government.
The response was swift and generous. By September 3, three days after
the Web site went live, more than 500 hospitals volunteered for duty,
and today that pool of hospital and health care facility volunteers is
over 800. This information was forwarded on a daily basis to the
Department of Health and Human services.
Very quickly, through conversations with our member hospitals, it
became apparent that the need was not primarily immediate trauma and
emergency care, but rather the facilities and ability to assist
patients and evacuees suffering from chronic conditions. It was finding
a way for the cancer patient to continue chemotherapy treatment, for
someone suffering from kidney disease to continue dialysis, and for
someone with hypertension to obtain the right medication. At the same
time, we needed to care for those who suffered minor injuries as a
result of the storm. In the hurricane-stricken areas, as well as other
areas where evacuees have been taken, we're seeing an increased demand
for mental health and substance abuse services, chronic care, and
public health services.
The AHA also has been working to help locate patients who--in the
initial evacuations from Louisiana's storm-battered hospitals--had been
taken to other hospitals, possibly without patient ID records. This
information will help ensure that these patients get the care they need
no matter where they are.
IMMEDIATE NEEDS
Currently, we have several critical needs in the disaster area--
restarting the cash flow to these facilities, relieving staff,
obtaining temporary housing, and accessing fuel. As we assess the
damage and attempt to rebuild our facilities it is critical that we
find a way to improve our cash flow. If we have no patients, we have no
income. If we have no income, we have no way to pay our workers, to
obtain services such as food and water, and to continue providing
health care services to areas that already have lost so much of their
infrastructure. During the first two weeks of the storm and its
aftermath, East Jefferson General Hospital lost approximately $12 to 14
million. Now we're losing about $500,000 a day. West Jefferson Medical
Center, the Oschner Clinic Foundation and my hospital each are caring
for about 150 patients a day. At East Jefferson, our average daily
patient population is 350.
Our situations are urgent. Unless we find financial relief within
the next seven to 10 days, we will be forced to make some very tough
decisions. We are committed to our patients, our hospital staff and our
community. However, we can't continue to care for our patients and
community--many of whom hopefully will return soon from the
evacuation--unless we have immediate financial assistance.
Hospitals, including ours, have caregivers who are reaching
``burnout'' and need relief from personnel from other hospitals, for
two-week rotations. These caregivers can help us by relieving staff who
are trying to rebuild their own lives after losing everything to the
hurricane, and, for facilities outside the immediate New Orleans area,
providing health care services to an influx of evacuees who have
settled, at least temporarily, in other communities. We also need
temporary housing--both for our personnel as well as for the temporary
health care workers who come down to assist us. And in order to get our
staff, as well as our emergency first responders, to the hospital, we
need fuel.
GOVERNMENT ASSISTANCE
More than a quarter of a million people fled New Orleans. They
ended up homeless, in evacuation shelters, or took up residence with
relatives in other states. Some of these victims--for certainly they
are victims of one of the worst natural disasters in our country's
history--may have had jobs, benefits that included health insurance, a
roof over their heads, plenty to eat and all of the basic necessities.
But, many may not have been as lucky and already relied on the
government to assist with their health care needs. Regardless of their
financial situation previous to this disaster, all now need help.
The AHA has identified several areas that require immediate
attention to ensure that patients continue to have access to health
care services and that hospitals continue to be able to provide them.
The Centers for Medicare & Medicaid Services already has eased some of
its regulations governing Medicare and Medicaid. There are, however,
additional measures that can be taken. The AHA suggests immediate
federal coverage for the uninsured people affected by the hurricane. So
that access can be granted as quickly as possible, additional relief
from Medicare and Medicaid red tape is needed. In order to facilitate
providing relief health care workers to the Gulf Coast region, the AHA
suggests granting broader liability protection to providers serving in
disaster areas. The AHA also asks that Federal Emergency Management
Agency funds be available for all types of community hospitals affected
by the storm. Additional priorities include reconstructing the hospital
and health care infrastructure in states battered by Hurricane Katrina;
aiding stressed health care personnel; and addressing the growing
caregiver shortages in affected states. I've included a full list and
more details on these issues in the attached document, ``Ensuring
Health Care for Individuals Affected by Hurricane Katrina.''
lessons learned
Every tragedy and disaster provides lessons to either avert the
next one, or, if that is not possible, mitigate the consequences. This
disaster is no exception. During the last few weeks, we've learned a
number of valuable lessons and gained some insights on how best to work
together. We realize that response to disasters is always ad hoc at the
start, when it is best to rely on good judgment rather than policies
and procedures.
We learned this time, as we did with the events of September 11,
2001, that communication systems are the first thing to go. From our
experience at East Jefferson, it is obvious that an alternative,
reliable communication service must be in place, so that public
officials, first responders and the health care community can
efficiently communicate their needs, situations and availability to
assist.
Mr. Chairman, I appreciate the opportunity to tell you about the
situation in my community, and offer suggestions for improving disaster
response in the future. In closing, I'd also like to add that I am here
representing the many people who work at East Jefferson and live in our
community, who are dealing with loss and tragedy, but have remained
steadfast in their mission of caring for the illnesses and injuries of
their neighbors.
Mr. Whitfield. Dr. Peters, thank you very much. We
certainly appreciate the valiant effort that you all put
forward, and your testimony is quite important to us.
Our next witness is Dr. Ardis Hoven, who is a member of the
Board of Trustees of the American Medical Association.
Welcome, Dr. Hoven, and you may give your opening
statement.
TESTIMONY OF ARDIS HOVEN
Ms. Hoven. Mr. Chairman and members of the subcommittees,
good afternoon. I am Dr. Ardis Hoven. I am a practicing
internist and specialist in infectious diseases and the Medical
Director of the Bluegrass Care Clinic in Lexington, Kentucky. I
am also a member of the Board of Trustees for the American
Medical Association and thank you for inviting me to speak with
you today.
It is now clear that Katrina is the worst national disaster
to affect our country. Our thoughts and prayers are with all of
the survivors. It is also now clear that the gulf region has
experienced an unprecedented public health disaster. Parts of
the public health and health care delivery infrastructures are
wiped out or severely damaged. Many physician offices,
hospitals and clinics are simply gone. The local drugstores do
not exist. Funding is needed so that this can be rebuilt and
restored.
The health care needs of Katrina's victims were and
continue to be significant. Physicians on the front lines faced
major challenges in treating patients.
We must plan so patients in hospitals, nursing homes and
those living at home are evacuated before disasters occur. The
AMA is prepared to play a leading role to meet these
challenges. However, we cannot do it alone. We need the support
of Congress and the Federal Government as well as other private
organizations like those that are on the panel with me here
today.
Our testimony today focuses on three key issues: First,
what were the health care needs of evacuees and what problems
did physicians have in treating and saving their patients?
Second, what must be done to rebuild physician practices and
the rest of the public health and health care delivery
infrastructures so that patients needs are met? And, finally,
how can we make sure that the medical and emergency response
communities are better prepared for future disasters?
Physicians were on the front lines of the response to this
disaster. Physicians tried to save and evacuate their patients
from hospitals and nursing homes that were flooded and had lost
power and communication systems. Physicians in the disaster
areas and across the country volunteered by the thousands to
help rescue and treat patients and evacuees. Physicians set up
emergency medical facilities overnight.
What problems did they face? Patients arrived with no
medical records and often could not remember what drugs they
were on or what the dosages were. Physicians treated many
patients with heart disease, high blood pressure, diabetes and
serious mental illnesses who had been without their drugs for
many days. Physicians needed to determine how to reconstruct
treatment for patients with special health needs such as those
with cancer and those needing dialysis and find facilities that
could take them long term. For example, the oncology community
acted quickly to help patients find physicians help across the
country in treating them.
Physicians also had to contend with many legal issues, such
as consent to treat, licensing waivers, protection from
liability and privacy issues. Another significant problem was
the lack of coordination and delays in accepting and placing
volunteers where they were most needed.
These displaced patients will continue to have major health
care needs that require ongoing medical management. We must
make sure that those with chronic conditions have access to
medication. We can expect more injuries as people return home
and attempt to clean and rebuild.
The AMA is doing everything we can to make sure that
patients can be reunited with their physicians and that
physicians can get back to treating their patients, but we need
Congress' help. To make sure patients have access to care, we
call on Congress to enact legislation to help physicians
rebuild their practices or relocate, help ensure that patients
have health insurance, rebuild laboratories to detect and track
infections, ensure adequate vaccine supplies, provide long-term
mental health services for both displaced persons and first
responders, conduct research on disasters to develop best
practices and lessons learned.
The AMA, through its Center for Public Health Preparedness
and Disaster Response, is ready to help lead and provide
guidance and the tools necessary to ensure effective response
in disasters. And, of course, we must learn from what happened
after Katrina. Effective response is a system. That system is
greater than the sum of its individual parts. We must train
more physicians with the skills to respond to future disasters.
As we have just learned, a disaster scene is not a classroom.
Thank you very much, Mr. Chair.
Mr. Whitfield. Dr. Hoven, thank you.
Our next witness is Dr. Bernard Simmons, who is the Chair
of the National Association of Community Health Centers.
Dr. Simmons, welcome. We look forward to your testimony.
TESTIMONY OF BERNARD SIMMONS
Mr. Simmons. Thank you, Mr. Chairman.
I have submitted written testimony to the committee, and I
request that the written testimony be entered into the record.
I will use the remainder of my time to present highlights in
oral testimony of the condition on the ground affecting
community health centers.
Mr. Chairman, thank you and the committee for the hearing.
I am Bernard Simmons, and I'm the Chief Executive Officer of
Southwest Health Agency for rural people in Tylertown, Walthall
County, Mississippi. I'm currently serving as Chair of the
Board of the National Association of Community Health Centers.
On behalf of America's health centers and the 15 million people
we serve, I thank you for the opportunity to speak to you today
about the Federal health center program and the vital role and
response they have played in Hurricane Katrina and the
aftermath.
Health centers across the country, but especially those
along the gulf coast, have been first responders, though often
not recognized as first responders and victims of this
disaster. I know that there has been a devastating impact on
many health centers, for I alone operate a community health
center, and I will be dealing with areas and issues that affect
rural community health centers especially, for they are
different animals and treated differently somewhat in the
emergency response scene.
I am in an affected State, I'm in an affected county, and
my health center also was affected. However, due to a 9-day
lack of power and electricity to my area, water not being
supplied to the area, our major sites were affected where we
could not provide care for 10 days in our primary site, and one
of our sites is also inoperable at this time.
I want you to know that, based upon a discussion with
emergency response persons in my county, 6,500 evacuees are in
the County of Walthall and are expected to receive care and
services in that locale. The hospital--we are located in the
hospital circle, and the hospital did have generators but no
power to other physicians' offices or community health centers.
There are many things, not only power, but water, because most
of the rural communities has been encouraged to become part of
a rural community water system that relies upon electricity.
Also, the advances of technology, also with the emergency
medical records and other things also need electricity to
operate. I know that many health centers are being affected.
But I want to share with you the fact that a community
health center is a community health center that responds
specifically to the needs and the desires and requirements of
that local community. As we look at the situation, America has
at its disposal a system of health care infrastructure that can
be expanded, can be also strengthened to be first responders in
the first zero to 72 hours. They are in the affected areas.
I am in a rural county and ofttimes, and even before I left
coming to our national meeting last week, some areas of the
county did not have power at that particular time. Telephone
service is sporadic. Electronic--not only electronic but cell
phone service is very sporadic in those areas.
Residents of my county are traveling 75--60 to 75 miles
just to try to access where possibly they can get Red Cross and
some FEMA assistance of immediate response. They will be coming
to our area, but as rural people hear of assistance and
services they are responding to where they heard it was
available, many without gasoline, to travel that distance but
to get in a line and then wait there for hours to be told we're
not serving your county today.
In the State of Louisiana, our health centers in New
Orleans are assumed 100 percent destroyed, with more than $43
million in facility damage, facilities that often served some
18,000 homeless individuals--health centers in other areas of
the State are saying the same--or more evacuees. They have
extended hours, hired temporary clinicians to handle the
growing number of new patients.
Health centers in Mississippi, Alabama, Louisiana also have
been hard hit by Hurricane Katrina. We believe that there are
54 health center grantees in 302 communities that have been
affected by the hurricane and the aftermath thereof. These
centers provide basic primary care as well as urgent medical
care, mental health and enabling services to thousands of
persons.
In Mississippi, along the gulf coast, the coastal family
health centers, which served more than 30,000 patients last
year, have been severely damaged and completely destroyed and
have only managed to open one of their sites in north Biloxi.
Several health centers in Alabama were severely damaged
both by wind and flooding, and the Bayou Labatte area health
development board, which served 17,000 patients experienced
structure damage but was able to provide care through a recent
generator that had been placed in the center.
As a result of this disaster, health centers across the
region are seeing an increased number of gulf coast evacuees.
They are being seen in Texas. They are being seen in Georgia.
They are being seen across the region.
Health centers always assume or are accustomed to
confronting adversity head on and providing health and enabling
services to communities; and, therefore, in the wake of this
storm, it's nothing new for health centers. We need to request
of Congress the ability to get funding, to have the ability to
rebuild, repair and restore health center facilities. We
estimate about $65 million in facility requirements--$45
million for Louisiana, $10 million for Mississippi and
approximately $10 million in Alabama--to enable existing health
centers to serve as many displaced individuals as possible.
Because we do it at a rate of about $500 per year. Therefore,
we will be able to serve approximately 400,000 people.
