<DOC>
[108th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:92128.wais]
SERVING THE UNDERSERVED IN THE 21ST CENTURY: THE NEED FOR A STRONGER,
MORE RESPONSIVE PUBLIC HEALTH SERVICE COMMISSIONED CORPS
=======================================================================
HEARING
before the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
FIRST SESSION
__________
OCOTBER 30, 2003
__________
Serial No. 108-108
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpo.gov/congress/house
http://www.house.gov/reform
______
92-128 U.S. GOVERNMENT PRINTING OFFICE
WASHINGTON : 2003
____________________________________________________________________________
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COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
DAN BURTON, Indiana HENRY A. WAXMAN, California
CHRISTOPHER SHAYS, Connecticut TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
MARK E. SOUDER, Indiana CAROLYN B. MALONEY, New York
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
DOUG OSE, California DENNIS J. KUCINICH, Ohio
RON LEWIS, Kentucky DANNY K. DAVIS, Illinois
JO ANN DAVIS, Virginia JOHN F. TIERNEY, Massachusetts
TODD RUSSELL PLATTS, Pennsylvania WM. LACY CLAY, Missouri
CHRIS CANNON, Utah DIANE E. WATSON, California
ADAM H. PUTNAM, Florida STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia CHRIS VAN HOLLEN, Maryland
JOHN J. DUNCAN, Jr., Tennessee LINDA T. SANCHEZ, California
JOHN SULLIVAN, Oklahoma C.A. ``DUTCH'' RUPPERSBERGER,
NATHAN DEAL, Georgia Maryland
CANDICE S. MILLER, Michigan ELEANOR HOLMES NORTON, District of
TIM MURPHY, Pennsylvania Columbia
MICHAEL R. TURNER, Ohio JIM COOPER, Tennessee
JOHN R. CARTER, Texas CHRIS BELL, Texas
WILLIAM J. JANKLOW, South Dakota ------
MARSHA BLACKBURN, Tennessee BERNARD SANDERS, Vermont
(Independent)
Peter Sirh, Staff Director
Melissa Wojciak, Deputy Staff Director
Rob Borden, Parliamentarian
Teresa Austin, Chief Clerk
Philip M. Schiliro, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on October 30, 2003................................. 1
Statement of:
Carmona, Vice Admiral Richard H., U.S. Surgeon General....... 22
Koop, Dr. C. Everett, former U.S. Surgeon General; Dr. Julius
B. Richmond, former Assistant Secretary for Health and
former U.S. Surgeon General; and Captain Gerard M. Farrell,
Executive Director, Commissioned Officers Association of
the U.S. Public Health Service............................. 49
Letters, statements, etc., submitted for the record by:
Carmona, Vice Admiral Richard H., U.S. Surgeon General,
prepared statement of...................................... 26
Davis, Chairman Tom, a Representative in Congress from the
State of Virginia, prepared statement of................... 4
Farrell, Captain Gerard M., Executive Director, Commissioned
Officers Association of the U.S. Public Health Service,
prepared statement of...................................... 70
Koop, Dr. C. Everett, former U.S. Surgeon General, prepared
statement of............................................... 52
Maloney, Hon. Carolyn B., a Representative in Congress from
the State of New York, prepared statement of............... 106
Richmond, Dr. Julius B., former Assistant Secretary for
Health and former U.S. Surgeon General, prepared statement
of......................................................... 65
Waxman, Hon. Henry A., a Representative in Congress from the
State of California:
Letter dated August 11, 2003............................. 7
Prepared statement of.................................... 17
Prepared statement of Charles LeBaron.................... 14
SERVING THE UNDERSERVED IN THE 21ST CENTURY: THE NEED FOR A STRONGER,
MORE RESPONSIVE PUBLIC HEALTH SERVICE COMMISSIONED CORPS
----------
THURSDAY, OCTOBER 30, 2003
House of Representatives,
Committee on Government Reform,
Washington, DC.
The committee met, pursuant to notice, at 10:15 a.m., in
room 2154, Rayburn House office Building, Hon. Tom Davis of
Virginia (chairman of the committee) presiding.
Present: Representatives Mr. Davis of Virginia, Shays, Ose,
Lewis, Mrs. Davis of Virginia, Duncan, Janklow, Waxman,
Maloney, Kucinich, Tierney, Clay, Watson, Van Hollen,
Ruppersberger, and Norton.
Staff present: David Marin, director of communications;
Susie Schulte, professional staff member; Teresa Austin, chief
clerk; Brien Beattie, deputy clerk; Corinne Zaccagnini, chief
information officer; Leneal Scott, computer systems manager;
Phil Schiliro, minority staff director; Phil Barnett, minority
chief counsel; Karen Lightfoot, minority communications
director and senior policy advisor; Sarah Despres, minority
counsel; Josh Sharfstein, minority professional staff member;
Earley Green, minority chief clerk; Jean Gosa, minority
assistant clerk; and Cecelia Morton, minority office manager.
Chairman Tom Davis. The hearing will come to order. I want
to welcome everybody to today's oversight hearing on the
Department of Health and Human Services' proposed
transformation of the U.S. Public Health Service Commissioned
Corps. In light of new and emerging threats to our Nation's
public health, this hearing will focus on proposed improvements
to make the Commissioned Corps a more readily deployable force
to respond quickly and effectively to emergency health needs
around the country.
We are slated to have a journal vote at 10:30, so we'll
move through opening statements, get the statements here and
get in as much questioning as we can and then take it from
there. Sometimes they end up not having the votes, but I just
want to explain, if we have that, we'll recess, go over and
vote and then come back.
The Commissioned Corps is one of the seven uniformed
services of the United States. It is comprised of highly
trained and mobile health professionals who carry out programs
to promote good health and understand and prevent diseases and
injury, assure safe and effective drugs and medical devices,
deliver health services to Federal beneficiaries and supply
health expertise in time of war or other national or
international emergencies. Corps officers have been providing
health care to American citizens for over 200 years and are
constantly adapting to changing demands and new challenges in
the public health field.
However, currently the Commissioned Corps is underutilized
and underdeveloped. As a result of this, HHS intends to
strengthen the public health infrastructure by transforming the
Corps to meet the challenges of the 21st century. The rationale
behind the proposed transformation is deeply rooted in new
emerging threats facing the country. If the United States
continues to face uncertain threats, including possible
terrorist attacks and infectious diseases, it's critical that
the Secretary has well trained medical professionals who can
respond immediately and appropriately to an emergency need.
These proposed changes are essential to improving our Nation's
public health and ensuring that the Commissioned Corps will be
an effective and efficient force of health care professionals.
There are three main principles guiding the transformation
proposal. The first is to expand and enhance the Commissioned
Corps. The second initiative aims to improve and expand
training and deployability of commissioned officers to areas
where primary care services are lacking. The third initiative
will improve the Commissioned Corps management and development
structure.
Under the proposal, the Commissioned Corps' size, structure
and response capabilities will evolve into a more accessible
team of health care and public health professionals. The Corps
will remain committed to traditional public health needs,
including providing health care to underserved areas around the
country, supporting the expansion of community health centers
and strengthening the health care safety net for all Americans.
These functions will be balanced with emergency response
efforts to create a better equipped and more effective
Commissioned Corps.
In closing, I think it's important to note these ideas for
reorganization are not novel concepts. Deployability and
fitness standards for Corps officers date back well over 100
years. Ultimately, the Commissioned Corps needs to be
strengthened and its mission broadened to include traditional
and evolving needs in the public health field. With these
changes, the Commissioned Corps will be better equipped to
protect, promote and advance our Nation's public health.
I understand that some of our witnesses this morning will
express concerns about specific elements of the transformation
plan and we welcome their comments. I look forward to a
constructive dialog on these concerns. I know we all share the
same goal at the end of the day, and that's a Commissioned
Corps dedicated to and prepared for emerging 21st century
challenges and needs.
We have a great selection of witnesses to provide testimony
this morning. Surgeon General Carmona is here to provide the
committee with an overview of the Commissioned Corps, and
detail the need for reorganization of the Corps. Joining us on
our second panel will be former Surgeon General Dr. C. Everett
Koop, who will offer his opinions on the transformation policy.
Former Assistant Secretary for Health and former U.S. Surgeon
General Dr. Julius Richmond will also provide the committee
with his expertise in the area of public health. And finally,
Captain Gerard Farrell, executive director of the Commissioned
Officers Association will offer the perspective of officers in
the Commissioned Corps.
[The prepared statement of Chairman Tom Davis follows:]
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Chairman Tom Davis. I now recognize the distinguished
ranking member, Mr. Waxman, for an opening statement.
Mr. Waxman. Thank you very much, Mr. Chairman.