The extension of the Federal Torts Claim Act liability
coverage. We would like to certainly request that physicians
and clinical personnel have the right to travel offsite and
across State lines and that that access be provided them or
that coverage, follow them wherever they go, and remain in
effect at the existing centers where they work.
We also need to encourage this panel, as you look at
Medicaid, that you enact emergency Medicaid spending to provide
Medicaid and SCHIP coverage for evacuees and that 100 percent
of that reimbursement be covered by the Federal Government
rather than by the States, provide emergency Medicaid coverage
for all evacuees, regardless of categorical eligibility and
expanded income and asset eligibility thresholds, streamline
the Medicaid process so that the eligibility requirement--and
ease documentation requirements in an effort to overcome
administrative problems.
America's health centers who specialize in providing care
in low-income communities throughout our Nation are bringing
their unique skills to this emergency relief effort now, as
ever. We are committed to being a shelter in the storm and a
health care home for the individuals and families in medically
underserved communities across this country.
Thank you, Mr. Chairman, for this time; and I will be glad
to entertain questions at the appropriate time.
Mr. Whitfield. Thank you, Dr. Simmons.
At this time, Mr. Joe Cappiello, who is the Vice President
of Accreditation Field Operations for the Joint Commission on
Accreditation of Healthcare Organizations.
We look forward to your testimony, Dr. Cappiello.
TESTIMONY OF JOE CAPPIELLO
Mr. Cappiello. Thank you so much and good afternoon, Mr.
Chairman.
I am Joe Cappiello, Vice President of Accreditation Field
Operations for the Joint Commission on Accreditation of
Healthcare Organizations. I appreciate the opportunity to
testify before you today on the health care delivery situation
in the wake of Hurricane Katrina.
The Joint Commission, by background, is a private-sector,
not-for-profit entity dedicated to improving the safety and
quality of health care provided to the public. We accredit over
15,000 healthcare organizations in the United States along the
full continuum of care, including the preponderance of the U.S.
hospitals.
Now emergency management has been a priority for the Joint
Commission for over 30 years. Following the terrorist attack on
9/11, however, our efforts took on a new sense of urgency and
our standards began to focus heavily on issues of community-
wide planning. Among the many tools and resources that we have
developed is the document that you have before you entitled,
Standing Together: An Emergency Planning Guide for America's
Communities.
In continuing efforts to understand communities' response
and recovery of their health care systems following a large-
scale disaster, the Joint Commission sent a team to the region
devastated by Hurricane Katrina. Our charge was to make initial
observations and establish contacts for a more deliberate
debriefing in the future. Our mission was to develop a set of
lessons learned and openly share these with America. As a
member of that team, I'm here today to discuss our observations
and to highlight for you the immediate challenges for restoring
health care infrastructure to the gulf region.
In New Orleans, we witnessed a health care system
attempting to recover from a staggering blow. Major parts of
the infrastructure that support medical care--water supply,
sewage, electricity--have been significantly damaged. At the
time of our visit, only three of New Orleans 16 acute care
hospitals were fully operational. Other hospitals are trying to
open their doors as quickly as possible.
While New Orleans has been the focus of much of the press
reports, we visited areas in Mississippi where the destruction
was as severe and whose recovery will be just as difficult.
I would like to highlight from my written testimony a few
activities essential to the restoration of health care services
in the affected States. They are not listed in any specific
order of significance.
First, disseminate information at a national level to
advise returning residents and workers of certain
responsibilities, dangers and available services. Incoming
residents and workers should be apprised of the need for
immunizations and where to get them, specific hazards they may
encounter, the ways to access emergency help and the
limitations of the current health care system, what is open,
what is not, what services are available and where.
Second, provide this information to people again as they
enter the city in order to reinforce and update the information
as needed. I believe the Federal Government could be helpful in
such information dissemination.
Third, re-establish the post-acute care infrastructure,
such as home health, rehabilitation, and nursing home care,
quickly to ensure that hospital beds, which will be at a
premium as citizens return, are not unnecessarily tied up with
those who can be helped at lower levels of care.
Fourth, institute a process that insures that patients
receiving services in temporary care sites are provided with
their medical information so that it is portable to other sites
of care and to primary care providers who may treat them in the
future.
Fifth, focus on insuring that a number of critical physical
plant and environmental care concerns are addressed, especially
mold abatement. Engineers with mold abatement training should
be identified and brought in to support these facilities as
quickly as possible.
Sixth, implement and expand upon HHS's Critical
Infrastructure Data System to capture real time, accessible
data needed for recovery purposes.
Seventh, ensure that returning health care workers have
adequate access to housing, food and other supportive services,
including payroll. Because, without such services, they will be
less likely to return to those affected areas.
Last, integrate mental health and clinical services. There
needs to be a strong focus on appropriate mental health in
order to deal with increased risk of behavioral health issues
such as suicide, lack of or access to psychotropic medications
and post-traumatic stress disorder.
The Joint Commission will participate and collaborate with
appropriate oversight officials in developing a strategy for
ramping up hospitals and other healthcare organizations to
full-service institutions. For example, we are working with
representatives from the State and Federal Governments to help
get systems back up and running by establishing a minimal,
consensus-driven checklist of physical plant safety that will
provide organizations with guidance on what they must do to
meet oversight requirements for reopening their facilities.
That checklist will add increasing granularity as levels of
care increase.
In conclusion, there remains much work to be done in the
gulf States, but there is also an opportunity here so rare and
unusual that it cannot be overlooked. The opportunity presents
itself to be innovative in the reconstruction of the health
care infrastructure of a major city to make New Orleans a model
health care delivery city that will do more than just bring
back the professionals and citizens that fled that city due to
the storm but a model that will attract the best and the
brightest of every profession. God willing, we will never have
this opportunity again.
Thank you, Mr. Chairman.
[The prepared statement of Joseph Cappiello follows:]
Prepared Statement of Joseph Cappiello, Vice President, Accreditation
Field Operations, Joint Commission on Accreditation of Healthcare
Organizations
I am Joe Cappiello, Vice President of Accreditation Field
Operations for the Joint Commission on Accreditation of Healthcare
Organizations. I appreciate the opportunity to testify before the
subcommittees on Health and Oversight and Investigations on the health
care delivery situation in the wake of hurricane Katrina.
Founded in 1951, the Joint Commission is a private sector, not-for-
profit entity dedicated to improving the safety and quality of health
care provided to the public. Our member organizations are the American
College of Surgeons; the American Medical Association; the American
Hospital Association; the American College of Physicians; and the
American Dental Association. In addition to these organizations, the
29-member Board of Commissioners includes representation from the field
of nursing as well as public members whose expertise spans such diverse
areas as ethics, public policy, insurance, and academia.
The Joint Commission currently accredits over 15,000 organizations
in the United States. These include hospitals (both general acute care
and specialty), critical access hospitals, laboratories, health care
networks (including integrated delivery systems, HMOs and PPOs),
ambulatory care, office-based surgery, assisted living, behavioral
health care, home care, hospice, and long term care organizations.
About one-third of accredited organizations are hospitals, comprising
the nearly 85% of hospitals that contain 96% of U.S. hospital beds.
Emergency Management has been a priority for the Joint Commission
for over 30 years. In 1999 with the help of emergency management
experts and 2 years before the disaster of 9/11, our emergency
management standards were revamped to reflect the most current thinking
in the field. At that time, the Joint Commission started the process of
assessing and modifying our accreditation standards to better reflect
the need for health care organizations to be involved in community-wide
planning, as opposed to only focusing on their institution. Following
the terrorist attacks on September 11, 2001 and the subsequent anthrax
exposure, our efforts took on a new sense of urgency.
In 2003, the Joint Commission published Health Care at the
Crossroads: Strategies for Creating and Sustaining Community-wide
Emergency Preparedness Systems, a report that reflected the work of a
roundtable of experts. These experts were assembled under the Joint
Commission's Public Policy Initiative to frame the issues associated
with (and to recommend strategies for) developing community-wide
preparedness.
More recently, the Joint Commission partnered with the Illinois
Department of Public Health, the Maryland Institute of Emergency
Medical Services Systems, and the National Center for Emergency
Preparedness at Columbia University to convene two expert roundtable
meetings. In addition, over the past four years, Joint Commission has
conducted site visits to communities impacted by a disaster, such as
New York City and Washington, DC (following the terrorist attacks and
anthrax exposure), Houston (massive flooding during 2001 Tropical Storm
Allison), Southern California (wildfires), Florida (the 2004
Hurricanes) and the North East (power outage in August, 2003).
Information gleaned from the roundtable meetings and site visits to
communities impacted by a disaster was used to develop Standing
Together: An Emergency Planning Guide for America's Communities.
In continuing effort to understand communities' response and
recovery of their healthcare system following a large scale disaster,
the Joint Commission sent a team of disaster experts to the region
devastated by Hurricane Katrina. The charge of that team was to make
initial observations and establish contacts for a more deliberate
debriefing in the future. I was part of that team and I am here today
to discuss our observations and to highlight for you efforts that are
underway to restore the health care infrastructure in the Gulf Region.
WHAT OUR TEAM SAW LAST WEEK
In New Orleans, we witnessed a health care delivery system
attempting to recover from a staggering blow. In recent history, a
major city in the United States has never experienced the destruction
wrought by Hurricane Katrina. Major parts of the infrastructure that
support medical care--water supply, sewage system, and electricity--
have been significantly damaged. At the time of our visit, only three
of New Orleans' 16 acute care hospitals were fully operational. Other
hospitals are trying to open their doors as quickly as possible. When
we departed New Orleans on September 16, there was no 911 system
(although a call center was being established), no ambulance transport
system, no Level 1 trauma center, no burn center, no home health care,
no long term care nor any dialysis centers. That is part of the
challenge this city faces.
In New Orleans, we visited Ochsner Medical Center where we took
part in the ``virtual'' daily briefing, which brought together a broad
array of federal, state and local healthcare leaders to discuss daily
status reports and coordinate their efforts. We also visited several
other facilities that were in the process of recovery. While New
Orleans has been the focus of much of the press reports, we visited
areas in Mississippi where the destruction was as severe and whose
recovery will be just as difficult. For example, Hancock Medical Center
in Bay St. Louis will face the same challenges to restore service to
its community as any hospital in New Orleans. For a period of time,
they were being supported by federal Disaster Medical Assistance Team
(DMAT) teams in their parking lot and coping with extensive water
damage.
In Mississippi, we had the opportunity to visit several deployable
medical units designed to accommodate surge control for an existing
functioning hospital. Nevada 1 is an air transportable, expandable
Federal Management Shelter capable of treating a wide range of health
care conditions and a large number of patients. It has a capacity of
100 beds and can be set up for both primary and ICU care, as well as
labor and delivery. Carolina 1 is an air transportable facility that
has at its core, an 8 bed fully equipped ICU and a fully functioning
Operating Room. These deployable units are clearly life saving entities
that can supplement existing medical infrastructure. These health care
assets can bring much needed supplies and emergency systems with them,
and can be helpful for staging, surge control, and providing special
medical services.
Furthermore, we learned of many acts of heroism and caring that
medical professionals rendered throughout this disaster and I can say
with certainty that there were a thousand other acts of compassion that
will go unrecorded and unnoticed. Such is the nature of health care
professionals.
I would remind the members that the Joint Commission is interested
in and accredits the full spectrum of care. My remarks are directed
with equal importance to the care provided outside of the hospitals, as
well as hospital-based care. Hospitals in every community rely on and
need the support of community-based structures to effectively
accomplish their mission. My comments are directed toward the
restoration of the synergistic interplay of all health care resources
that comprise the fabric of care.
resuming the delivery of health care services in the gulf states
The following is a list of activities that are essential to
restoring health care services to the affected states in the next few
weeks to months. They are not listed in order of significance.
<BULLET> Disseminate information at a national level to advise returning
residents and workers of certain responsibilities, dangers, and
available services. Incoming residents and workers should be
apprised of--
--the need for vaccinations, especially Tetanus and Hepatitis A;
--locations of facilities providing free vaccinations;
--specific hazards, such as water, mud, debris;
--the ways to access emergency help; and
--limitations of the health care system, e.g., what is open and
closed, what services are available and not available,
where services are located, and how to contact service
providers.
<BULLET> Provide the information noted above to people a second time as they
enter the city in order to reinforce and update the information
as needed.
<BULLET> Resume the traditional 911 services as soon as possible because
alternative call centers are not as effective--i.e., people
will not remember the number or find it quickly during a
crisis.
<BULLET> Begin Level 1 trauma services in the New Orleans area.
<BULLET> Restore supportive medical services as quickly as possible and
commensurate with the re-population plan. These services
include, but are not limited to pharmacies, laboratories,
diagnostic imaging centers, ambulance services, and dialysis
centers.
<BULLET> Develop a plan for the delivery of healthcare to the chronically ill,
but ambulatory low-income and uninsured populations, whose
normal health care providers are not operable. The affected
states had high rates of both low income and uninsured people.
In New Orleans, for example, the majority of those uninsured or
in poverty relied upon Charity Hospital for primary care and
other services, but it is unlikely that this hospital will
reopen any time soon.
<BULLET> Establish services for disabled and special needs populations, such
as medical transport and rehab facilities, as soon as possible.
<BULLET> Re-establish the post-acute care infrastructure, such as home health,
rehabilitation, and nursing home care, quickly to ensure that
hospital beds--which will be at a premium--are not
unnecessarily tied up with those who could be helped at lower
levels of care.
<BULLET> Ensure that providers have broad scale access to the Department of
Health and Human Services (DHHS) network of pharmaceutical
records in order that the pharmaceutical history of residents
can be known by those providing treatment.