I want to thank Chairman Davis for agreeing to my request
to hold this hearing today on the future of the Commissioned
Corps of the Public Health Service. A bipartisan hearing on
this issue is fitting. As administrations and Congresses have
come and gone, the Commissioned Corps has steadily advanced
public health for more than 100 years, saving millions of lives
in the United States and around the world.
It's easy to overlook the critical contributions of the
Commissioned Corps to our Nation's health and safety.
Commissioned Corps officers review drug applications at the
FDA, search for breakthrough cures at NIH, and staff the front
lines of response to public health emergencies. The Corps
responded to the disaster at the Three Mile Island nuclear
plant in 1979, the measles outbreak of the late 1980's, and the
emergence of SARS earlier this year. To date, the more than
6,000 members of the Corps fulfill critical functions in more
than 20 science-based agencies and offices.
Today's hearing will focus on a plan proposed by Secretary
Tommy Thompson to transform the Commissioned Corps. The plan
has two main goals: to increase the preparedness of the United
States for a public health emergency and to improve care for
the medically underserved. Both of these goals are critically
important, and there is widespread support for modernization of
the Corps. The question we face is not whether the Corps should
be altered to meet today's challenges, but how and by what
process. Details matter. Unfortunately, the details of the plan
put forth by Secretary Thompson have serious flaws.
I have written to Secretary Thompson expressing my concerns
about the proposed transformation plan. The problems with his
plan include the new physical fitness and deployment
requirements that could drive many experienced and dedicated
scientists and other health professionals out of public
service. That's one big problem. The plan also leaves the
Surgeon General with too little management authority over the
Corps. I ask, Mr. Chairman, that the letter I wrote to
Secretary Thompson be included in the record.
Chairman Tom Davis. Without objection, so ordered.
[The information referred to follows:]
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Mr. Waxman. In fact, the current administration proposal
has so many problems that it has raised serious concerns among
those who should be its stronger supporters. For example,
Commissioner Mark McClelland of the Food and Drug
Administration has written to Secretary Thompson that the
physical fitness standards could drive ``extremely talented and
committed officers'' out of public service. Dr. Elias Zerhouni
is the Director of the National Institutes of Health, where
more than 400 officers serve in many leadership roles. Dr.
Zerhouni told me at a recent Energy and Commerce Committee
hearing that he has serious concerns about Secretary Thompson's
proposal. He testified that he was willing to share a letter
that he wrote to the Secretary about these concerns with the
committee. I'm disappointed that the Department has blocked him
from doing so.
Public health experts at the Centers for Disease Control
and Prevention have also voiced serious concerns. According to
a senior CDC bioterrorism expert, Dr. Charles LeBaron, this
proposal could undermine public health preparedness. Dr.
LeBaron is concerned that by emphasizing deployment and
physical fitness, the transformation plan will produce a Corps
that is long on mobility but short on expertise. Dr. LeBaron
asks, if a dirty bomb were to explode in the United States,
``would the Nation be better served and defended by experts in
radiation or by a collection of persons whose primary
credentials lie with the number of situps they could perform
and their ability to align the seams of their upper and lower
garments?'' I ask that his written comments on the proposed
transformation plan be included in the record.
Chairman Tom Davis. Without objection, so ordered.
[The information referred to follows:]
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Mr. Waxman. I requested that Dr. LeBaron testify, and
Chairman Davis invited him to this hearing. Unfortunately, the
Department has said it would only let him testify as a private
citizen, without his uniform and at his own expense.
Others who should support the plan to improve the
Commissioned Corps include former leaders of the Corps. I have
heard from several former Surgeons General and former Assistant
Secretaries of Health. These distinguished public servants, two
of whom are here today, are concerned that the transformation
plan leaves the current Surgeon General with very little
authority over the Corps. They believe that a splintered Corps
management system threatens to undermine recruitment, morale
and effectiveness.
A transformation plan should also be supported by
commissioned officers themselves. In that regard, we will have
the opportunity today to hear from Gerald Farrell of the
Commissioned Officers Association, which represents 70 percent
of active members of the Commissioned Corps. He has previously
said that the proposal appears ``crafted to destroy Corps
morale'' and ``drive officers out of Government service.''
A Corps reorganization plan requires the complete support
of the current Surgeon General, who is the historic leader of
the Corps. I welcome Vice Admiral Dr. Richard Carmona to this
hearing. I hope this is an opportunity for him to speak frankly
about what changes are needed to the Secretary's original
proposals.
Let me conclude with an observation. There is simply too
much at stake for a major Corps transformation to be bungled. I
have spent my career in Congress fighting to expand access to
care for the underserved and to improve our public health
system. I would love to see a Commissioned Corps for the 21st
century that is even more involved in these longstanding
concerns. But if there is so much opposition among those who
should be supporting this proposal, then it is time to take a
step back. HHS should develop a clear process to make sure any
changes to the Corps achieve their intended goals.
I want to thank you, Mr. Chairman, for holding this
hearing, and the witnesses for coming, and I look forward to
their testimony.
[The prepared statement of Hon. Henry A. Waxman follows:]
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Chairman Tom Davis. Thank you very much. Are there any
other Members who wish to make opening statements? Hearing and
seeing none, we have Vice Admiral Richard Carmona here. Would
you rise with me, and I'm going to swear you in, it's our
committee tradition.
[Witness sworn.]
Chairman Tom Davis. Thank you very much. We're pleased to
have you with us. We have a light in front that will go orange
after 4 minutes, red after 5. If you need to go over a little
bit, do it, but your entire statement is in the record, and
we'll base our questions on that. We're looking for votes in
about 15 minutes. We may be able to get through questions and
get out of here if we do it quickly.
STATEMENT OF VICE ADMIRAL RICHARD H. CARMONA, U.S. SURGEON
GENERAL
Admiral Carmona. Thanks for the opportunity for allowing me
to come before you today. Secretary Thompson sends his
greetings but also his regrets that he cannot be here today.
I appreciate the opportunity to address the Committee on
Government Reform about the administration's efforts to
transform the Public Health Service Commissioned Corps into a
more mobile and responsive national resource for meeting some
of our Nation's most important public health challenges. I am
particularly pleased to have this opportunity to describe to
you and the members of the committee the Department's vision of
the transformation, to delve into the overall objectives and to
clear up any of the misconceptions about the transformation and
what it is and what it is not.
I want to start my prepared statement with a clear message:
the Public Health Service Commissioned Corps has a long and
proud history. I am proud of its service to this country and
the officers who serve in the Corps are justly proud of their
accomplishments. I have pride in the achievements of people
such as Rear Admiral Craig Vanderwagen, whom Secretary Thompson
deployed from the Indian Health Service to Iraq. There is no
better way to illustrate his service than to quote from his
recent e-mail message back to us. He wrote: ``The Ministry of
Health in Iraq has some marvelous professionals who are very
happy to have the opportunity to do good things for their
country after years of neglect. We will build a primary care
system that has not existed here before to complement the
improvements in public health systems. I am happy to be here
and growing immensely in this environment and thankful every
day for the opportunity to be part of this.''
I applaud the work of commissioned officers like Captain
Ken Martinez of the National Institutes for Occupational
Health, a component of CDC and Commander Tim Cote of the Food
and Drug Administration. Captain Martinez, an engineer who
works in the field of industrial hygiene, was among the
officers responding to the anthrax release on Capitol Hill. He
was deployed from CDC and served 24/7 for several weeks.
Commander Cote, who is currently the Chief of Therapeutics and
Blood Safety at the Center for Biologics at the FDA, not only
served during the anthrax release, when he was assigned to the
NIH, but also volunteered to deploy for duty in Iraq. It is the
dedication of individuals like Commander Cote, Captain Martinez
and Rear Admiral Vanderwagen that exemplifies the best of the
Corps, past, present, but more importantly, future.
While the Corps has responded well during many public
health emergencies, including most prominently the September
11th attack and the anthrax release on October 15th, Secretary
Thompson and I believe that our capabilities will have to be
broader, our resources deeper, and our flexibility enhanced if
we are going to be ready to address the needs of our citizens
when they are faced with future national emergencies. We need
to be ready should local and State public health resources be
overwhelmed by urgent public health needs, whether engendered
by a terrorist attack, a natural disaster such as a significant
earthquake, or a nationwide disease threat, such as would be
created by an influenza pandemic. In fact, during the past few
weeks, in preparation for and in response to the havoc created
by Hurricane Isabel, Secretary Thompson deployed 176
commissioned officers to several communities, to seven State
emergency operations centers and to six State health
departments. These officers served with distinction and I am
proud of what they have accomplished.
In addition to addressing public health emergencies,
ongoing Corps deployments across the country are essential to
protect public health. For example, the Indian Health Service
is facing both significant recruiting problems and a large
number of vacancies, half of them for nurses, in providing care
for our American Indian and Alaska Native populations.