<BULLET> Institute a process that ensures that patients receiving services in
temporary care sites are provided with their medical
information so that it is portable to other sites of care and
to primary care providers who may treat them in the future.
<BULLET> Focus on ensuring that a number of critical physical plant and
environment of care concerns are addressed, especially mold
abatement. Engineers with mold abatement training should be
identified and brought in as soon as possible. Environment of
care issues are paramount to resuming patient care. Other
concerns involve air quality, sanitation, and contamination.
<BULLET> Monitor on a daily basis the number and geographic location of
individuals with rashes, fevers, and diarrhea to ensure that
any trends indicating a public health concern are identified
early. Disseminate this information to all relevant health care
and public health entities.
<BULLET> Establish mechanisms to communicate across health care facilities so
that care delivery can be coordinated and made efficient and
effective. A common communication system will help to leverage
health care assets and disseminate essential information that
is necessary for recovery.
<BULLET> Implement and expand upon the Department of Health and Human
Services' Critical Infrastructure Data System (CIDS) to capture
real time, accessible data needed for recovery purposes.
<BULLET> Make available safe water and restore sewage capabilities, so that
health care organizations can resume operations.
<BULLET> Ensure that returning health care workers have adequate access to
housing, food, and other supportive services (including
payroll) because without such services, they will be less
likely to return to affected areas.
<BULLET> Assist health care facilities to establish laundry services and
sterilization capabilities.
<BULLET> Establish telemedicine services, to provide access to specialists
from unaffected areas.
<BULLET> Integrate mental health and clinical care services. There needs to be
a strong focus on appropriate mental health care in order to
deal with increased risks of behavioral health issues, such as
suicide, lack of access to psychotropic medications, and post
traumatic stress disorder.
EFFORTS UNDERWAY
The Joint Commission is commonly recognized as an entity with the
unique capability of bringing disparate groups together to focus on a
common goal. We are engaged in that activity today. The Joint
Commission is working collaboratively with federal, state and local
officials to ensure that health care organizations in the affected
areas can obtain a sufficient level of functioning to provide safe
health care services. There has been significant study on the graceful
degradation of care but few studies or experiences with the
reestablishment of care. The Joint Commission will participate and
collaborate with these officials in developing a strategy for ramping
up hospitals and other health care organizations to full service
institutions
For example, we are working with a wide spectrum of organizations
to help get systems back up and running by establishing a minimal,
consensus-driven checklist that will provide organizations with
guidance on what they must do to meet state and federal requirements
for reopening their facilities. That checklist with add increasing
granularity as levels of care increase. For example, there will be a
basic set of criteria for re-opening the doors of closed facilities so
that they are safe for occupancy by staff and patients. The criteria
will become more specific as particular types of services are brought
on line, such as surgery.
The Joint Commission is also an active participant the ``Emergency
System for Advanced Registration of Voluntary Health Personnel (ESAR
VHP).'' This Health Resources and Services Administration (DHHS)
project brings public and private sector groups together to identify
and address issues and formulate responses associated with
credentialing and privileging volunteer health care personnel.
Hurricane Katrina was the first real test of those states who have been
funded to put this system into practice. We were pleased that this
system could be activated to help.
CONCLUDING REMARKS
In conclusion, there remains much work to be done in the Gulf
states, but there is also an opportunity so rare and unusual that it
cannot be overlooked. The opportunity presents itself to be innovative
in the reconstruction of the healthcare infrastructure of a major city,
to make New Orleans a model health delivery city that will do more than
just bring back the professionals and citizens that fled the city but a
model that will attract the best and the brightest of every profession.
God willing, we will never have this opportunity again.
Mr. Whitfield. Thank you, Mr. Cappiello.
Our next witness is Mr. Bob Dufour, who is Vice President
of Pharmacy Services with Wal-Mart Corporation.
TESTIMONY OF BOB DUFOUR
Mr. Dufour. Thank you. And I'm a Director, not a Vice
President.
I'm here today testifying on behalf of the NACDS. I was
asked because of my involvement in helping to organize chain
pharmacies to respond with emergency medications to the
shelters and to evacuees.
My testimony today is really a success story. We have a lot
of successes. I know that many of you, as you visited the area
or you saw in the media the different shelters going up, these
shelters were provided with prescription medications, many of
those from chain pharmacies.
In total, we contacted over 400 shelters; and we served
hundreds of thousands of evacuees who were in these shelters,
in hotels, staying with relatives and staying with friends. We
did this without any formal Federal contract, without any State
contracts. It was an ad hoc response by community pharmacy
because we recognized need of these evacuees to have their
medicines. This was possible because of the cooperation we had
with several different groups, first of all, with the
pharmaceutical manufacturers; and I think the congressman from
Florida this morning mentioned the contribution they made.
Starting on Tuesday after Hurricane Katrina hit, I
approached six different manufacturers with the notion that the
company I work for, Wal-Mart, wanted to provide a 7-day supply
of emergency medications to anyone who was affected by
Hurricane Katrina. I asked them for their support by asking if
they would provide replacement products for those prescriptions
that were donated. Four of those companies immediately said
yes. Two other ones said they would have to get back with us
after they checked with other folks in their company. Later on,
we had our pharmaceutical buyers contact other manufactures.
I also contacted Mr. Billy Tauzin, who is now with the
Pharmaceutical Manufacturers Association, explained what we
were trying to do and sent him a letter that he distributed out
to the PHARMA companies. So we really appreciate his support.
There was also great cooperation with the government at the
State and Federal level.
On Wednesday, I contacted folks at the emergency operations
centers in Louisiana and in Mississippi to offer help to find
out what they needed. We also worked with boards of pharmacy.
The boards of pharmacy in Mississippi, Louisiana and Texas
recognized the urgency of the situation and provided a means
for pharmacists to dispense medicines to patients where they
may not have a prescription with them, could not get ahold of
the doctor or the pharmacies and they may be in shelters where
there were no physicians yet, so pharmacists were using their
good professional judgment in dispensing these.
We also had cooperation from the DEA, where they allowed us
to dispense controlled substances under these emergency
guidelines.
I would also say we had good government cooperation with
the Medicaid departments in Mississippi and Louisiana and also
Texas. They worked very hard to allow out-of-State pharmacies
to quickly enroll and provide services because many of the
evacuees had gone out of their home States. We had real good
cooperation which provided a lot of help there.
We started this retail network. It started on the Wednesday
evening after Hurricane Katrina hit.
I was speaking with Fred Mills, who was in Baton Rouge
working for the Louisiana emergency operations center. As
shelters were starting to pop up, they were trying to figure
out how do we get medicines to all of these different shelters.
They did consider at one point a scenario of maybe having some
type of government pharmacy and how would they get people, how
would they get the drugs from the Federal supply down to these
pharmacies; and we brought up the fact that there were a lot of
Wal-Marts in a lot of the locations where the shelters were
going. I offered the support of Wal-Mart, saying we would
provide a 7-day supply of medicines to each of these shelters
that were close to us.
I then asked them to prepare a list of the shelters and fax
it over to me, which they did. When I saw how extensive the
list was, we enrolled the help of the other chain pharmacies.
The following day we held a conference call with chain
pharmacies.
We also invited Larry Kolcot from CMS, who was a very big
help in this process. What we did was we would e-mail out the
list of shelters and how many evacuees were in these shelters
and we would ask chains to adopt a shelter. And what adoption
means is that the pharmacy chain that adopted the shelter would
take responsibility for sending pharmacists over to the shelter
and making sure prescription medicine were given to these
people who needed it. We did this each day.
As more shelters were opened in Texas and Mississippi, with
these shelters, what we would do--if you've got a shelter
typically of less than, say, 2,500 people, the most efficient
way to provide medicine in the large shelters like the Houston
Astrodome and George Brown Convention Center, places like that,
mobile pharmacies were dispatched.
I think this was a real good example of the value of
community pharmacy and what we can do. You did not hear a lot
in media about the independent pharmacists, but I'll tell you
the independent pharmacists also participated in this to the
extent they could.
The recommendations that I would have for this panel as
we're looking at Hurricane Rita and we know that other
catastrophes will happen, one way we could organize the need
for prescription medicines is for the Federal Government to
create a Federal Government disaster prescription drug program
very similar to what employers have for their employees, or
with the Federal Government you have a little plastic card
that's in your wallet you use to purchase prescriptions. Under
this Federal disaster, the Federal Government would get a VIN
number and they would set up the parameters of what drugs would
be covered, what days supply and, very simply, the Federal
Government could turn on this plan electronically whenever a
disaster hit.
By doing that, there's some distinct advantages. You could
have every community pharmacy in the Nation participate. If you
think about emergency response and how do you get drugs to
where they're needed, 95 percent of Americans live within 5
miles of a community pharmacy. So wherever the disaster is
you're going to have community pharmacies with personnel and
drugs already on hand.
This prescription drug program would also give the Federal
Government real-time access to what prescriptions are being
dispensed, the names of people and what shelters they're at.
The second thing I'd recommend is, when we talked earlier
about the national data base, and I think Mr. Engle and also
Dr. Hoven mentioned the importance of having medical
information. Dr. David Braylor with the Health Information
Technology Group in HHS has been working for the last couple of
weeks with three different pharmacy technology companies as
well as chain pharmacy and independent pharmacies to create a
data base. I believe today they are announcing that. They have
over a million health care records of people in the path of
Hurricane Katrina. I would recommend the committee take a
closer look at that and say, how can this be applied to other
areas when a disaster is coming.
Overall, besides working the prescription network, I was
also involved with responding in Mississippi and in Louisiana
with other health care needs, supplies to hospitals, nursing
homes. And I would say, in general, the biggest thing I saw
was, if we were going to focus on something to make this
better, is to look at fuel, look at communications and look at
coordination. One piece of coordination I'd like the committee
to consider is if emergency responders had a phone number they
could call in and their needs could be posted on to a website
that was monitored by FEMA or the emergency operations center
of a State, they could--the State could see all the needs that
were coming in, determining if they were valid needs. And then
if they wanted to respond, they could do it with a FEMA
response, a Federal response, or they could post that over to
another website that was open to authenticated suppliers who
could look at what those needs were, and those suppliers could
respond. So, for instance, if there was a need for water or if
there was a need for medicine you could go to a web page and
you could see that being posted by FEMA and a supplier could
come back and say we can respond back in 1 hour, we could
respond back in 2 hours. Thank you.
[The prepared statement of Bob Dufour follows:]
Prepared Statement of Bob Dufour, Director, Pharmacy Professional
Services and Government Relations, Wal-Mart, Inc. on Behalf of National
Association of Chain Drug Stores
Mr. Chairman and Members of the Subcommittees on Health and
Oversight and Investigations. My name is Bob Dufour and I am Director
of Pharmacy Professional Services with Wal-Mart.
I am here on behalf of the National Association of Chain Drug
Stores (NACDS). NACDS asked me to testify because of my involvement in
helping to coordinate the chain pharmacy industry's response following
Hurricane Katrina.
The purpose of my statement today is to help the Committee better
understand the response of the community retail pharmacy infrastructure
to the Hurricane Katrina disaster. We would also like to provide some
recommendations that would help facilitate the role of community retail
pharmacies in responding to future public health emergencies.
retail pharmacy supply chain role in public health emergencies
There are about 56,000 community-based retail pharmacies in the
United States. There is a community retail pharmacy within 5 miles of
95 percent of the population in the United States. Therefore, retail
pharmacies are an important point of entry into the health care system
for most Americans.
Hurricane Katrina showed us that the existing community pharmacy
infrastructure plays a vital role in providing medications and other
health care products and services to individuals in their communities
during public health emergencies as well as daily activity. Obviously,
in many communities located within the Gulf Region, much of the health
care infrastructure was devastated and will have to be rebuilt. We look
forward to working with the Committee to ensure that this vital
infrastructure is restored as more and more people return to their
homes.
As evacuees from the Gulf Region were relocated to various places
across the United States, pharmacists and pharmacies helped to respond
in many different ways to meet the health care needs of these
individuals. First, many pharmacy chains established mobile pharmacies
in evacuee centers and other areas along the Gulf Coast so that they
could provide prescription drug services and other health care items to
these individuals. We all heard news and press reports about
individuals who had been evacuated without vital health care supplies
such as insulin and other prescription drugs, which are needed to
sustain life and health. Pharmacies worked with physicians at these
evacuee sites to assess each patient's health care status--given that
they had little or no medical history with them--and get them started
back on their prescription therapy.
Many community retail pharmacies also filled tens of thousands of
prescriptions for evacuees that were relocated to smaller shelters or
temporary housing. Many of the evacuees were low-income individuals who
are Medicaid recipients in their home state, and obviously they did not
have their Medicaid cards with them when they came to the pharmacy.
Others had lost their insurance information, or had no insurance at
all. We have been working with the Centers for Medicare and Medicaid
Services (CMS) and host state Medicaid agencies to ensure coordination
with their efforts.
Thus, as policymakers consider what might be changed in the future
to make those responses to public health emergencies more effective, it
is equally important to ensure that we maintain and strengthen
infrastructures that are already in place that can respond quickly to
emergencies within the communities in which people live. One of these
infrastructures is the neighborhood retail pharmacy.
We all agree that the nation needs certain stockpiles of
medications and other supplies readily available to ship to emergency
centers or disaster zones. However, when it comes right down to it,
there are many more community pharmacies and other types of local
health care centers that are accessible and convenient to people in
their communities. The retail pharmacy is at the heart of this
distribution system, and each part of this system--from the drug
manufacturers to the wholesalers to the pharmacies--responded in such a
way to keep the flow of prescription medications moving to shelters and
the pharmacies and ultimately to the evacuees.
The success of the prescription drug distribution infrastructure in
serving the needs of evacuees is best demonstrated by the fact that, in
a survey of evacuees in Houston shelters, 67 percent reported that
there was not a time since they were evacuated that they did not have
their prescription medications. States have been reassuring the
pharmacy industry that they will do everything they can to see that
pharmacies will be compensated at some point in the future for
providing these services to their residents. We appreciate the efforts
of the Bush Administration in granting a Medicaid 1115 waiver to the
state of Texas to establish an uncompensated care pool to help pay
providers like pharmacies for the care that they provided to evacuees
with and without any form of prescription coverage. NACDS is hopeful
that other states will adopt similar measures. In addition, it is
important that the federal government consider developing a clear
policy to address the reimbursement of health care providers for
uncompensated care.
organizing the retail community pharmacy response
To facilitate the response of community pharmacy to the Hurricane
Katrina crisis, NACDS and other pharmacy-related associations and
interests were in daily communication. These daily calls allowed us to
ensure that we were quickly deploying resources where they were needed,
without duplicating efforts. For example, pharmacies were adopting
shelters, meaning that a chain pharmacy would take responsibility for
providing pharmacy services to that shelter. This method allowed a
quick coordinated response and prevented duplication of efforts to
service the prescription needs of those housed at the shelters in
Louisiana, Texas, and Mississippi.
A large number of chain pharmacies and members of the supply chain
contributed as well.
<BULLET> Wal-Mart helped to contact and organize contributions from brand and
generic pharmaceutical companies to provide replacement
medications for some of the products being dispensed by
pharmacies to evacuees.
<BULLET> Wal-Mart adopted 99 shelters to provide emergency medications.
<BULLET> Wal-Mart worked to help supply oxygen to health care entities in the
region that were running low on these vital supplies. Finally,
some of our stores in the area helped to supply medications to
nursing homes that were running out of these supplies.
<BULLET> CVS/pharmacy said last Friday that it has completed its emergency
pharmacy operations at the Astrodome in Houston, where it has
been filling prescriptions for Hurricane Katrina victims, now
that all evacuees have been relocated out of the stadium to
other facilities. Utilizing delivery service from area CVS
stores and two mobile pharmacy units on-site at the Astrodome,
CVS reported that it filled more than 20,000 prescriptions for
7,000 people who took shelter in the Astrodome. CVS/pharmacy
also deployed mobile pharmacy units to the Convention Center in
Austin, Texas, and Kelly Air Force Base in San Antonio, Texas.
It will continue to serve the prescription needs of Gulf Coast
evacuees at local CVS locations.
<BULLET> Walgreens offered to deploy as many mobile pharmacies as needed and
provided hundreds of pharmacists to dispense prescriptions to
evacuees.
<BULLET> Rite Aid is continuing to fill emergency prescriptions for evacuees.
The chain also set up temporary pharmacies at evacuee shelters.
<BULLET> Many other pharmacy chains, such as HEB and Kroger, sent additional
pharmacists to these shelters and the pharmacies that are
located in the Texas and Louisiana areas. This was important,
given that the demand for prescription services increased
significantly in the areas where evacuees were relocated.
<BULLET> Pharmaceutical wholesalers worked to ensure that needed products
would remain in-stock for dispensing, and helped to transfer
them to the shelters and the pharmacies.
<BULLET> Groups representing health plans helped to provide specialty drugs to
AIDS and cancer patients in the shelters.
<BULLET> Individual pharmacists and technicians at a large number of chain
pharmacies, as well as many independently-operated pharmacies,
should be recognized for their efforts. Many worked day after
day putting in long hours providing services to people in these
shelters.
working with state public health agencies
NACDS and community retail pharmacy also worked with state
government agencies to help ensure that the response to the crisis was
as organized as possible. Boards of Pharmacy from affected and host
states worked with us to approve the use of emergency policies and
procedures to provide needed prescription drugs to evacuees.
For example, the combined efforts of the Louisiana Board of
Pharmacy, Louisiana Medicaid Department, and Louisiana Department of
Health and Hospitals were particularly instructive in coordinating a
response to a crisis of this nature. These agencies immediately
recognized a need to have a system that would provide timely access to
medical supplies and pharmaceuticals. They recognized that the existing
statewide network of community pharmacies and wholesalers could respond
immediately and serve many of those in need.
A state-based wholesaler provided the majority of bulk shipments
needed to shelters, hospitals, and other areas identified by this
group. Wal-Mart also responded with two shipments from its pharmacy
warehouse. Many independent community pharmacists responded to the
local needs of their community by providing emergency prescription
medications.
The efforts of the state of Mississippi in helping to ensure that
their evacuees could continue to obtain Medicaid services should also
be noted. The Department asked out of state pharmacies to provide
prescription services to Mississippi Medicaid recipients during this
emergency. The Medicaid program would reimburse these pharmacies at the
prevailing Medicaid rate. Mississippi Medicaid did allow out of state
pharmacies to use an existing ``in state'' Medicaid provider number if
the pharmacies were under common ownership.
electronic database of evacuees' medical history and prescription needs
One lesson that this unfortunate event has taught us is that
electronic medical records are valuable in providing continuous patient
care to displaced individuals, especially in cases where important
medical and prescription information is lost, possibly forever. Our
industry coordinated efforts with federal, state, and local government,
as well as other industry partners through daily conference calls and
work groups. This constant communication allowed us to collect and
integrate as much medical information as possible about the evacuees'
from various sources, including prescription files, and provide it to
the health care professionals caring for those displaced by Hurricane
Katrina.
For example, in response to this need to create a better database
of information about evacuees' prescription drug therapy, our industry
has been working with HHS and the HHS' Office of Health Information
Technology, headed by Dr. David Brailer, to create a single database of
close to 1,000,000 names from the region affected by Hurricane Katrina.
By working together over about an eight-day period, several chain
pharmacies, SureScripts and Florida-based Gold Standard built the
database and designed the interface that all participating health care
professionals could use. The database lets a pharmacist, physician, or
other health care professional treating patients know what medications
an individual had been taking over the past ninety days. This system
has been established just for people in the areas affected by the
hurricane.
A program that was initially piloted to a few chain pharmacies is
now becoming available to growing numbers of pharmacies, doctors and
other health professionals. With these records, the first question a
physician asks--``What prescription medications are you taking?''--can
be answered accurately.
NACDS believes that this event has reinforced the need for a single
national patient identifier number to help access those records. If the
national patient identifier had been in use, then it is likely that it
would have been easier and faster to match evacuees' medical
information with their prescription information. This would have helped
deliver care to these evacuees, who in most cases did not have any of
their medical information with them.
recommendations to enhance the public health response to emergencies
We have already made some recommendations about how we might
improve the ability of community retail pharmacies to respond to public
health emergencies. We believe that community retail pharmacy worked
well with various state and federal agencies, although there are always
ways that the efficiencies of these interactions can be increased. Here
are some ideas:
Consider Federal Emergency Rx Claims System: The Federal government
should consider establishing a system that would allow retail
pharmacies to process prescription claims for evacuees through a
special Federal prescription drug plan that would be used only in
emergency situations. Many evacuees that filled prescriptions in our
pharmacies were uninsured, or had prescription drug coverage, such as
Medicaid and third party coverage, but did not have their
identification cards, so pharmacies were not able to process their
claims to the correct payers. While pharmacies filled prescriptions for
these individuals, a Federal emergency system would help keep track of
prescriptions that are being filled for evacuees, as well track the
expenditures incurred by individuals for prescription drugs and other
medical supplies.
In the event of an emergency, the plan could be activated via its
Bank Identification Number (BIN) or routing number. This would allow
emergency prescriptions to be filled at any pharmacy in the nation. The
adjudication of these claims in real time would provide the government
valuable information on the medications being dispensed, to whom, and
in what volumes. Parameters could be preset for reimbursement,
eligibility, and other important factors. We would be interested in
working with HHS, FEMA and other relevant agencies on this issue.
Encourage Development of EMR Technology: Continue to encourage the
development of electronic medical records, the use of the national
patient identifier, and integrated databases that can be used both in
delivery of medical care in ordinary times and extraordinary
circumstances. We have a long way to go in developing the
infrastructure necessary to support this system, but the disaster in
the Gulf Region reinforces how important it is that the health care
system maintains the ability for providers to deliver care to
individuals wherever they might be.
Strengthen Retail Pharmacy Infrastructure: Please do everything you
can to strengthen and maintain the existing community retail pharmacy
infrastructure. The disaster in the Gulf Region reinforces the
importance of community pharmacies, particularly since many of them are
located in rural areas, are often the ``first responders'' to the
health care needs of many individuals, both in emergencies and in
normal times.
Post Specific Needs on Web: Fourth, the government may also want to
consider a web-enabled program on which emergency responders could post
specific needs. FEMA or state emergency response agencies could review
these request, and respond with government resources, or determine how
fast the private sector could respond to this request.
Mr. Chairman, again on behalf of Wal-Mart and the entire chain
pharmacy industry, we appreciate the opportunity today to provide the
Committee this testimony. Thank you.
Mr. Whitfield. Mr. Dufour, thank you.
The next witness is Ms. Barbara Blakeney, President of the
American Nurses Association. We welcome you and look forward to
your testimony.
TESTIMONY OF BARBARA BLAKENEY
Ms. Blakeney. Thank you, Mr. Chairman.
It's a pleasure to be here today to be able to address the
committee. Not only am I the president of the American Nurses
Association, but I have been a nurse practitioner for over 30
years with experience in public health, including 18 years
working as a director of Health Services for the Homeless for
the city of Boston. I have spent 18 years in shelters, Mr.
Chairman, and I consider myself an expert in what happens in
those shelters and what the needs are long term.
ANA has been very, very actively involved in the work. Our
State nurses associations have been very, very involved.
Through our communications network, we have been able to
trigger a response of over 20,000 nurses available and ready to
respond to this disaster and, unfortunately, the disaster
that's about to hit in Texas. We have board members currently
in Gulfport, Mississippi, directly providing care, and I'd like
to acknowledge today that Ms. Ricky Garrett, the executive
director of the Mississippi Nurses Association, is here today
and leaned over to me a half hour ago and said to me, it is an
unusual experience to sit here and listen to us all talking at
a systems level about the people that I know who have been
harmed and killed. And so I'd like to try to put a face on who
it is that we're talking about, Mr. Chairman.
In the Gulf Coast, prior to Katrina, one out of every three
children were dependent on Medicaid for their health coverage.
Prior to Katrina, 22 percent of the Louisiana residents and 19
percent of Mississippians lacked any health insurance, which is
compared to a 15.7 percent ratio percentage nationally. Prior
to Katrina, a family of three could not earn more than $174 per
month in order to qualify for Medicaid in Louisiana. This is
only 17 percent of the national poverty threshold, Mr.
Chairman. Prior to Katrina, almost 24 percent of all
Mississippians lived in poverty. It is very, very well known
that poverty and ill health go hand in hand. These are the
people who have been displaced, these are the people who
currently sit in shelters, on broken porches, environments that
are unhealthy and unsafe.
And as we think about what they need in the short term, we
must understand that long after this event goes below the fold
on the front page of our local newspapers and long after the
fact that this event goes to the back page of the newspapers
and long after we have moved on to other events in this
country, these people will still not be home. They will still
not be healthy. They will still be in need of major, major
support from an infrastructure that has been destroyed, an
infrastructure that will take months to years to recover,
hospital records lost, patients in the middle of chemotherapy
without treatment, patients needing dialysis. The city of New
Orleans has the highest rate of dialysis needed for people in
the entire country. That infrastructure is gone. That
infrastructure prior to the storm was not effective to manage
the basic day-to-day needs, and now we're asking that
infrastructure to manage the surge capacity that is not only
short term but will go on for years.
The American Nurses Association participates in a program
called the National Nurse Response Team, which was originally
designed and created in partnership with Health and Human
Services in 2002. The goal of that program was to create 2,000
nurses ready to go to be able to be Federalized in case of
bioterrorism. To the best of my understanding today, we have
700 nurses in that program. Many thousands of more are
interested, but because there is a bottleneck in the paperwork,
have not been able to sign on.
That team has not been activated. It cannot be activated
because this storm is outside of the scope of its mission.
Recommendation No. 1, Mr. Chairman, is that we readdress that
mission. Our ability to respond to a crisis is highly dependent
on the strength of the infrastructure to respond to the daily
needs of the people in this country. It is no secret that the
health care infrastructure is in disarray. People waiting 8,
10, 12, 24 hours in emergency rooms to receive care. If that
system cannot respond to those people, Mr. Chairman, that
system is no way able to respond to the overwhelming demands of
the crisis that we have in front of us.
We cannot afford to stop paying attention to the needs of
the infrastructure. One of the things about public health is
that public health is viewed as successful when things do not
happen, when an outbreak doesn't occur, when an illness doesn't
spread, when we have enough vaccine for flu. It's hard to
measure how successful you are when something doesn't happen.
It's the bane of all of us in public health.
The bottom line, Mr. Chairman, is that we cannot respond to
the daily needs of our citizens today, never mind a disaster. I
could tell you what we have done as nurses and the heroic
things of our nurses in Louisiana and in Gulfport, Mississippi
and Biloxi and all the little towns we seem not to be thinking
too hard about right now. But you already know those stories.
We need to address the issues of the infrastructure that
prevent us from being able to respond well. We can talk about
all the things that the doctor talked about this morning, but
if we cannot base those responses on an existing system that is
efficient, effective, and functional on a daily basis, no
matter how hard she tries, no matter how hard the rest of us
try, it will not work.