Similarly, the President and the Secretary, from the beginning
of this administration, have recognized that we need thousands
of health care professionals to overcome shortages in health
centers and National Health Service Corps placement sites where
recruitment efforts have fallen short of expectations.
Secretary Thompson and I are equally concerned that we do
not have a sufficiently large force, appropriately trained,
suitably experienced, and readily deployable to address special
needs, such as the critical issue of childhood immunization.
Across our Nation, there are urban and rural areas where the
percentage of children unprotected from critical diseases is a
serious concern to us all. Further, we need to strengthen our
national prevention effort. For example, early diagnosis of
diabetes is important, particularly among some of the most
needy members of our society. That public health professionals
are attuned to the early signs of diabetes is crucial to
controlling the progress of that disease, as well as
controlling the cost of treatment and more serious conditions
connected with progression of the disease. Another example is
the need to respond to the difficult health care issues we face
along the southwest border. The fact of the matter is that when
it comes to national resources to address urgent and unexpected
national public health demands such as these, there are too few
readily accessible public health professionals at our disposal
to deploy as needed.
Over the past several decades, ever since the public
service hospital system was disbanded, the management of the
Corps has become more and more decentralized and the structure
of the Corps less and less distinguishable from the Civil
Service. The requirements that were placed on the department
during the events of September 11th and the anthrax attack
underscore the importance of the Public Health Service
Commissioned Corps, as well as the need for more direct
responsibility exercised by the Secretary. Therefore, the
Secretary has asked his principal health official, the
Assistant Secretary for Health, to be responsible for policy
and oversight of the Corps and the Surgeon General to implement
these policies and be responsible for the operation of the
Commissioned Corps.
To strengthen our Corps and broaden its mission to include
new dimensions that are clearly necessary, we need to revamp
and strengthen our recruitment efforts, use our promotion
systems to reinforce and reward the best of qualities of a
truly national, mobile public health force, bring our
administrative management systems into the 21st century, and
adapt the best DOD personnel practices for use in managing the
Public Health Service Commissioned Corps.
For years, authority has existed in the Public Health
Service Act to appoint warrant officers as part of the
professional Public Health Service Commissioned Corps.
Secretary Thompson now needs to use the authority to expand the
capacity of the Commissioned Corps. We need to be able to
access the clinical resources of registered associate degree-
trained nurses that every State recognizes and licenses to
provide clinical nursing services. Appointing them as warrant
officers permits us to expand the service delivery capacity of
the Corps. At the same time, we want to give them access to the
education that would be required if they wanted to be
commissioned officers after receiving a bachelor's degree in
nursing. Likewise, we want to use the rank structure to add
other members of the health care team such as laboratory
assistants, physical therapy assistants and paramedics.
As part of this effort and at the direction of Secretary
Thompson, I am already strengthening our Basic Officer Training
Course to ensure that newly recruited officers are fully aware
of our readiness standards and deployment systems when they
first enter on duty. Also, as part of the transformation of the
Corps, Secretary Thompson and I believe we should explore ways
to strengthen and expand our reserves as a readily available
source of additional officers, should we be required to respond
to public health emergencies and other urgent requirements that
exceed our active duty capacities. Therefore, the Secretary has
asked me, working with the Assistant Secretary of Health, to
look into options for that aspect of the transformation.
Growing and maintaining a healthy, robust reserve could be
instrumental in the pursuit of easing the maldistribution of
public health professionals, without significantly adding to
the size of the Federal payroll. These public health
professional reservists could practice their professions within
their communities all across the Nation and strengthen the
capacity to respond to emergencies at a local level without the
need for massive relocation of people and assets in times of an
emergency.
There are several other reforms that we are developing as
part of the transformation initiative. I have mentioned reforms
directly affecting the lives of officers currently serving in
the Corps. The continued dedication and commitment of
commissioned officers to the public health of this Nation is
very important to both the Secretary and me. We will move to
strengthen the development of those members of the Commissioned
Corps who have devoted their careers to research in public
health by establishing more formally structured career tracks.
They will provide officers with clear growth opportunities to
which they can aspire.
Our Nation asks much of these dedicated individuals, many
of whom could migrate to the more lucrative private sector.
Instead, these dedicated officers choose to serve in the Corps
to the benefit of the entire Nation. In the past, the mission
statement of the Commissioned Corps has been tailored to focus
on supporting the activities of agencies that comprise the
Department of Health and Human Services. Secretary Thompson and
I believe that we need to revise that statement to better
emphasize all of the values that have long been part of the
Commissioned Corps: to protect, promote and advance the public
health, science, and security of the Nation, domestically and
globally, as America's uniformed service of uniquely qualified
health professionals.
Because much has been speculated about the impact of this
transformation on existing officers and the potential for
disruption of their service, I want to conclude and emphasize
what the transformation is not. Much information has been
printed and, contrary to characterizations in the media and
misconceptions elsewhere that have caused concern among
officers, I would like to make two points. First with regard to
deployment of officers, any deployments undertaken will be
congruent with an officer's skills, competencies and physical
capabilities. To be clear, sending officers such as bench
scientists, FDA regulatory specialists or epidemiologists from
CDC to achieve mission objectives that are not consistent with
their specific training and physical capabilities makes no
sense. The transformation contemplates no such thing.
Second, with regard to promotion standards, no system will
be adopted that places undue demands on an officer with regard
to training or physical strength. In fact, the three-tiered
readiness standards we are proposing will impose no new
physical fitness standards at the basic level through the
calendar year 2004, and will establish, as other uniformed
services do, a medical waiver provision. There will be phased-
in incentives for officers to seek higher levels of training
and deployment capability, but no officer will be disadvantaged
for promotion by physical fitness standards in the 2004
promotion cycle.
Mr. Chairman, for over 200 years, the U.S. Public Health
Service Commissioned Corps has served our country well. But
today, faced with new challenges and new threats,
transformation of the Commissioned Corps is a necessity. As
envisioned, the transformed Corps will provide this and future
Presidents with a more highly trained, capable and mobile cadre
of public health professionals. We can accomplish this without
disadvantaging any current members of the Corps, and we can
accomplish this within the limits provided us by Congress for
the size of the Commissioned Corps.
Mr. Chairman, that concludes my statement and I am ready to
respond to any questions you may have. Thank you, sir.
[The prepared statement of Admiral Carmona follows:]
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Chairman Tom Davis. Thank you very much. I have to tell
you, before this I knew very little about it. This has not been
a subject in my years that I've spent much time on. I know Mr.
Waxman has spent a lot of time with this, so I'm learning my
way through.
What distinguishes the Commissioned Corps from the Civil
Service?
Admiral Carmona. We are in uniform, sir. We are one of the
seven uniformed services of the United States. Our function,
our mission, as I stated, is to protect and advance the health
of the Nation. As you know now, with the threats upon us, that
has really increased somewhat to be more of a global
responsibility. As you see, we have officers in Iraq helping to
rebuild the Health Ministry.
Chairman Tom Davis. Being uniformed gives your superiors
more ability to direct than civil servants, too, doesn't it?
Isn't there more flexibility to direct the uniformed personnel?
Admiral Carmona. Yes, sir, I think that is one element,
just as our sister services, that it allows the leadership to
direct those assets where they may be needed.
Chairman Tom Davis. OK. Secretary Thompson claimed in his
announcement of the plan back in July that it would give the
Surgeon General more authority over the Commissioned Corps than
ever before. Do you agree that your position will receive added
responsibility?
Admiral Carmona. Sir, based on the plan that the Secretary
has put forward, I think the Surgeon General will have
unprecedented authority for the operations of the Public Health
Service Commissioned Corps on a day to day basis. Working in
concert with the Assistant Secretary and the Secretary who will
develop the policy for administering the Corps, and in effect,
the direction to the Surgeon General as to how to operate the
Corps on a day to day basis.
Chairman Tom Davis. How do you interact, under the new
management structure, how does it work with the Assistant
Secretary for Health? Can you walk me through the new versus
old, if there is a difference?
Admiral Carmona. The way the system is proposed to be set
up, sir, is that the Assistant Secretary, being the Secretary's
chief deputy for public health matters, oversees the Office of
Public Health and Science. The Surgeon General reports through
the Assistant Secretary to the Secretary, and the Secretary, by
delegation, delegates to the Assistant Secretary certain
authority to generate policies and oversee the Commissioned
Corps. In addition, I will have certain delegated authorities
to operate the Corps on a day to day basis.
Chairman Tom Davis. OK. We learned after September 11, the
anthrax scare, SARS, and other recent public health
emergencies, that solid coordination between Federal, State,
and local levels is key to handling emerging public health
threats. We had testimony here last week on the Post Office,
where some of the advice that was given, frankly, wasn't the
right advice, it was something that was newly handled by CDC
and the Postal Service. How will the new transformation improve
coordination between Federal, State and local levels? Is that
one of the goals of this, to improve that?