Our recommendations today are to expand the NNRT mission to
allow appropriate advanced practice nurses to serve as primary
case managers--it is amazing to me that that is not permitted
under Federal requirements--to create a mechanism for seamless
transfer of licensing authority during times of crisis. In some
States, we've managed to do it very well, and in other States,
we have a backlog of nurses, physicians and other licensed
clinicians who cannot be authorized to practice because of
cumbersome bottlenecks. We need to strengthen the health care
infrastructure and increase access to care.
The people I'm describing to you, sir, are among the
poorest in the country. Their health care was poor to begin
with. If we think that basic emergency responses are going to
get them on their feet, it's not the case, and we delude
ourselves if we think otherwise.
I know that this hearing is not supposed to be about
Medicaid, but I would be remiss, sir, if I did not say to all
of you that that is the safety net. How big do we want to
create the holes in our safety net? Big enough to drive a tank
through or small enough to catch these people? Mr. Chairman,
the challenge is to catch these people long after they drop
below the fold on the first page of our newspapers. Thank you,
sir.
[The prepared statement of Barbara Blakeney follows:]
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Mr. Whitfield. Thank you.
And thank you for the testimony that all of you have given.
We appreciate it very much, on a very serious issue. And at
this time, we will go to questions. I will begin the question
period. We'll each have the appropriate time, 5 minutes.
Dr. Peters, thank you for being with us today. When you
talked about the evacuation of your hospital, you mentioned
that you moved the neonatal care up to Baton Rouge. Did you
evacuate anyone else in the hospital in preparation for
Katrina?
Mr. Peters. We evacuated a few other patients due to some
special needs that they had, but the great majority we did keep
at our hospital.
Mr. Whitfield. And the ventilator patients were kept there
as well?
Mr. Peters. Correct. We had a discussion of the pros and
cons of transferring, moving those patients out. That was
actually a day after the storm, when we were having power
difficulties and looking at what were the risks associated with
further power outages. We made the determination that we felt
that we were best at that point, due to the myriad of
communication issues on the outside and also some of the
saturation of the spots where we would normally send patients,
to keep them there.
Mr. Whitfield. Were your hospital records destroyed or
damaged?
Mr. Peters. No, they were not.
Mr. Whitfield. So they're in tact.
Mr. Peters. They're all in tact.
Mr. Whitfield. How would you describe your dialog with
emergency officials and emergency responders during this
period. Did you have to obtain any approval to move patients,
or do you have the authority to do that on your own?
Mr. Peters. I think we used various approaches. Because of
all the circumstances and some of the challenges that we have
all talked about, I think the communication piece or the
difficulty with that caused us to look for multiple solutions,
multiple different carriers to transport those patients. All of
them were very responsive to us, but it was a matter of getting
them lined up with us.
One of the things that, into this, that we decided was that
we really were going to have to make some decisions and take
the ball and run with it. In choosing to transfer our patients,
we lined up the transport and got them out.
Mr. Whitfield. Now, did I understand you to say that, if
you do not receive financial assistance within 7 to 10 days,
that you will have to close the hospital?
Mr. Peters. I didn't say that. What I did was say that each
day us and the other two hospitals are losing significant
dollars. There's a point that we all reach in the near time
where we have to reassess services and how fully staffed we're
going to be. To give you an example, we have a 450-bed
hospital. Usually, we'll have about 400 patients in beds. Since
the storm--we started the storm at 300--we dropped to about
150. So we're running, if I do my math correctly, about a third
capacity.
We will be forced to quickly, as the other hospitals look
at overhead, look at all the things that go into make our
facility what it is and maybe have to make some hard choices.
The problem with this is that once we start doing that, those
health care workers that have other alternatives will leave the
area. When the anticipated and almost certain influx of needs
occur, then we're all going to find ourselves to be short-
staffed, to not have capacity. And what really, frankly, is at
risk is we'll then have the second evacuation of patients from
the greater New Orleans area.
Mr. Whitfield. Congress has passed two supplemental
appropriation bills in the amount of about $62 billion to FEMA
to assist. Have you all been in discussions with FEMA about
interim funding or assistance in funding?
Mr. Peters. We've spent this week discussing this issue
because it's so important to the three hospitals. We have
talked directly with FEMA, and first off, I would say it is
very complicated for us to understand, but our understanding is
that there are certain regulations where FEMA can spend its
money on the housing issue and for any damages done to our
facilities, building damages, of which we all have, but those
are not the issues at hand for us. We're talking about
operational funds.
Mr. Whitfield. You need payroll.
Mr. Peters. We need payroll. There have been some
suggestions of maybe there are ways to quickly alter some of
the regulations of what FEMA can be supportive of.
Mr. Whitfield. Is that what you were referring to in your
testimony this morning when you said we need some regulations
changed?
Mr. Peters. Those regulations that I was talking about have
to do with the support of the private practice of medicine.
Today, as a hospital, I can do very little for a practicing
physician because there is a suspicion that I'm going to induce
him to send patients to me. What we're asking in these unusual
times is a relaxation of things such as helping with their
staffing, helping with rent and with areas of need, especially
in primary care, direct financial assistance for a period of
time to allow recovery. Also selected specialties, which are
very important, because everyone has issues with recruiting.
New Orleans especially is not an easy place to recruit
people to. The cost to all of us to try to replace rather than
to retain what we have is markedly different. That goes for
hospitals also.
Mr. Whitfield. Thank you, Dr. Peters.
My time has expired. At this time, I'll recognize the
gentleman from Michigan, Mr. Stupak.
Mr. Stupak. Dr. Peters, you have heard us talk today about
the Baucus-Grassley bill, which would make Louisiana people
immediately eligible for Medicaid, and therefore, you'd have a
flow of dollars coming in. Would that be of help to you, or is
that too slow, too late? I understand what you mean about if
you don't get geared, you're going to lose your hospital and
doctors are going to be gone. You're never going to come back.
Mr. Peters. I separate it into both short-term and long-
term issues. I think there have been a lot of very positive
funding issues, whether it be Medicaid, whether looking at
Medicare for a while with something like a critical access
designation that gets hospitals, more temporarily, to a cost
base reimbursement.
All of those help us, but also, right now, today, even if
the 150 patients that we have in the hospital were Medicaid, we
still don't have the revenue coming in that support the
operation, and that is true of our hospital and the other two.
We're in this trough, and it's hard to judge when the trough
ends because of the influx of patients coming back. We
anticipate by wintertime part of that trough is going to be
gone. So we're looking at a window of support to get us through
that time.
Mr. Stupak. Any suggestions you'd have? You mentioned a
couple of them, some of the waivers. We'd like to see it. I've
been on health care for, what, 12 years now. Some of us are
very interested in that area.
With Hurricane Katrina, we saw--I want to ask about the
first responder communication, because I've been on this issue
for years, ever since September 11. Being a police officer,
I've seen it for decades. After every major event like this
occurs, the President and everyone says, we're going to get all
this communication stuff for first responders. That will last
for about 1 year, never address it, even though we've had
legislation for years and can never seem to get a hearing on
it. Maybe one of these days we will.
But the frustration in the faces of medical professionals
who did not have communications, couldn't save lives, they
certainly deserve our gratitude, but you also deserve our help
and a better communication system. And I was listening to your
testimony, and in there, you say that an alternative reliable
communications service must be in place so that public
officials, first responders and the health care community can
firstly communicate their need situations and availability to
assist.
Can you please expand on this based upon your most recent
experience? And do you have some specific recommendations about
equipment and planning? Just explain the need for
communications for us and then why it's so critical when you
lose it.
Mr. Peters. It's critical because, as we all dealt with
this storm and any other disaster, any time you become
isolated, you don't have all the facts to make your decisions.
All of the planning for disasters involve a team approach. It's
not just East Jefferson, not Charity Hospital; it's everybody
being involved. And there is a plan in place. Along with that,
there are always curve balls that happen, things that you do
not anticipate. The security issue, which became a huge issue
in this subject, the lack of communication, lack of awareness
of what was going on, and just the unknown fear created
apprehension within our hospital.
I think the most difficult day we had at East Jefferson was
the Thursday after the storm when there was a lot of stories
about what was going on, that our hospital was at risk for
violence, and our staff and both physicians and nurses were
very appropriately scared. I think that was the most difficult
to hold it together. If we would have had more information,
been able to communicate more effectively, I think it would
have made that markedly diminished.
I'm not a communications expert. I don't have the
solutions, but it also is very amazing how we all have become
dependent on cell phones, and the cell phones were gone. I've
heard people talk about ways to put up temporary towers. Again,
this is way beyond my expertise, but the lack of that creates
some significant holes; it really does. It allows for, I think,
the lack of coordination of effort.
Mr. Stupak. Had there been any effort to put an alternative
communications system in New Orleans prior to Katrina?
Mr. Peters. Not that I'm aware of.
Mr. Stupak. Mr. Cappiello, hopefully, I said that right.
I'd like to ask you about your accreditation standards for
emergency communications. You said in your statement that the
organization went through a 5-year process to update the
emergency preparedness standards in 2003. I'd like to know if
the emergency telecommunications infrastructure is a criteria
for hospital and other health facility infrastructure
accreditation today.
Mr. Cappiello. Thank you for that question. One of the
things that our standards does address, it says that
communication is a key component to planning and recovery from
disasters. The standard, because the standard must apply to
every hospital and every community in the United States, it is
not specific. So the standard does not say that the standard
must have--to meet the standard for communication, you must
have 800 megahertz radios, for instance. We don't go that far.
What we do say is, you need to look at your community, plan
with the community and develop communications networks within
the community that will stand up and be viable at the time of
disaster.
The reality is that some communities are simply not there.
They just don't have the capacity and the ability to do that.
Mr. Stupak. When you do your accreditation of hospitals, do
you score them on that?
Mr. Cappiello. What we ask is that--the standard looks for
an emergency management plan that is robust, that is exercised,
that is planned for, that engages not just that particular
facility but sister facilities; that there's planning within
the community and that there is contact between the hospitals
and their community as they develop their emergency management
plans.
One of the requirements of that plan is certainly the
ability to communicate. So we say that in your emergency
preparedness planning, there must be thought given to and
dialog with the community about how to communicate.
Mr. Whitfield. The gentleman's time has expired.
When you all were giving your testimony, I was pretty
lenient, and I allowed everyone to go 2 and even 3 minutes over
the 5 minutes. I'm going to try to get through a 5-minute
opening, 5-minute questions from every member because we're
going to be voting soon. And then those who are interested, I
hope you would have time that, if we want a second round, we
have an opportunity to do that.
At this time, I recognize the gentleman from Georgia, Mr.
Deal.
Mr. Deal. Thank you.
First of all, Mr. Dufour, I want to thank you for your
efforts, your cooperation efforts, the efforts of the chain
drug stories, of the private pharmacy community druggists and
so forth and the pharmaceutical industry for the cooperation
that you have outlined. I think it is truly one of the
nongovernmental participatory efforts that have been a true
success in this emergency. I just simply wanted to say thank
you for that.
Let me hit a couple of other topics right quickly. Mr.
Simmons, you indicated that currently the Federal Tort Claims
Act, as I understood your testimony, would not provide
protection under it for your providers if they provided
services off the site. That is my understanding.
Mr. Simmons. Off site and across State lines where it's not
my facility doing it, it is facility specific. The facility is
deemed and the provider is contracted with the facility.
Therefore, the coverage goes with the provider and the
facility. In an emergency, if a facility in Ohio wanted to send
a provider team, mobile van or just providers down to the Gulf
Coast of Mississippi, there were questions and roadblocks as to
whether or not they were covered under Federal Torts Claims.
Mr. Deal. A community health center employee from one State
could not go to a community health center in another State and
still have that Federal Tort Claims protection. That is what
I'm understanding, or it's questionable.
Mr. Simmons. It is questionable.
Mr. Deal. We need to straighten that out.
Mr. Simmons. The main issue is: Is it going to a shelter
or----
Mr. Deal. I got you. Off-site from a community facility
itself. I got you. Let me explore, because I think we've had
two other witnesses, Ms. Blakeney, you alluded to it, and I
think you called it the need for a seamless transfer of
licensure or words to that effect. Let me ask you and Dr. Hoven
in that regard, from your two professional points of view,
we've heard the doctor talk about the Federal certification
process. That seemed a little bit slow and cumbersome to me,
quite frankly, and we do need, if that's the route we're going,
we need to ramp that up in terms of the numbers of individuals
pre-licensure, pre-certification so that we don't have to do it
after the emergency and then cope with everything else that's
going on.
With regard to transfer and recognition of licensure,
normally licensure is something that is a State prerogative
through your State medical boards, et cetera. Are there
reciprocity agreements among certain States to allow that? And
if not, is that an area that your associations could explore,
even if it were not a carte blanche recognition, to allow,
through a reciprocity agreement, through the States, in a time
of crisis, that this could be done? Both of you or either of
you.
Ms. Blakeney. Thank you, Congressman. It is a State
authorization for licensure. What happens when a professional
whose license is Federalized, as long as they have a valid
license in one State, because they've been Federalized, they
can move freely to provide services as long as they're working
within that construct of Federalization. Where we get into
difficulty is with people who have not gone through that
process prior to the event occurring, so there's not a data
base that people have not already submitted their paperwork and
had all of that done.
With the National Nurse Response Team, the 700 nurses who
participated in that have completed that process and are
available to be activated by the Federal Government. Volunteers
going through the Red Cross, volunteers going through church
groups or through individual activities have to go through
their individual--move from their State, the affected State,
and be approved in that affected State. Even though we all take
the same licensing examination, the accreditation process
within that State varies enough so that the State board has to
individually look at each one of those candidates.