Admiral Carmona. We are working on improving this right now
through our Assistant Secretary for Public Health and Emergency
Preparedness, where we have Corps officers, CDC, NIH, we're
really all partners in this preparedness. The threats that were
thrust upon us on September 11 and then on October 15 are very
new. Having to revitalize, reorganize ourEMS systems from the
local to the State to the Federal level so that we have a
seamless system that's able to deal with all hazards, that
includes the every day things--the hurricanes, the earthquakes,
the fires in California that are being experienced now--as well
as the new threats where, quite frankly, who could have
expected that planes would have been characterized as weapons,
or pathogens characterized as weapons? It's a very new world,
but I think we're making significant progress in moving in that
direction.
Chairman Tom Davis. What's the communication been like? As
this plan was being developed, what was the communication like
from the bottom up ranks? Were there meetings and solicitations
of ideas, or did this come in basically a top-down
reorganization?
Admiral Carmona. I don't think it was a top-down, sir. I
think what occurred, and I will state that, prior to my
becoming Surgeon General, this was an issue for the Secretary
that he was bringing forward. In fact, as I went through my
interviews, I was questioned about the Public Health Service
structure, what I saw as the future of the Public Health
Service, if I was in that position, how I would lead the Corps
in this transformation. So it predated me.
Chairman Tom Davis. Right.
Admiral Carmona. When I came in, there was already a
structure in place by the Acting Surgeon General, who is my
deputy now, who had formed committees to begin to discuss
information within the troops and begin a dialog that would
move up and down the chain of command on how the transformation
should go forward.
Chairman Tom Davis. Has the dialog been satisfactory from
your perspective?
Admiral Carmona. The dialog has been a good one. It's been
a vigorous one. There have been, as you can imagine, as many
opinions as we have officers. So as you all in Congress have to
deal with thousands of constituents who see the world
differently, we have to work hard to develop a consensus and
try and accommodate all of the input.
Chairman Tom Davis. Thank you. Mr. Waxman.
Mr. Waxman. Thank you, Mr. Chairman.
Admiral Carmona, I want to welcome you to our hearing
today.
Admiral Carmona. Thank you, sir.
Mr. Waxman. To followup on that point about how this plan
was put together, the Surgeon General is the historic leader of
the Commissioned Corps. Were you the main author of the plan?
Admiral Carmona. I think it was a team that put together
the plan, sir. I could not take credit for it. It was all of us
who worked on it.
Mr. Waxman. When it was announced on July 3, had you
personally reviewed the plan and signed off with your approval?
Admiral Carmona. The announcement that the Secretary
brought forth on July 3rd I was fully aware of and fully
supportive of. In his statement that was delivered, if that's
what you mean, on July 3rd, yes, sir. I had seen that and was
fully supportive of his vision to transform the Corps.
Mr. Waxman. We know that FDA's Commissioner McClelland has
written to the Secretary, critical of some parts of the
proposal. And I heard from NIH Director Zerhouni who also had
serious concerns about the plan. How is it that this plan was
produced without finding some basic agreement with the
directors of these critical public health agencies which employ
hundreds of Corps officers?
Admiral Carmona. Sir, if I might, I'm not sure that it was
so much criticism as, for instance in Dr. McClelland's case,
whom I was in contact with continually, as well as Dr. Zerhouni
and Dr. Gerberding, who are my peers, he asked for input from
his troops as to what the issues are. In fact, he assigned me
two senior officers of our Commissioned Corps to work with me
in getting that information. I viewed his letter more as a
synthesis of the input he got that was then transferred to us
to take appropriate action on. So we welcomed his input, as we
did Dr. Zerhouni's and Dr. Gerberding's.
Mr. Waxman. I think they're reflecting a lot of unhappiness
with members of the Corps, and I'm sure you've heard from
people in the Corps as well, the draft proposal establishes
universal fitness standards for all Commissioned Corps
officers. Those who don't meet the standards would lose
promotions and face dismissal from the Corps. I wrote to the
Secretary in August that this could prompt an exodus of
expertise from science-based agencies.
Can you explain how the proposed physical fitness
standards, which include a minimum number of pushups, are
relevant to experienced officers who are world class scientists
or expert drug reviewers?
Admiral Carmona. Yes, sir, I'd be happy to and I appreciate
your asking the question, because certainly that's been the
crux of some of the misconceptions. The proposal as we put it
forth has a three-tiered system. In fact, only if you're going
to be in the upper tiers, the advanced tier, where you'd have
some more stringent physical requirements, would you be doing
anything like pushups or timed runs. So the entry level or
basic level really is for any one of our officers. Basically,
it consists of a current physical exam on file that you're
healthy, that you've got your vaccinations up to date, that
you've got your basic CPR card on file, and the online modules
of education that will bring you up to speed, so to speak, on
emergency deployments and how our system works.
So in fact, there really is no intent to affect the
officers as far as losing ability for promotion or for an
exodus from the Corps. In fact, it allows the officers to
gravitate to the level based on their skills, competencies and
what they do, using the example of that lab researcher that you
alluded to. There would be no intent to deploy that person to
an environment that they could not work in. However, prior to
September 11, or October 15, we never expected we'd have to
deploy a lab scientist some place to figure out some complex
issue, as we did with anthrax, for instance.
Mr. Waxman. Before you get into that, you're suggesting the
policy is different than what I read in the draft proposal.
Have there been changes in the draft proposal? For example, I
wrote to Secretary Thompson and I asked him what will happen if
an officer cannot meet the fitness standards, for example, the
weight limits or physical fitness requirements. Will promotions
be withheld or not? And it seems to me that the answer I got
back was, ``Well, there can be a waiver, but still it's in
place.''
Admiral Carmona. Sir, if I might, I think that maybe
there's some confusion with the old Commissioned Corps
readiness force. That is changing, the concept that the
Commissioned Corps readiness force was always looked to be
phased out. We have about 50 percent of our Corps qualified now
as Commissioned Corps readiness force, which does meet physical
standards of running or swimming and pushups and things like
that.
Mr. Waxman. So only 50 percent has to meet these?
Admiral Carmona. No, what I'm saying is that was the
previous system. What we've done now in this proposal is to
begin to phaseout CCRF where the whole Corps would be looked at
as a deployable force, but with different standards within the
Corps: an entry level, a middle level and an advanced level.
And that entry level is, for instance, let's say a bench
scientist who's not going to have to go out and do rescues or
something that's highly physical, but we want to make sure that
if they had to be deployed, which would be unlikely----
Mr. Waxman. Is there anything in writing about this?
Admiral Carmona. Yes, sir.
Mr. Waxman. Other than the draft statement, draft proposal
itself?
Admiral Carmona. We have many things in writing, sir, that
have been circulated as we were going through the dialog with
all the authors and staff----
Mr. Waxman. Well, if there's been some change, I'd like to
be sure we get it. But let me ask you----
Admiral Carmona. We'll get with your staff, sir.
Mr. Waxman. Great. Just one, because my time is up and I
hope we'll get a second round. You testified about the role of
the Surgeon General and you say it's unprecedented authority.
We're going to hear from two former U.S. Surgeons General, Dr.
C. Everett Koop and Dr. Julius Richmond, both will testify that
this reorganization plan does not give enough authority to the
Surgeon General. The plan sets up a new Office of Corps Force
Management that's responsible for training, recruitment and
assignment of support, officer support, and the new office is
separate from the Office of the Surgeon General and reports to
the Assistant Secretary for Health. You said that you are going
to have unprecedented authority day to day. But it sounds like
some of your predecessors are saying when it comes to policy
and recruitment, you as Surgeon General will have less
authority than Dr. Koop and Dr. Richmond had. Do you agree with
that?
Admiral Carmona. Well, sir, first of all, I certainly
respect the large shoes I filled following Drs. Richmond and
Koop, who were certainly role models for all of us. So no
question, I welcome their input. I have not seen specifically
what they have said, though. But based on the plan that is
before us, and understanding the history of the Corps from
1966, this plan proposes to give the Surgeon General the
authority to operate and manage the Corps based on policy that
emanates from the Secretary and the Assistant Secretary.
Mr. Waxman. But the policy used to emanate from the Surgeon
General, is that right?
Admiral Carmona. I think if you go back historically, prior
to 1966, when there was no ASH and there was a Surgeon General
that really did both positions, that's a different issue. But I
think if you look at the history over the last 40 years, the
Surgeon General has had periods where he was strong and periods
where he or she was not. I think this plan really does put some
meat on the bones, so to speak, and gives the Surgeon General
authority.
The issue of OCFAM is an interesting one, because I think
there was a misconception. The Secretary has clarified that.
OCFAM is a staff or an advisory group that the ASH will have at
his or her disposal to be policy advisory. They are not going
to be operating anything. The operation will be delegated to
the Surgeon General for all functions of the Corps. That would
include recruitment and that would include personnel functions.
But the policy that would give instruction to the Surgeon
General on how to operate the Corps would come from the
Secretary and the ASH. That's the distinction, sir.
Mr. Waxman. Well, it's a, it's a distinction that disturbs
many of us, because we have always seen the Surgeon General as
the key person, and not the Assistant Secretary for Health. We
think a lot of your prerogatives and responsibilities are being
taken away and we don't see that as particularly a good idea.
But I'll get back to you on the second round.
Admiral Carmona. Thank you, sir.
Chairman Tom Davis. Thank you. I'm going to recess the
hearing. Can you stay with us? We should be back in probably
20, 25 minutes.
Admiral Carmona. Yes, sir, thank you very much.
Chairman Tom Davis. We'll take a break and reconvene in
about 25 minutes. We have three votes over on the House floor.
Committee is in recess.
[Recess.]
Chairman Tom Davis. The committee will come back to order.
Mr. Waxman, you are recognized for additional questions.
Mr. Waxman. Thank you very much, Mr. Chairman.
Admiral Carmona, you can understand how there's a lot of
anxiety out there by members of the Corps that they're going to
have to go and pass some physical fitness test, even though
they're working in something that has nothing to do with that.
We'll want to look for some clarification on this whole point,
because Dr. LeBaron, I mentioned in my opening statement, is a
CDC bioterrorism expert. He's expressed concern that we're
going to have a retrogression in our preparedness if we don't
have the experts needed to lead our emergency response because
they couldn't pass the physical fitness exam and do the
requisite number of pushups.
We're hearing from people who are very anxious, because if
they are commissioned officers and they have to leave the Corps
prior to 20 years of service, they lose all their retirement
benefits. When you change the promotion and other rules mid-
stream, they're put in a terrible position. I'm sure you can
understand why so many of these officers are concerned about
having the rules changed in the middle of their careers.
They've given a lot to public health and it's imperative to
avoid mistreating them and draining our science-based agencies
of expertise.
I suppose it was a debate within the administration as to
who's better able to handle the management structure and to set
the actual policy for the Corps. On the one hand, it could be
the Assistant Secretary of Health. On the other, it could be
the Surgeon General. Give me the arguments for both sides, very
briefly. Why would we want to have that management decision in
the Assistant Secretary as opposed to the Surgeon General? It
used to be one person, but now it's two.
Admiral Carmona. It's a far more complex world now, and
greater responsibility. But the Secretary encouraged us to have
a vigorous debate about this issue. Because there is no right
answer. But we were looking for a logical division of
responsibility and authority and policy----
Mr. Waxman. Just give me the argument. If you were
advancing the argument for giving it to the Assistant Secretary
of Health, what would you say?
Admiral Carmona. That the Surgeon General, in being the
commander of the Corps every day, running the operation for the
U.S. Public Health Service, as well as being an advisor to the
President and the Secretary and being on the road quite a bit
for public health issues around the country if not the world,
probably has enough to do with just those components, and that
policy might be much too much. Now, on the other side----
Mr. Waxman. Give me the argument the other way. Let's say
you were making the argument, self-interested as it may be, but
for the institution and the decision in general.
Admiral Carmona. I never was on a debate team, but I'll
play the game. [Laughter.]
The issue of the Surgeon General having it, really, if you
argued for it, would be that, some would argue that, why would
you divide management and policy, that they are intricately
related and that we should probably consider having those
together. Now, notwithstanding the fact that really the
Secretary is the one that has the authority for the entire
Health and Human Services, and delegates that authority for
certain functions to the ASH or the Surgeon General. So really,
the ASH doesn't have policy authority unless it's delegated
from the Secretary.
Mr. Waxman. OK. You're a combat-decorated Vietnam war
veteran, aren't you?
Admiral Carmona. Yes, sir.
Mr. Waxman. You served in the military?
Admiral Carmona. Yes, sir.
Mr. Waxman. As Surgeon General, what's your rank?
Admiral Carmona. I'm Vice Admiral, 09 pay grade.
Mr. Waxman. And how many stars are associated with this
rank?
Admiral Carmona. That's a three star billet, sir.
Mr. Waxman. It's my understanding that if an Assistant
Secretary for Health is a member of the Commissioned Corps and
is not also the Surgeon General, this person becomes a four
star general. I also understand that Congress authorized this
structure at a time when the Assistant Secretary for Health had
more responsibility than today. Is it typical in other branches
of the uniformed services that political appointees would be
put in a uniform and take the rank of a general or admiral?
Admiral Carmona. Well, sir, it's a good question. The
system that we are proposing is parallel to that of the
Department of Defense. My colleagues in the Army, Navy and Air
Force are also three star billets, so either admiral or
lieutenant general, vice admiral, lieutenant general at an 09
level. So Army, Navy, Air Force and myself, we are the four
Surgeons General, if you will, of the country.
The Assistant Secretary in the Department of Defense that
those Surgeons General report to is what you would call a four
star equivalent, has the authority of a four star general or
admiral, but doesn't wear the uniform because they are a
civilian in an assistant secretary position. So your
distinction between HHS and DOD is correct, that in the past,
there was a change in statute that allowed for the Assistant
Secretary to put on the uniform and not just be an equivalent
of a four star.
Mr. Waxman. But would you recommend that an assistant
secretary of health who was a political appointee put on the
uniform of the Commissioned Corps and become a four star
admiral over the Surgeon General? And would having too many
political appointees in uniform pose any danger for the
professionalism of the Corps?
Admiral Carmona. That's a very tough question, sir. I've
been involved in discussions and have had discussions with my
colleagues at DOD as well as within the Corps and others as to
should that be more of a DOD type position at Assistant
Secretary. There are pros and cons, just as there were with the
issues that you asked me to take both sides of just a moment
ago.
I think that when you put a uniform on a person who hasn't
come up through the ranks or understands, you do put them at a
disadvantage because there's a certain culture that's
engendered in that uniform that takes decades to get to. So I
think that, unknowingly, that person is put at a disadvantage
with their peers because they're, from everything from not
being sure how to wear the uniform or salute or what the common
courtesies are and the culture of the uniform. It makes it very
difficult. So you'd have to propose an argument that would say,
well, what is the benefit to putting the uniform on that
person, rather than just having the equivalent and give them
all of the graces that go along with the position, so to speak,
but not the uniform itself.
Mr. Waxman. Do you feel like you're now becoming a lawyer
because you're saying on the one hand and then on the other
hand?
Admiral Carmona. Almost. A little more practice I'll be OK.
Mr. Waxman. You're doing a good job.
One last question I want to ask, and then I know others
have things they want to pursue. The transformation plan
proposes to create a warrant officer rank within the Corps to
hire hundreds of associate nurses. My understanding is that the
Navy has tried and abandoned this approach and that it's drawn
criticism from the Chief Nurse Officer. Have you studied the
experience of associate nurses and other services, and what is
the logic for not proceeding more slowly with this plan?
Admiral Carmona. Sir, that's a very good question. It's
probably best to answer it in terms of why we even considered
it. As you know, nationally, there's a nursing shortage,
whether they're associate degree nurses or bachelor-trained
nurses. It's certainly easier to access the associate degree
nurses who are in a 2-year program than a 4. Now, I'm a former
registered nurse. I understand the issues of nursing.
The reason that the Secretary chose to move in this
direction was, we have huge unmet needs in the Indian Health
Service and underserved areas around the country, and nursing
is one of those biggest needs. So we were looking to be able to
get nurses at the bedside, in the communities, to serve those
underserved populations. In fact, I just got an e-mail last 24
hours, request for nurses specifically in Alaska and the Arctic
Circle; for nurses to do OB/GYN as well as primary care,
because the Eskimos have to travel over 500 miles if we can't
get some people up there to fill the void.
In your area, sir, we got a request for nurses because of
the forest fires.
Mr. Waxman. My question that I don't think you're
answering, not that you don't have good intentions behind it,
but there has been an attempt to do this and it didn't succeed.
My question was, whether anybody studied the experience of
associate nurses in other services and the fact the Navy tried
it and abandoned it later should have been some lesson.
Admiral Carmona. We did, sir, and in answer to your
question directly, we did study those experiences and spoke to
our colleagues in the other uniformed services. The driver for
this was, we still have these huge, unmet needs. We looked at
it as an opportunity to get nurses on the ground where they
were needed to serve these underserved populations that are in
desperate need of care.