Mr. Deal. So that's still a problem then.
Ms. Blakeney. It is.
Mr. Deal. Dr. Hoven?
Mr. Hoven. Thank you. The AMA has particularly been
concerned about this and has been working with the States that
have been involved to do credential verification to expedite
that in order to enable these physicians to participate in
care. The AMA's master file, for example, has track of all the
physicians since 1906 and can do primary source credentialing
on all training, practice, et cetera, so it provides a very
useful tool to be used in this particular setting.
Mr. Deal. Thank you. My time is about out. Thank you. I
would encourage everyone to work in that regard.
Very quickly, Mr. Cappiello, I would wonder when you made
the statement in response to the earlier question about
communications that your standards have to be basically one
size fits all, everybody has to have the same standards. I
would simply ask, in your accreditation, it would seem to me
that we all ought to say that there needs to be specialized
criteria for those who are in harms' way or known harms' way,
previous hurricanes, previous flooding; it would seem to me not
only in the communications arena but also in the construction
of the facility itself. We've heard about, why is the operating
room not on the second floor rather than the first floor?
I know I don't have time for a response, but I would tell
you that I would be concerned that certification organizations
ought to be looking at differentiating and not just have a one-
size-fits-all.
Thank you, Mr. Chairman.
Mr. Whitfield. At this time, we recognize Mrs. Capps.
Mrs. Capps. Thank you, Mr. Chairman.
Ms. Blakeney, there are over 2 million registered nurses in
this country. You are the president of the American Nurses
Association, by far the largest organization of the nurses, and
I'm one of your proud members. So, today, in your testimony,
you're really speaking on behalf of a profession deeply engaged
in the delivery of health care services in this country. In
fact, when we think about federally funded health programs,
which Medicaid is one, and we think of who provides care for
all of the people enrolled in Federal programs, it's the nurses
across the land. And so you have credentials to speak on the
topics that we're addressing today.
And I know you also mentioned that you carry in your heart
the stories of the nurses who are serving as we speak in
difficult situations responding to this disaster, those that
are Federalized and those that are frustrated because they're
not, and the myriad of ways that nurses are engaged in
addressing this situation that we have and also the underlying
needs of those who do not have access to health care.
Now, I want to focus if I could on a bill that Senators
Baucus and Grassley have introduced, Senate Bill 1716, that
would provide immediate federally funded medical assistance
through Medicaid for Katrina survivors. States hosting Katrina
survivors could cover all low-income individuals, not just
those who would ordinarily be eligible for Medicaid, like
pregnant women or children. This bill would ensure that the
sick could quickly access, no matter where they are, health
care treatments and wouldn't be delayed due to lack of
insurance coverage. I know that several of the organizations
represented on this panel have supported that bill, and you
have indicated the American Nurses Association also supports it
and supports full Federal funding for it.
I wonder if you would expand on the reasons for that and if
you would also like to further--at the end of your testimony,
you mentioned your deep concern in your organization about
proposed cuts to Medicaid. And if you'd like to have that be
part of your answer as well.
Ms. Blakeney. Thank you, Congresswoman, for the question.
It is important that we be able to move quickly to provide
care regardless of where the victims of the hurricane end up,
both in the short term and in the long term. That needs to
occur as seamlessly as we can possibly make it happen, and
obviously, there has to be financing to support that. So
anything we can do to relieve States of the additional burden
that they carry because they have been hosts for these
individuals, needs to occur. So in the short term, it's an
important step to take. In the long term, I think we have to
acknowledge and recognize that the people who have been
displaced, the providers who have been displaced, the
infrastructure that has been destroyed is going to take a very,
very long time to reestablish. Some of it can happen very
quickly, and it will look as though, fine, we're okay, we can
move on. But the bottom line is, medical records are gone
forever. Rebuilding peoples' health care histories, rebuilding
their pharmacy histories, understanding what their needs are,
are going to take a very, very long time.
The bottom line is that it's going to take the region years
to recover from this both economically and from every other
component of societal thought and concern. So the long term
investment needs to be there. We cannot afford to expect an
infrastructure to respond effectively to a crisis and a surge
capacity if it can't respond to its day-to-day needs. The
bottom line is, as a provider of health care, as an individual
who represents nurses who are so frustrated, they're leaving,
that they're crying at the end of their shifts because they
can't provide the kind of care that they need, to say to them,
okay, now on a faulty infrastructure that's barely standing, we
want you to surge to a new capacity, and yet they manage to do
it for the short term. We've heard the stories. We know that.
So the question is, how long can we ask a system that's
crippled to be able to surge? We can't. It's not realistic.
It's not possible. And to then turn around and blame the system
for not being able to respond when the system has been terribly
under-supported is just not fair.
Mrs. Capps. So we need to do, and I heard this in your
presentation, we need to do several things at the same time.
That's not easy to do.
Do you want to, just a few seconds left, go No. 1, No. 2,
No. 3 in prioritizing, the triaging, if you will?
Ms. Blakeney. We have to fund the surge capacity that's
needed right now. We need to make sure the people who have
dispersed all over the south and other parts of the country
seamlessly can access care, No. 1. No. 2, we need to look to
rebuild a structure that has been harmed and the locations that
it's been harmed in. And No. 3, we need to take a very, very
hard look at the harm that's been done to the health care
system over these last couple of decades, and we need to fix
it. We need to re-prioritize where health care goes. We need to
focus on primary prevention and secondary prevention. We need
take a look at preventing the things causing harm.
In this country today, almost 50 percent of the health care
burden is carried by chronic diseases, chronic diseases that
are preventable or delayable. If we could delay the onset of
diabetes for 5 years, billions of dollars would be saved. Those
are the kinds of things we need to think about simultaneously.
And you're right, it will not be easy. But if we don't do it
now, it will be later. We have children with hypertension--
children with hypertension. We have children developing type 2
diabetes. The cost of that alone is huge. We've got to turn our
focus as much on prevention as we do on acute care because it
will be expensive. It'll be a whole lot more expensive later
on. We're going to have people dying young, not old.
Mr. Whitfield. The gentleman from Illinois.
Mr. Shimkus. Thank you very much, Mr. Chairman.
This has been a great panel, and I want to appreciate all
your testimony. There's really so much there that you just
can't get a handle on. It's a big disaster in so many different
arenas. I'll try to run through a couple of things.
First of all, one of the most frustrating things about
health care is the payment scheme or the lack thereof and the
cost shifting, and I think that's talking to part of the
preliminary problem. I wouldn't totally just disregard reform
because, in the debate, Ms. Blakeney, as you just mentioned,
that if we reform our entitlement health care programs that are
designed primarily to do the amputations from diabetes instead
of initial diabetes screening and care--that's our current
system right now. So reform would be, let's do preventive care.
In the Medicare reform bill, the Welcome to Medicare
screening, which was never done before, is an attempt to start
caring for people and managing their health instead of just
doing the catastrophic emergency operations. People still flock
to the United States because it has the best health care system
in the world. We have a funding issue, and it's really tied to
this, though, because if we talk about--with my military
background, the military has been trying to go digital with dog
tags. Now this would address records, the medical records for
our soldiers. Because this is the same issue, what happens on
the battlefield, what if there's a catastrophe, the guy can't
talk, you can't get his papers out in the mountains of
Afghanistan? So you put him on a digital dog tag. And with a
catastrophe this size, that's kind of what we're talking about,
or having a stockpile of digital records somewhere or dispersed
in different areas so when the individuals comes in, if they
can speak and give you some identification, maybe it's
biometric. I mean, we will have constitutional debates over who
keeps digital records, how they're stored, who can access, but
that's kind of one of the major hurdles that we're facing. When
people are displaced to the Superdome, and they say, I need a
drug, I'm taking a drug, I don't know what it is though, it's a
little green pill, I've been taking it for 3 years, I don't
really remember the name anymore.
So I don't know how to solve that. But these are the
debates that we have to have and start thinking outside the
box. I live in Illinois, along the Mississippi River, the New
Madrid fault has been a concern forever until it breaks again,
and then we're going to have a catastrophe like this.
I've been talking to my community about this sister city
relationship that they ought to develop more extensive, not,
hi, I'm your mayor, you're the mayor, let's shake hands and
here's the key to the city, but also go across State lines to
do mutual supporting operations.
And I'm wondering if the hospital association is now
looking at sister hospital relationships out of region, like
Louisiana hospital marrying up with a hospital in Virginia or
one in Illinois, or maybe for Illinois, we would have to look
at, if my communities wanted a sister city relationship that
would do mutual support, maybe firefighters, policing and stuff
if the New Madrid fault broke, they'd have to go to Indiana,
they may do one with a city in Missouri, but if the bridges are
all down, it doesn't help.
So I think we have to also think in that vein. I also
wanted to mention, on the communications issue, because the
telecom subcommittee has been working on this, what the first
responders need is, we need the 7 megahertz band. That's what
our digital transition bill is all about. This will just add
fuel to the fire to make sure that that's moved so that it's
not--they need more space to be able to communicate across the
lines.
We have--I'm going to finish on this. I think that this
country, because of the health funding issue--I'm not a one-
payer guy, I don't believe in national health care delivered by
the Federal Government, because we know how well the government
provides services. I'm not sold on it. But I do think it's time
for us to debate--like other industrialized nations making sure
that everyone has access to some type of health insurance
policy. I think that addresses a lot of the crises of
portability of records. It may be a critical care model, but
even the industrialized nations that have national health care,
many of their models are insurance projects. They'll give their
citizens three or four choices of different insurance products
that would be portable based upon the event if there were truly
a national policy. So we're working on it.
Thank you. Although I didn't ask any questions, you spurred
a lot of, obviously, thoughts in my mind, and I appreciate it.
I yield back, Mr. Chairman.
Mr. Whitfield. Thank you.
At this time, the gentleman from Illinois, Mr. Rush, is
recognized for 5 minutes.
Mr. Rush. Thank you, Mr. Chairman.
Mr. Chairman, I really want to congratulate the chairman of
the committee for--and I want to thank him for bringing Dr.
Simmons in as a part of this hearing because I know that, in my
district and other similar districts throughout the nation,
community health clinics are really indeed on the front line,
in the trenches along with hospitals, but I think that there is
a place, a vital role that community health clinics play in the
delivery of health care. And if there is one thing that we all
can agree on as a result of what happened in Louisiana with
Hurricane Katrina, that is that there is a segment of our
society that is invisible, that just is very much in need but
because they don't have a particular voice as a group. They are
not heard by many of policymakers, including Members of
Congress, and so their needs are mostly unmet.
First of all, I have a couple of questions, and before I
return to this theme, I want to ask I think Dr. Kirsch, if I'm
not mistaken, Dr. Kirsch, I want to ask, at a meeting, a
breakfast meeting that the Congressional Black Caucus had with
the president of the American Red Cross, specifically in the
aftermath of Katrina and days immediately following, the
question was put to her, why did the Red Cross hesitate to go
into New Orleans? They were out on the outskirts for a couple
of days, 2 or 3 days, but they didn't go in. And she said that
they didn't go in because of the Governor's refusal to allow
them to go in.
I just wanted to concur, is that a statement that you would
make for the record?
Mr. Kirsch. She knows better than I do, but I can tell you
that the primary mission of us is to create shelters in safe
environments. That was my mission, to make sure the
environments were safe. And if there is any question of
environmental or any other type of safety, the Red Cross will
not establish shelters in those areas. We usually defer to the
State or local officials to make that determination, in fact,
now working with the State public health department in
Louisiana to look for sites to go back into just prior to the
evacuation.
Mr. Rush. So was the appearance of the unsafeness of the
area, was that instability caused by the flood or was that the
threat of so-called--so-called threat of violence? Which one?
Mr. Kirsch. There are many factors that go into safety from
my point of view. Being a public health official, my concerns
were always based on the multiple warnings coming out from
State officials about contamination and don't get people in
there and let's get everyone out. So the directive was to move
as many people out. And I believe, I'm not privy to the
ultimate decisions made by the Red Cross leadership, but I
believe that was the primary reason.
Mr. Rush. Mr. Chairman, I believe, and witnesses, I believe
that our public health system in this country was stretched
almost too thin anyway prior to Katrina as it relates to poor
people. And I just would like to ask, Mr. Simmons, in these few
seconds that I have left, can you express your opinion about
the health care delivery system as it relates to poor people
now and how that played into New Orleans and the catastrophe at
New Orleans?
Mr. Simmons. If I may speak personally as a health care
provider and not necessarily speaking for the national
association as its chair, I know it is our job to try to assure
that patients don't fall through the cracks, so they depend on
community health centers to maneuver the waters and all the
bureaucratic red tape to assure they get care. One of the
reasons we indicated our concern that health centers be
involved as part of first responders is because the population
is used to going to that location, asking those people to help
them, assist them with whatever. I am also convinced that a
large majority of the population that was in the Superdome and
the Convention Center were patients of the community health
care system in the city of New Orleans. It is stretched, and it
is frayed, and there has been tons of money--well, not tons,
lots of money placed into the community health center
appropriation line, and we need that, but we have to look at
what is happening to the existing infrastructure and demands
placed on health centers.
Mr. Whitfield. The gentleman's time has expired.
Recognize the gentleman from Texas, Dr. Burgess, for 5
minutes.
Mr. Burgess. Dr. Simmons, let's continue along the line
that Mr. Rush was just asking about. If the health care
delivery system for disadvantaged individuals, presumably your
community health care center is the model for the sort of the
provider of last resort, how many people across the country are
cared for in community health centers as their only source of
care?