Now, with that, we understand the concerns of all of the
nursing leadership nationally who said, you know, the bachelor-
trained nurse is more capable, has more experience, has more
academic background. But why not put those together? And we
looked at a continuum. So if we bring in associate degree
nurses and put together an educational program that allows them
to progress while they're working and become a bachelor trained
nurse, under the supervision of our bachelor-trained nurses, to
me that's a win-win situation for the Corps, it's a win-win
situation for the communities that so desperately need those
nurses.
Mr. Waxman. Thank you very much, Mr. Chairman.
Chairman Tom Davis. Thank you very much. Just a couple of
last questions. I'll put this under one big question.
Under the transformation proposal, I just wondered what
type of emergencies would the Commissioned Corps respond to and
are you planning on sending any Corps officers to respond to
the California wildfires?
Admiral Carmona. Thank you, sir. As I alluded to with Mr.
Waxman, we just got a request, in fact I brought the e-mail
with me, from the Red Cross in California to ask us to send
five public health nurses for a 2-week deployment to assist
them with public health needs that are being unmet in those
communities from the fires, and one of our liaison officers for
our Commissioned Corps readiness force to support them through
communications and should we need more resources there. We are
in the process of deploying half a dozen nurses and a
pharmacist up to the Arctic Circle now, because there are
10,000 Eskimos who have no care unless we can get those people
there, because there is such a shortage of nurses and other
health care professionals.
These come in on a daily basis from around the country and
around the world sometimes, like Iraq. We do everything we can
to meet that unmet need wherever it may be. So we really look
forward to those opportunities to serve. We have a very robust
6,000 member Corps. We could probably use more, because
sometimes we can't meet all the needs. But I'll tell you, we
look forward to those challenges on a daily basis.
Chairman Tom Davis. That's why people go into it, to serve.
Admiral Carmona. They do. We've got the most committed,
hard working people I've ever worked with in my whole life.
They subordinate their whole lives to serve others. So we would
love to take in all the ones that we turn away because we don't
have the billets for them. But we certainly have opportunities
for them to serve if we could get them in.
Chairman Tom Davis. How much larger do you think the Corps
ought to be to fulfill its mission?
Admiral Carmona. How much larger should it be? Well, sir,
to answer that----
Chairman Tom Davis. I know you're off script here.
[Laughter.]
Admiral Carmona. To answer that academically I'd have to
ask you to give me some time to study it. Because we know that
we have unmet needs throughout the country. We have community
health centers where doctors aren't there, nurses aren't there,
therapists aren't there. There's mental health needs in our
underserved communities that are unmet. We could certainly look
at that for you. But just generally, there is a large unmet
need, as all of you know in this country, that public health
officers could meet if we had those numbers.
Chairman Tom Davis. Thank you very much.
Any other questions? Mr. Van Hollen.
Mr. Van Hollen. Thank you, Mr. Chairman. Thank you,
Admiral. I think we all have a great interest in the future
success of the Corps. It has a long and distinguished history,
and we're all very interested in making sure that continues and
we have a big stake in its reorganization. In addition, I also
have many members of the Corps in my district. I represent a
district right near our Nation's Capital here in Maryland, and
many members of the Corps are at the FDA and NIH and other
Federal agencies in this region.
I think you would agree, would you not, that it's
important, whenever you undertake this kind of transformation
and reorganization, that you get the support, the buy-in in
this case, of the members of the Commissioned Corps and the
officers of the Commissioned Corps in order for it to be
successful in the long run? Would you agree with that?
Admiral Carmona. Yes, sir.
Mr. Van Hollen. Are you aware of any surveys that have been
done to determine whether or not members of the Corps or
members of the officers in the Corps, what their reaction is to
this reorganization plan?
Admiral Carmona. I'm aware of a lot of discussions and
meetings that have taken place. I work through my colleagues,
Dr. Zerhouni, Dr. Gerberding, Dr. McClelland, Dr. Duke, all the
optive and staff within HHS. They then test their people to
bring back information. I've gone to a number of all-hands
meetings where I've asked for input from officers and that
comes in and we take a look and see where the themes are
developing. So there's been a number of ways that has been
done. But really the input has come in various forms.
Mr. Van Hollen. Would you agree that in a particular
agency, if 72 percent of the members of the officer corps said
that, as a result of this planned reorganization, they intended
to leave after 3 years, that would be a problem, I assume?
Admiral Carmona. Well, I'd certainly, if that was the case,
I'd want to talk to them, first of all, to make sure that they
understood what we were doing and that there was no
misconception, misperception, of what the intent was, and find
out specifically what are the issues.
Mr. Van Hollen. Right. Well, I think that, one of the
problems as I understand in talking to people, is that part of
the cause for the misunderstanding may be a failure to
communicate by the Department with members of the Corps. I have
a survey that was done by the Commissioned Corps officers at
the CDC, Centers for Disease Control. According to the results
of that survey, 82 percent of the CDC officers who responded to
the survey said they were considering leaving the Corps within
3 years because of the transformation. And of the physicians
among them, 75 percent of the physicians said that as a result
of the transformation plan, they were considering leaving the
Corps. If that were to occur, you would agree that would be a
significant degradation in the ability of the Corps to do its
job, would you not?
Admiral Carmona. Certainly, sir. If I might add, though,
that as Mr. Waxman alluded to earlier, there were
misperceptions at the time the survey was done. For instance,
the physical requirements that people would have to,
everybody's doing pushups and situps and being trained. That
wasn't an issue. So when we heard about that, we did everything
we could to correct those misperceptions that was not the
intent, that there were three levels of physical ability. I
think that was the biggest complaint that people pushed back on
that: ``Whoa, I'm a researcher, I shouldn't have to run miles
and do pushups and situps.'' That wasn't the issue. I'm not
sure how that got out there, but we've done everything we can
to correct that misperception. Certainly, once the appropriate
information is out, I'd love to see a survey done, once
corrected, if that was still the opinion.
Mr. Van Hollen. Well, 70 percent of the commissioned
officers, I understand, are members of the Commissioned
Officers Association. So would you agree it's a representative
body, a body that represents them?
Admiral Carmona. Yes, sir.
Mr. Van Hollen. Don't you think it would be important to
consult with them in coming up with this reorganization plan?
Admiral Carmona. Well, as far as I know, I've spoken to Mr.
Farrell many times, and the leadership, and I was not present
at meetings, but I am told that there were two meetings with
the commissioned officer directors, the COA director and
leadership at HHS. But I was out of town those times and I
don't know about those discussions.
Mr. Van Hollen. Well, Mr. Farrell is here, but I just
happened to see the October issue of the Commissioned Officers
Association newsletter, this month's issue. In it, he says,
``Over the last several weeks, I have presented COA's views on
the transformation process in many different places. Capitol
Hill, OMB, various journalists and to several COA branches.
Interestingly, the one place I have not been invited to present
our views is DHHS.''
Now, if that's the case, and according to his testimony it
seems to be, doesn't that suggest a very serious problem in how
this plan was put together in the first place? You mentioned,
what you're saying is confusion that hopefully we can sort out
today. But it sounds to me like a lot of the confusion resulted
from a failure to approach this reorganization in a way that
makes sense, which is going to talk to the people who would be
most affected. Doesn't that seem to--would you agree with that?
Admiral Carmona. No, sir, respectfully I wouldn't in this
case. I do agree with you that there has been some confusion
and misperception. I have great respect for Mr. Farrell and the
COA, I'm a member and have had many discussions with them over
time. But there's a lot of venues to get to our officers. COA
of course is a leadership group that is involved with our
officers. But we've gone through the optive, the stafftivs,
we've met with the leadership at CDC, NIH, FDA, SAHMSA. So it's
not any one point of contact, it's multiple points of contact.
And, certainly, I know personally, I rely on Mr. Farrell for
input when I have questions, when I'm trying to learn the
culture of the Corps and maybe the best course of action. He's
got a little historical perspective that I don't have, and he's
provided me great information since I've been in this position,
which is only about 15 months.
Mr. Van Hollen. Well, just in closing, Mr. Chairman, I
think the results of the CDC survey where you've got 80 percent
of the people surveyed suggesting they would leave the Corps as
a result of this reorganization within 3 years and Mr.
Farrell's statements that he has not really been included with
respect to DHHS, thinking in this, suggests to me that if it's
a question of confusion as opposed to significant substantive
issues, then that confusion has clearly resulted from a failure
to consult broadly with the people who would be most affected.
Thank you very much, Mr. Chairman.
Chairman Tom Davis. Thank you. Mr. Shays.
Mr. Shays. Thank you, Mr. Chairman. Thank you very much.
I don't know whether to call you General or Admiral, so I'm
going to call you Doctor. [Laughter.]
Doctor, what makes the Corps unique?
Admiral Carmona. I think the most unique aspect of the
Corps is that we are a uniformed service of health
professionals, unlike any other service in the world, that
provides for the needs of public health to the United States
and the globe now, on a daily basis, but also has the ability
to respond to any contingencies that arise as far as
emergencies.
Mr. Shays. I see it as, you don't follow the standard 40
hour work week.
Admiral Carmona. No, sir.
Mr. Shays. You have that military kind of ethos, in a way.
And it seems to me that if you are not fulfilling your unique
responsibility then you need to say, ``we need to change.'' It
strikes me that change is going to make some people think,
``Maybe this isn't the organization I want to be in.'' But if
you're like any other health care organization in the country,
there's really no point in your existing. That's kind of how I
react. Obviously you want to interact with your employees and
your employees need to buy into this organization. But if some
people leave, that to me is not necessarily a bad sign. It's
just a sign that they don't want to be part of what is unique
about the Corps.
What are the new public health threats? I wasn't responding
to my colleague from Maryland, it was something I wanted to say
beforehand. Because I do think if you have a large number, it
does say, ``Hey, we're not communicating well, and we need
to.'' But what are the new public health threats, and how are
you responding to these new public health care threats?
Admiral Carmona. The U.S. Public Health Service really is
that anonymous backbone for public health in the United States.
So when you turn on the water, when you take your medications,
we all take for granted that those things are safe. But it's
because we have this very robust public health service at FDA,
CDC, NIH that does the research, does the work there.
The new threats really that are upon us began on September
11, because, prior to that, we characterized the emergencies we
responded to as all hazards, hurricanes, earthquakes, and other
types of disasters--chemical spills and so on--where we would
assist communities in mitigating and recovering from disasters.
But since September 11, we're dealing with issues of planes and
weapons and pathogens as weapons, so it's an entirely new
world. But the expertise that we have in the U.S. Public Health
Service is very adaptable to those new threats. And whether
it's bioterrorism or conventional weapons of mass destruction,
that is bombs and bullets and fires and explosions, we are
prepared to work with our colleagues throughout the country to
be able to make our country a healthier and safer environment
for all.
Mr. Shays. Someone sitting at this exact desk a few years
ago, in one of my hearings on national security, a doctor of a
noted major medical magazine, said his biggest fear was that a
small group of dedicated scientists could create an altered
biological agent that could wipe out humanity as we know it.
This wasn't someone on the extremes, this was a pretty Main
Street kind of personality and organization. Do you think that
statement is worth being concerned about?
Admiral Carmona. Absolutely, sir. We on a daily basis have
intel briefings and look at the potential threats around the
world. Certainly the bio threat is a very real one, from
naturally mutating organisms as well as purposely creating
mutations that could be more virulent. So we are very
concerned.
Mr. Shays. Former Speaker Gingrich believes that
bioterrorism is the greatest threat that we face. My
subcommittee is concerned about botulinum toxins, more so than
even smallpox and so on. Is this something that you have
focused any attention on?
Admiral Carmona. Our officers at CDC and NIH, you bet,
would be doing the research on that, to develop appropriate
mechanisms to respond should that occur. But botulinum toxin is
a very real threat, especially as it relates to the food
supply, its ability to be disseminated easily. So we are
concerned about that, and there is active research going on
right now.
Mr. Shays. As we speak, we don't really have a vaccine
against it?
Admiral Carmona. No, sir.
Mr. Shays. Which to me, Mr. Chairman, raises some gigantic
concerns.
I want to conclude, because I know that we also have former
Surgeons General. I just want to say that I view you as the
chief spokesperson for health needs and health concerns. I
believe that office is, and I believe in some ways there's
almost been an attempt to downgrade the office. You are a moral
authority that has to speak out. My view is that you sometimes
may have to speak out when no one else in the administration
agrees with you. I hope that you feel that you have that duty,
because I believe you do.
Admiral Carmona. I agree with you, sir, I do feel I have
that duty. A day doesn't go by that I don't get up and really
understand that term when people say the weight of the world is
on your shoulders. I understand the immense responsibility I
have and I take it very seriously. Thank you for your comments,
sir.
Mr. Shays. Thank you. Thank you, Mr. Chairman.
Chairman Tom Davis. Thank you. We have another panel to get
to, but I want to make sure if Members have questions they have
an opportunity to ask them. Are there any other questions? Mr.
Tierney.
Mr. Tierney. Just quickly, Admiral, thank you. Can you give
us in 25 words or less what's the rationale for the Service
being a uniformed service as opposed to a civil organization?
Admiral Carmona. Twenty-five words or less. Well,
professionalism, visibility, mobility, all of the issues we
spoke a little bit earlier in some of the questions that I was
posed. But not dissimilar from our sister uniformed services,
that there is a command and control structure, there's an
authority. And just like the Army and the Navy and the Air
Force who have specific missions that they are tasked with, the
U.S. Public Health Service also has those missions. We are
proud to be seen as a uniformed, visibly fit, mobile service.
Mr. Tierney. Would you not function as well as a civil
organization as opposed to military?
Admiral Carmona. I think it would be much more difficult to
do it as a civil servant, sir.
Mr. Tierney. Because?
Admiral Carmona. Well, because you wouldn't have the
control of the troops, you wouldn't have the training, you
wouldn't have a lot of the constraints of a uniformed service.
As Congressman Shays just said, it's not a 40 hour week for us.
We typically put in 60, 70, 80 hours a week, and we don't count
the clock when we're deployed and we have to take care of those
in underserved communities.
Mr. Tierney. I notice that amongst your physicians you have
dieticians also serving in your force.
Admiral Carmona. Yes.
Mr. Tierney. And we're talking about serving the
underserved. What prospect if any does this reorganization have
for any plans that you might have for addressing the issue of
obesity as a national health concern, particularly amongst the
underserved?
Admiral Carmona. I am so happy you asked that question,
because it is something that Secretary Thompson is passionate
about, as I am. It is the fastest growing epidemic we have in
this country, with 9 million children being obese or
overweight, two-thirds of the American public being overweight
or obese, huge costs, $117 billion a year. What we want to do
is to be able to use this force for those reasons, to get out
there and deal with this public health issue through education,
through intervention. Our officers at NIH and CDC are doing
research on it. It's a very big team approach. But we're
already out there doing this.
Mr. Tierney. Are you going to make that a focal point of
your----
Admiral Carmona. It already has been, sir, as far as
prevention. Prevention is one of the focal points of my
portfolio as assigned by the President and the Secretary. And
obesity is probably the key element within prevention right
now.
Mr. Tierney. Thank you very much. I yield back, Mr.
Chairman.
Chairman Tom Davis. Thank you, Mr. Tierney. The gentleman
from Missouri.
Mr. Clay. Just two quick questions.
Chairman Tom Davis. Sure.
Mr. Clay. Thank you, Surgeon General Carmona, for being
here. Good to see you again.
Tell me, what efforts are being made to recruit and train
minority applicants wishing to become commissioned public
health service officers?
Admiral Carmona. As part of our transformation, we're
looking at a scholarship program which we would like Congress
to be involved in, where we would work with Congress to have
Congressmen select worthy young men and women who could come
into the Public Health Service and serve. We certainly would
hope that would include a robust portion of underserved
minorities, Native Americans, Black, Hispanic, etc. Because we
recognized that, in fact, we need to have a more robust work
force.
Now, with that said, of all the uniformed services, about a
third of our officers identify themselves already as minority.
So we are very proud of what we have achieved with diversity
within our ranks already. But we don't want to stop there. We
want more.
Mr. Clay. I'd be interested in hearing more about the
program that you want to develop.
Let me also ask you, what do you and Secretary Thompson
envision to be the cost of the proposed transformation or
reorganization plan, and how long will the implementation take?
Admiral Carmona. The entire transformation is still being
worked on, sir, as far as the specific details. Part of it,
we're doing as much as we can through policy and just
administrative changes within the Corps, which really there is
very little cost associated with that, it's just a
reorganization. Some of the issues that in the future we would
like to bring before Congress as far as having an academy,
having additional resources allocated to train minority
doctors, nurses, dieticians, and others, have career pathways,
we would like to engage in a discussion with Congress and other
leadership to answer those questions because we feel that it
will help us to meet the unmet need in many, many underserved
populations in this country.
Mr. Clay. OK, I thank you for your responses. Thank you,
Mr. Chairman.
Chairman Tom Davis. Thank you. Any other questions?
Admiral, General, Doctor, nurse, I'm not sure what to call
you--[laughter]--you've requited yourself well. Thank you very
much. We appreciate your being here, and we'll take a 2-minute
recess and get our next panel up. Thank you very much.
Admiral Carmona. Thank you, Mr. Chairman. Thank you all.
[Recess.]