Mr. Simmons. I can't tell you the exact number of how many
as their only source of care. I can tell you, as of the UDS
reports as of 2004, about 15 million people were served across
the country.
Mr. Burgess. Fifty or fifteen?
Mr. Simmons. Fifteen million.
Mr. Burgess. I know when Secretary Levitt was down in
Dallas visiting one of the shelters, he maintained that one of
his visions was to--I don't think he used the word, the adverb,
maybe I wish he had, but to expand the community health centers
in areas that previously may not have had them in order to
provide ongoing care because we have a number of individuals,
the Mayor of Fort Worth calls them guests, but I believe
they're going to be residents of our city, that previously
received their care at a community health care center and may
well need to--we have parts of the city that historically are
poor but don't have a community health center available to
them. We do have the Tarrent County Hospital District not too
far away, but one of the things that's impressed upon me in my
few years in this job is: Access is one thing; utilization is
another. And the community health center has an advantage in
that it is in the neighborhood and visible, and hence,
utilization tends to go up.
Do you have any thoughts on that? Do you think that was a
genuine expression that Secretary Levitt made that we're
perhaps going to see the expansion of community health care
centers as a consequence of Project Katrina?
Mr. Simmons. I'm not going to try to speak for the
Secretary, but I will tell you, the National Association of
Community Health Centers supports the President's expansion for
community health senior centers across the country. One of the
reasons is because we're sure, to the best extent of our
ability, that no one falls through the cracks.
Mr. Burgess. This is one member who will work with you to
see that the President is true to his word, and the Secretary
as well.
Our representative from the Joint Commission of Hospitals,
Mr. Cappiello, you heard, if you were here during the early
part of the day, the anxiety and angst in my voice about
hospital generators being located in the basement. We learned
that lesson with Tropical Storm Allison in Houston and those
very dramatic stories of residents carrying patients on a
ventilator down a staircase to get to an ambulance. I know it's
not the Joint Commission's job to site those generators when
the hospital is built, but surely it's your job when you come
in and inspect the hospital and certify it as functional and
safe, that its emergency equipment, i.e. A generator, is it
going to be one of the first casualties of a hard rain? Would I
be wrong?
Mr. Cappiello. You would be correct. I think the issue of
generators is a complex one. And here is a place that perhaps
the Federal Government can help. Even if you remove generators
out of the basement of many of our facilities, a lot of the
switching gear for that power and the power panel still resides
in the basement or in susceptible floors. Now my background is
not that of an engineer, but I understand that even if you move
the generator but the sources of going from the generator into
the hospital still flow through those bottom floors, you still
have the same problem. So the generator is dry, but it shorts
out for other reasons.
Mr. Burgess. I'm a simple country doctor, but surely
someone is smart enough to pick that out, particularly in
hospitals that live in coastal areas where flooding is a way of
life. It's happened in Houston before. I pray that it doesn't
happen Saturday morning, that we hear the same stories all over
again in the hospitals in Houston. Again, I pledge to work with
you. I'm not trying to be antagonistic about this, but we can't
keep learning this same lesson over and over again.
Mr. Cappiello. I could not agree more. I guess I started
out just giving that as a little explanation that the problem
is not just generators alone, but it's a bigger problem. So you
have to look at this problem in its whole, not just in its
exponent part. The problem is, if you go back and you look at
many of these facilities that may be as old as old Hill-Burton
facilities and the generators were built down there in those
basements, the replacement, the capital expenditure to move
generators and replace generators is quite enormous. And many
of the hospitals in the United States are sort of on the
financial edge. And to layer on a requirement to do a fairly
significant, for some of these facilities, project at great
expense, I think that if you're going to ask that--and I think
it's the right thing to do--I think there needs to be some
support to do that.
Mr. Burgess. I wouldn't completely rule that out, but you
hold a lot of power in your hands. I know from my days that I
spent in the hospitals that if you give someone, I forget
whether it's a 1 or 5 or whatever, I mean, they respond. And
I've seen private for-profit hospitals pay a great deal of
money to overcome those deficiencies.
Mr. Whitfield. The gentleman's time has expired.
The gentleman from Pennsylvania is recognize for 5 minutes.
Mr. Pitts. Mr. Chairman, I yield my time to Dr. Burgess.
Mr. Burgess. I thank the gentleman.
Dr. Peters, I apologize, I wasn't here when you gave your
testimony. Dr. McLennan, I was chairing a meeting he was
speaking at along the lines of preventive care. He was telling
a good story from the perspective of one person at the table.
Dr. Peters, I know you had a week that you would hope to
soon not ever replicate. Can you tell us a little bit about
what happened to you and your group at the East Jefferson
Hospital during Katrina?
Mr. Peters. Sure. We geared up for the storm per our plan,
brought staff in, both medical staff and our hospital staff.
Issues that we dealt with were the communication issues, a
sense of isolation of not being able to effectively communicate
with the outside world. We dealt with power issues. Our
generators fortunately are 12 feet up, and we were able to keep
going, although even with that, we had to conserve energy; no
air conditioning, which put some demands on patients, and we
had to be very careful with that.
Security was probably the third component that caused a lot
of issues. As I mentioned before, I think that that was
probably the biggest difficulty that we had, the perception
that we were at risk. Fortunately, we never really had violence
on our campus or close to us, but our employees heard about
that, our medical staff heard about that, and fortunately for
us, the National Guard, the local police responded when we were
able to get in contact with them and provided good security.
So those were the three variables that I think placed a lot
of demands on all the people providing the care. Fortunately
for us, I'm able to say we did not lose a patient; a patient
did not die that we would attribute to the storm, and I think
that that's a lot of good work that people did.
Mr. Burgess. I would agree very much with that statement.
Did you ever feel that it was hard for help to get in to you?
Clearly, you have got a generator that's not going to go out,
but it's only designed to get you through a period of power
outage, not meant to be your main source of power from then on.
So the evacuation, were there impediments to the evacuation
that were encountered afterwards?
Mr. Peters. As far as the generator goes, we did have
concerns. And there were a few days there that just getting the
diesel fuel to continue the generators got to be a little bit
dicey. We had to search in multiple different directions. Some
of our Jefferson Parish officials helped us with that. I think
that it makes you look at things differently, and constantly it
caused us to reassess, and like a lot of things in life, you
weigh the risks of whether something is going to happen or not
going to happen.
And just the balance of that with trying to decide whether
to transfer patients or not 2 or 3 days into it, you know, what
are the odds of that generator going down and what is going to
happen to those patients that are there? And I personally think
there are no right or wrong answers, it's a matter of judgment
and leadership and making the calls and moving on Mr. Burgess.
Well, I just have to tell you from my perspective, probably
some 400 miles west, I got a call in the middle of a night from
a mayor who said, you're a Congressman but you're also a
doctor, and I've got have a friend of a friend of a friend who
is having trouble getting a patient out of the hospital. And I
said, come on, it's midnight, there's nothing I can do. The
next morning I thought, well, maybe I should at least call this
friend of a friend of a friend, and I did.
And as the story unfolded, what he reported to me was
actually accurate, that there was a hospital, a specialty
hospital that maintained patients on a ventilator, and they
couldn't the get their patients out; the ambulances had been
stopped at the gate--I don't know where the gate was. And
indeed when I talked to this person I said, well, where are the
patients now if they're not in the hospital; and she said
they're at the corner of I-10 and the causeway. And I said what
building is that? And she said, well, it's just the corner of
I-10 and the causeway. And I said, ma'am, you mean to tell me
you've got patients on the medium? And she said, no, they're on
the side of the road. Well, it turns out that was actually
true, and through some phone calls we did get the ambulances in
later that day.
And of course I had gotten my call at midnight, so we were
easily 12 or 14 hours into that ordeal for those poor people.
And then I saw the news that that they was exactly right, there
were people on the side of the road on gurneys being hand
ventilated. I've got to tell you, that just left me with a
terrible feeling that--how poorly we were prepared, State,
Federal, local. I guess this was a private hospital, so
certainly they weren't prepared, though they did have the
facilities to evacuate the patients, they had new facilities
for them to go to, obviously it became much harder as you got 2
or 3 days into the time post hurricane than if they had
transported them the Friday night before. These are just things
that we've got to work on for the future.
Thank you, Mr. Chairman, for your indulgence.
Mr. Whitfield. Thank you, Dr. Burgess. And there's no one
else to yield time to you, so----
All of us have completed one round of questions. You all
have been very patient and your testimony is vitally important.
And we're going to have a series of about 7 votes probably
within about 10 minutes or so, so if you would remain with us,
we would like to just give everybody an opportunity to ask
another couple of questions, if that's okay with you all. And I
will go first.
First of all, Dr. Hoven, you had mentioned in your
testimony I think that the physicians and other healthcare
professionals must be better trained in how to respond to
disasters. Would you mind elaborating on that a little bit?
Ms. Hoven. I would be very glad to.
Physicians are trained in the daily care of their
profession in delivering healthcare, but disaster preparedness
and public health preparedness are special issues; some of us
are trained more than others in that area. In that light, the
AMA has actually undertaken an education and n training program
which has been extremely well recognized and accepted, now
training up to about 14,000 physicians in public health
preparedness and disaster response. There are special issues.
And we learned anecdotally after Katrina that, in fact, those
physicians who had been trained this way, when they went in to
do the work that needed to be done, actually were much more
efficient. So this is something that we would encourage and
continue dialog with our colleagues throughout the country on.
Mr. Whitfield. Thank you.
Dr. Peters, you had talked about you're losing $500,000 a
day, your hospital, and certainly fixed costs are so much, and
are you losing this money because of the lack of patient load
right now? Or----
Mr. Peters. Yes, it's a patient load, both on an in-patient
standpoint and out-patient. If you think about all the things
that people access hospitals for.
We're very optimistic that that's going to return, and
that's why we feel it is worthwhile in asking for those short-
term assistance so we can maintain the capacity that we
currently have.
Mr. Whitfield. Okay. And three hospitals are still in
operation, or 4?
Mr. Peters. Four; one of which is on the north shore, which
received less damage.
Mr. Whitfield. And how many are closed, do you know?
Mr. Peters. Eight are closed.
Mr. Whitfield. Okay. And Dr. Simmons, on the community
health center, I know that there are some very stringent rules
about using community health center money for capital projects,
and I guess there's a prohibition on that. So how do you go
about rebuilding this community health center?
Mr. Simmons. We are requesting Congress to reconsider that
line or that regulation in terms of allowing 330 funds to be
used for capital such that an increase in funding for that
purpose, but right now we're doing the best we can. Hopefully
the health center had insurance and it will pay some portion.
We also have access to file a claim with FEMA, but that's
going to be after insurance does what it's going to do, if it
does anything. So the facility will be down unless there is
some direct grant fund or authority granted to health centers.
Mr. Whitfield. Thank you.
Dr. Kirsch, how would you briefly describe the medical
condition of the people at the centers that you are responsible
for?
Mr. Kirsch. I think from both my indirect observations in
dozens of shelters, as well as from interactions at the major
emergency hospitals and the D-MAT teams, the major issues are,
like everyone has mentioned, the chronic underserved population
and their health needs, and the lack of prescriptions, the lack
of access to medications, et cetera, was just an overwhelming
program earlier. One of the D-MAT team guys complained to me
that, you know, I came down here to do surgery in the field and
all I've been doing is writing prescriptions for people for
their blood pressure medication. But that's truly the need that
we identify in the field and that's what has to be addressed.
Mr. Whitfield. Thank you.
Mr. Stupak.
Mr. Stupak. Thank you.
Mr. Simmons, you mentioned, in earlier questions, that you
and Dr. Peters were talking about how to keep the hospital
going if you're down to one-third of your clientele, yet
Secretary Leavitt and the President are saying we should have
more community health centers being built, and that's going to
take about 6 months. So if we don't have a population base
that's strong enough to support the hospital, why put a layer
of community health services on top of it, presuming you don't
have enough people to support the community health centers then
either at this point in time. So aren't we really just
duplicating and further driving the health delivery system
further into bankruptcy in the New Orleans area? Sure, Dr.
Peterson.
Mr. Peters. I think one of the things that has happened--
which is very unfortunate, obviously, of this storm--but it is
an opportunity to really ask the questions, what does the
system and the region need to move forward. And I think a knee
jerk replace everything that was there before, at least the
questions should be asked. You know, we're talking about three
facilities that are currently in operation. We anticipate, with
the influx of people coming in, that on the in-patient hospital
side there will probably be capacity issues, not enough beds 6
months out. So the question has to be, well, should all
hospitals that were damaged have a lot of dollars put into them
to rebuild? And how is the general population best served?
Our Governor, when she was elected, had a healthcare task
force 2 years ago, had a lot of experts come in and really were
very, very supportive of everything that has been mentioned
there, preventative care, community clinics, to move away from
just sick care. A combination of that with using existing
facilities, looking at where the holes are graphically I think
is what needs to be done at this point without just repeating
the past.
Mr. Stupak. It reminds me a little bit like those debit
cards, we gave everyone $2,000 and everybody was just standing
in line changing. We needed more and more debit cards, not even
knowing if the people who were supposed to get them were
getting them. And I don't want to see that continue to happen,
especially in healthcare, it's an issue near and dear to my
heart. And community health centers I have in my district, I
support them, I will do everything I can to help the qualified
clinics, but I just don't think we start throwing more stuff
into New Orleans without really understanding what's going on.
So in the meantime, in the 6-month period then what do we
do? I asked about the Baucus bill and the Grassley-Baucus bill,
how do you get those services back, keep you afloat, but
provide service to the constituency that's there until we get
that built up, it's going to take at least another 6 months?
Mr. Peters. When I talked about the other facilities that
are currently not open, I think there's efforts for them to
gradually reopen, but probably not to the same scope that they
were before. So if we have several out-patient facilities and
an emergency room in Orleans Parish, that's a start, it's a
start providing those initial care for those patients.
The three hospitals have made a commitment that we're going
to step up for the hospitalization of those patients in Orleans
Parish. I think working with some of the existing physicians,
some of the academic centers, I think some unique things could
be put together to serve that ambulatory population.
Mr. Stupak. Mr. Simmons, do you care to comment at all on
this?
Mr. Simmons. Thank you, sir. Most of the population that
has been evacuated from New Orleans, that burden has become on
now other community health centers because it is a natural
thing for a person to look for the system of care that they've
been usually getting their care. One of the reasons we're
talking about now providers and the funds being available to
health centers for the increased burden.
It is also a need for health centers in the area to be able
to be--if the population is underserved, I'm not sure where the
underserved population is going now in the city of New Orleans,
with the health center service, in our opinion, totally
destroyed. And most of the care probably is at the Charity and
Tulane and some of the academic health centers in the area.
There is a need for mobile or some type of medical service that
will address the returning evacuees that are going back there
to take those jobs in the service industry and other places.
We do want to commend Secretary Leavitt, they have moved up
funding for the December 1 round of 330 health centers that was
going to receive funding, and in the affected States they can
begin to expand and do some things, but it doesn't address the
issue, Chairman Whitfield, in regards to capital and
facilitator issues.
Mr. Stupak. Thank you, Doctor.
Mr. Whitfield. The gentlelady from Tennessee, Ms.
Blackburn.
Mrs. Blackburn. Thank you, Mr. Chairman. And I want to
thank all of you for your patience today. And I want to thank
you for continuing to serve constituencies. We have gone
through Katrina and look at Rita. And I had had some questions
for Dr. Gerberding when we did panel No. 1, and I want to
continue in that vain.
We talked a little bit about CDC and the strategy that they
felt was necessary, going through exercises, that they had
learned a lot from the way the military approached this, and in
the same vain I--and Dr. Kirsch and Dr. Peters, I think I'm
going to address this to the two of you if I may. If I you were
to look at the three things that really hampered you from doing
your job after the storm hit, I would love to hear those. Now
I'm not talking about disaster-related, I'm talking about the
rules and regulations, the poor communication, the lack of
coordination, all of those things that we heard either through
many of your opening statements or through the questioning that
has taken place in this committee today.
And Dr. Kirsch, if you will go first.
Mr. Kirsch. I'm betting we're going to agree without
prearranging.
I think the No. 1 problem that everyone faced in this
disaster, from Red Cross to the hospitals to providers is the
communication was essentially gone. I was there 4 days after
the event and remained there for a week after that, and the
cell phones in the more distant areas were not available, and
the land lines were not available, and there were no radios and
no SAT phones. And so I think by far and away the No. 1 issue
is communications.
The second one that was an early problem, which I think was
relatively rapidly resolved, was logistics. I have to
compliment Wal-Mart because I was fascinated to go to these
small towns and find the Wal-Mart stores open, and Red Cross
volunteers going to Wal-Marts and getting baskets full of
supplies for their shelters and stuff. So logistics is another
tremendous issue that has to be addressed, and I think
coordinating with private industry is an excellent way to
address that.
The third issue is, I do believe, interagency coordination,
although it was pretty good at the EOC level and the two
States, I don't think it was perfect. And there was this
tremendous lack of coordination of actual health delivery. And
like I said, they had all these voluntary doctors wandering
around with limited direction, and I think they need to have a
better handle on that.
Mrs. Blackburn. Okay, thank you.
Dr. Peters, do you have anything to add to that?
Mr. Peters. Two things that I would say. I would put
security on my list because I think that, both for the
facilities and the people out in the field, it created issues.
Our ambulances didn't run at night for a while because of
concerns and fear. And I would guess and almost certain that
has had some impact on healthcare in our community. I think
coordination of efforts.
And I just did want to say that about 5 or 6 days into
this, HHS organized a daily working group of which--the three
hospitals, and then started with gradually pulled in CDC
multiple other people so now that group is very big and
continues to meet every morning at nine o'clock. And the first
4 or 5 days there were a lot of issues with lack of
coordination of efforts, well-meaning people that were crossing
paths. And I think that effort, although everything is not
perfect, has given us all a great benefit that at least the
people are talking to each other, we are understanding in, I
think, a more teamwork approach to things.
Mrs. Blackburn. Okay. Thank you.
Mr. Whitfield. The gentlelady's time is expired.
We recognize the gentlelady from California, Ms. Capps.
Mrs. Capps. Thank you again, Mr. Chairman.
During my first round, I used the bill in the Senate
introduced by Senator Grassley and Baucus and focused on one
witness to expound on support or not support for it, and now I
want to use this time, at least part of it, to get a quick
answer from some of the others of you whose organizations have
made some statements so that we can have that for the record.
Dr. Mark Peters, the American Hospital Association letter
that I have here States AHA's support for this legislation,
stating in the letter that AHA believes it is critical that any
healthcare coverage provided to survivors in Katrina must
follow them wherever their journey for temporary or permanent
housing and work may take them. Do you also support 100 percent
Federal funding for low-income hurricane evacuees through
Medicaid in the devastated States as this bill does?
Mr. Peters. Yes.
Mrs. Capps. All right. Thank you. I think, Dr. Kirsch, the
same, the American Red Cross is on board in support of the
Grassley-Baucus bill. The letter from your organization States
that, quote, as our Nation faces the challenging task of
ensuring that the victims of Hurricane Katrina receive care and
compassion and support needed to reconstruct their lives,
legislation such as this Senate bill helps to ensure that their
healthcare needs will be met. And this is something that you
also support?
Mr. Kirsch. If my president supports it, I certainly
support it.
Mrs. Capps. A true team player.
Also, Dr. Simmons, the national Association of Community
Health Centers supports Senate bill 1716, and I won't read the
quote from your letter, it's a similar kind of quote. Do you--
maybe I'll ask you a more targeted question, can you elaborate
on what 100 percent Federal funding would mean for getting
community healthcare centers back on their feet?
Mr. Simmons. We do support strongly the Grassley-Baucus
bill. One of the things that 100 percent Federal match would
do, it would eliminate thing States from shying away from
serving the Medicaid population because of a State matching
their own individual dollars.
And in consideration also waivers; we are concerned, as
community health centers, that if this bill does not provide
100 percent financing or reimbursement for Medicaid, that
waivers or other means that are used--there are two services
that health centers provide that will probably be eliminated,
one of them is EPSDT, and the other one is the deferred----
Mrs. Capps. Mm-hmm.
Mr. Simmons [continuing]. Payment, which will severely
strain or cripple the health center system.
Mrs. Capps. Mr. Chairman, I also want to get on record that
Dr. Hoven, the AMA endorses this legislation.
Ms. Hoven. Yes, it does. And if I might make a point here,
I think we recognize strongly that the safety net is a
Medicaid-driven safety net right now. And it is what you're
hearing today are stories about the safety net not working, and
so for that reason we speak very much in support of this.
Mrs. Capps. And finally, I know I'm over now, but this will
make it unanimous. Mr. Dufour--I'm sorry, I don't want to
interrupt you. You don't represent necessarily a service--well,
yes, you do, but you are also part of the private sector. And
you nodded, however, when somebody else said yes. Do you want
to commit on this issue, on the Senate bill?
Mr. Dufour. Well, I haven't read the bill. I will agree
with the fact that a lot of State budgets are stretched,
they're trying to find ways to save money; and by the Federal
Government stepping up and doing this it is going to help
provide needed relief for the States.
Mrs. Capps. Makes it unanimous. Thank you very much.
Mr. Whitfield. Thank you.
Dr. Burgess, you are recognized.
Mr. Burgess. Okay. Well, since we're talking about the
Grassley bill, now I am from Texas, and we took in a lot of
people who were displaced, and now we've got some problems of
our own coming our way. Last Friday, Secretary Leavitt created
a special temporary category for Medicaid eligibility for
hurricane evacuees, and these individuals do receive a full
Federal match. They are not going to be burdens upon the
State's match. But even more, it goes a little further, it
creates an uncompensated care pool for many of those services
that don't fit into traditional Medicaid or you would have to
ask for a waiver to get them to fit into Medicaid.
So this seems to me--this administrative fix seems to me to
be a much more logical approach rather than depending upon us
to write legislation, get it through the House and the Senate,
conference committee, over to the President to get signed--good
luck if you expect to see it before Christmas, it's probably
going to hit sometime around Valentine's Day. The reality is
we're already doing that, the Secretary is already doing that
for Texas. And if that needs to be expanded to other places, I
would encourage perhaps the Department of HHS to consider that.
But the whole purpose was not to recreate a Medicaid system
that may at its very core be dysfunctional, but to prevent the
very costly complications of disease, many of which are
absolutely preventable.
We saw the situation with the buses when they arrived in
Dallas, it was simply a question of getting somebody back on
their blood pressure meds who had been off for 4 days, someone
who was up against probably a hospitalization or disability
because of not treating their disease, folks, as they came off
the bus were, are you on medication, even if they didn't know
what it was, triaged over to a desk where they could be
interviewed, their prescriptions written.
As the gentleman pointed out, people went down there to do
surgery, but were writing prescriptions. But I've got to tell
you the doctors in Dallas, Paul Peppy and Ray Fowler, did a
tremendous job. Here it is Labor Day weekend, they send out a
blast fax to all the doctors of the Dallas County Medical
Society, 3,600 members, 800 showed up on a holiday weekend.
And we've got to figure that a quarter of them are on call
anyway at other hospitals and couldn't respond. So that is
tremendous response from the private sector. Stepped up, did
what was necessary. Out of 17,000 patients brought to Reunion
Arena, 200 were hospitaled at Parkland Hospital. 200 patients
out of a pool of people who had been in the Superdome, many of
them on chronic medications and hadn't taken them for 4 or 5
days, let alone all of the other horrors that they had to live
with while they were inside there.
So actually, there's a situation that worked well because
people were given the freedom and the flexibility to do the
right thing.
And I know I haven't asked a question, Mr. Chairman, but I
appreciate the extra time, I just wanted to make that point.
You know, we'll do legislative fixes if we need to. Dr. Peters,
if we need to roll back the star clause, I'm with you, I'll
help you, but Grassley-Baucus, it's months away before you get
that help. Secretary Leavitt has provided that help this week.
Thank you.
Mr. Whitfield. Thank you, Dr. Burgess.
Mr. Rush, do you have any questions?
Mr. Rush. Thank you, Mr. Chairman.
Ms. Blakeney, according to the Joint Commission, the
affected areas in Louisiana will suffer from a shortage of
doctors and nurses because they have left or are leaving for
other communities. This is a segue into what I consider one of
the most serious problems our public health system is
confronted with across the Nation. And I think that what
happened with the Katrina really kind of focuses the attention
on the shortage of doctors and nurses in the underserved
communities.
Could you expand upon the thought that maybe this is an
opportunity for us to have some incentive programs to get
doctors and nurses trained and serving in inner city areas?
Mrs. Blackburn. Thank you for your question, Congressman.
The fact of the matter is that if we do nothing to address
the nursing shortage, we will have a shortage of about 30
percent shortage of nurses in this country by the year 2020.
Funding for nursing education, funding to support nursing
education, while Congress has been very kind to us and has
gradually increased that line item in Title VIII for the last
few years, as much as we are appreciative of that, you need to
understand that it only touches the tip of the iceberg. The
bottom line is to get nurses and physicians into those areas,
we must first have them in the first place.
Loan forgiveness programs, the ability to support, both
financially and with access to continuing education in
universities in those areas, would be a great incentive to
bring nurses and other clinicians back into that area. The
bottom line is that it's--many of our nurses who have relocated
to other areas can easily find jobs in those areas. There are
shortages of nurses in Texas, Arkansas, Tennessee, all of the
surrounding States. So those nurses can easily, once they have
the identification and their licenses, can find those jobs.
Bringing them back is going to require specific attention.
Mr. Rush. Thank you very much.
Mr. Dufour, the remaining seconds of my time. I was reading
a story in the Wall Street Journal a couple weeks ago, and it
was fascinating, about Wal-Mart and how Wal-Mart was able to
communicate, organize and mobilize with the divisions of the
military really. Can you expound upon that briefly, what you
all were able to do and why were you able to do it.
Mr. Dufour. Wal-Mart has an emergency operations center
where someone is dedicated to that, just like as of now, folks
who are in the emergency operation center are preparing for
Hurricane Rita. We use our data to determine what products
customers need and want in these disasters and start staging
those products. Once the disaster hits, we have a lot of folks
manning the phone and just a lot of coordination within the
company of what the needs are. Regional vice-presidents and
other folks go out to the field, assess the situation of the
stores and what the needs are and communicate that back to our
corporate office.
Mr. Rush. Well, I want to just congratulate you all.
Mr. Whitfield. Well, I want to thank all of you for your
patience; I know many of you have been here since nine o'clock
this morning. Your testimony was invaluable as we look at ways
to be more responsive to this disaster. I want to thank you for
your dedication and commitment. And for those of you who've
made specific recommendations, I want to assure you that we are
going to examine that, explore that, and we my have some
jurisdictional issues that will have to be addressed, but
without your assistance we would be not as far along as we are
now. So thank you very much, and this hearing is adjourned.
[Whereupon, at 3:26 p.m., the subcommittee was adjourned.]
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