Chairman Tom Davis. Our next panel is a very distinguished
panel; Dr. C. Everett Koop, who was U.S. Surgeon General from
1981 to 1989; Dr. Julius Richmond, who was Surgeon General from
1977 to 1981 and professor emeritus at the Harvard School of
Public Health; and Captain Gerard Farrell, who is executive
director of the Commissioned Officers Association.
It's our policy to swear you in, so if you would just rise
with me and raise your right hands.
[Witnesses sworn.]
Chairman Tom Davis. Thank you very much.
You know the rules, the light will turn orange after 4
minutes and red after 5. You don't need to read your entire
statement, because it's already in the record. You can
highlight it. But we'll be generous, whatever you need to get
your points across, and then we'll move to questions. I just
want to thank all of you for being here. This is a really
important issue that has not been highlighted at the
congressional level much. We're very interested in your
comments and your taking the time to be with us today. I'll
start with Dr. Koop and move this way. Dr. Koop, thank you very
much for being here.
STATEMENTS OF DR. C. EVERETT KOOP, FORMER U.S. SURGEON GENERAL;
DR. JULIUS B. RICHMOND, FORMER ASSISTANT SECRETARY FOR HEALTH
AND FORMER U.S. SURGEON GENERAL; AND CAPTAIN GERARD M. FARRELL,
EXECUTIVE DIRECTOR, COMMISSIONED OFFICERS ASSOCIATION OF THE
U.S. PUBLIC HEALTH SERVICE
Dr. Koop. Thank you, sir. I will, because of the
constraints of time, skip the niceties of introduction and ask
you to refer to my prepared remarks.
I would like to say that I support Secretary Thompson's
vision and initiative in recognizing the need for improvement
in the Corps. The concerns I have are much more to do with
organization and process, not the overall goal of strengthening
the Corps.
I am the only living person who was Surgeon General and
leader of the Public Health Service Commissioned Corps under
two organizational concepts. One system worked well, but the
other was inefficient, tied the hands of willing, competent
experts and initiatives were stifled by bureaucrats with no
real solutions. This system undermined the morale of the Corps.
The following changes I believe are important, sir. The
Surgeon General and his staff must have complete and direct
control over all aspects of the day to day administration,
management and operation of the Corps. This is the system which
worked after my revitalization of the Corps in 1987. The Corps
needs to better define requirements, including personnel
requirements--no small task. The Corps will then be able to
move forward with its overall recruiting and assignment
strategy.
The growing need for the Corps to respond to emergency
situations demands some sort of a robust, ready reserve
component, similar to the reserve components of the other
uniformed services. The key to emergency response is the
training, organization and exercising of the response force,
well in advance of the emergency. This will require much
thought before instituting change, as well as evaluation of
trial and error, then reevaluation and, of course, funding.
Efforts to improve professionalism should include a
continuum of educational opportunities from pre-commissioning
through indoctrination through executive level management,
administration, leadership and even officership for those
selected for flag rank. The Corps has functioned best, in my
opinion, when officers were rotated every 3 years through, say,
Indian Health Service, Bureau of Prisons, public health service
agencies, and then a period of refreshment in one of the public
health service hospitals. The hospitals, except for those in
the Indian Health Service, were closed in 1981, which severely
impacted the opportunities to educate and re-educate our
officers. There must be some alternate plan, which would
include bioterrorism updates.
My concerns are that the plans do not support the important
changes just mentioned. The system that did not work well for
me was when personnel management of Corps officers was
separated from control or direction by the Surgeon General. The
new system I devised worked well. But in 1995, to my dismay,
personnel management functions were moved again, this time
under the HHS Assistant Secretary for Administration and
Management. As a result, the Corps experienced difficulties in
the recruiting and placement of officers, and has continued
until very recently to slowly grow smaller. Hardly the system
that would foster the desired increase in the size of the
Corps.
We do not need a new office for day to day management and
operation which reports to the Assistant Secretary for Health
on a co-equal basis with the Surgeon General. What then would
be the role of the Surgeon General for leadership of the Corps,
which is really one of the principal functions for which he is
nominated in the first place and then confirmed by the Senate?
And leaving compensation and medical affairs under the
authority of still another assistant secretary will add
confusion and inefficiency where least needed.
The plans also appear to devalue the role of Corps officers
in fundamental public health roles: research laboratory work,
regulation activities. Clinical health care for underserved
populations is not the only aspect of public health. Equally
important is the work conducted by Corps officers in
institutions like CDC, NIH, FDA. Let me remind you that the
world relies on the standards of FDA, the NIH is the premiere
source of medical research on this planet, and the CDC is
preeminent in international health.
In the Department rush to fix one problem, they might well
create two more if the process is not engineered critically.
Mission drives requirements, tempered by resources. Then, after
that, plans are developed to match resources against
prioritized requirements. It appears to me we are beginning
with the plans first.
Our public health infrastructure is not able to respond to
the threat of bioterrorism. There are insufficient health care
providers for some underserved communities, and improvements to
our research capabilities are demanded by new diseases such as
SARS. I would argue for an increased role for the Corps and the
Surgeon General in leading the public health infrastructure at
all levels. The Corps' role in emergency preparedness and
response, especially organizational issues, should be carefully
evaluated, as should be the relationship of the Corps and the
Office of the Surgeon General to the new Department of Homeland
Security.
In increasing the mobility of the Corps in emergent
response, remember that these highly trained and experienced
health professionals have day jobs. Their day jobs are
critically important, whether they are clinicians on a remote
Indian reservation or in Federal prison, or assigned as an
epidemiologist or researcher at CDC. You cannot routinely
deploy the only pharmacist on a reservation or in a prison
without a plan for substitution.
Also, the lifelong researcher at CDC may not be the ideal
choice to respond to an emergent situation where trauma skills
will be the primary need. New responsibilities for the Corps
must be carefully balanced against the still important role of
the Corps in traditional areas of public health. This can only
be successfully accomplished by using a strategic planning
process which is organized, inclusive and based upon data. My
impression of the current process is that none of these exist.
The Surgeon General is clearly recognized as the top public
health professional in the country. The Office of the Surgeon
General ought to be empowered to take charge of the
infrastructure and develop the changes necessary to make it
better. The Commissioned Corps is one logical tool already in
place at the Surgeon General's disposal to make this happen. To
do less, sir, I think, unnecessarily risks the public health of
this great Nation. Thank you.
[The prepared statement of Dr. Koop follows:]
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Chairman Tom Davis. Thank you, Dr. Koop.
Dr. Richmond, thanks for being with us.
Dr. Richmond. Thank you very much, Mr. Chairman.
I do want to express my appreciation to you, Mr. Chairman
and to Congressman Waxman and the other members of the
committee for your interest in this very important topic, which
is so important, as Dr. Koop and Dr. Carmona have already
indicated, to the health of our people. I'll make my comments
relatively informal and, I hope, quite brief, so that we will
have maximum time for questions, Mr. Chairman.
I want to say at the outset that I think it is important
not alone to have this hearing but, I would hope, Mr. Chairman,
that this committee would continue its interest in this matter.
I come currently from an academic community, and in our
academic community, oversight committees become extremely
important for our functioning. Committees, essentially from the
outside, and I view the role of this committee as an oversight
committee, and I think having to answer your questions is
extremely important in terms of our pursuing the best pathways
to the Nation's health.
As you've already heard from Dr. Carmona, in the context of
history, we have great reason to be proud of the record of the
U.S. Public Health Service and Commissioned Corps in responding
to emergencies which threaten the health of our people. History
tells us that this response to health emergencies has always
been full and effective. I have never known a situation where
that has not been true. But this reflects the matter of
constant training for emergency preparedness. Let me just give
some brief illustrations, Mr. Chairman. First, on September 11,
2001, I think it's very significant that, of all of the Federal
officials, Secretary Thompson was the first one to go on
national television after the crisis of that day to point out
that the Public Health Service had already responded by sending
support to the State and local health officials in New York
City. Again, that was not fortuitous, that was because of the
emergency preparedness of the Corps.
Let me just very briefly illustrate some anecdotal evidence
of the responsiveness of the Corps that I had personal
experience with when I was Surgeon General and Assistant
Secretary. One, the Mariel boat refugees arriving on our shores
from Cuba, hundreds of them, when Mr. Castro emptied his jails
and prisons and sent those people to our shores. Within hours,
our Public Health Service officers prepared the way for the
appropriate dealing with that situation. That had to go on for
an extended period of time.
Comparably, the Southeast Asian crisis of that time, in the
late 1970's, when the boat people of Southeast Asia were in
refugee camps in Asia and were being brought to this country to
relieve the pressures on the camps over there, some were found
to have tuberculosis. In consultation with the Secretary of HHS
at that time, we agreed that the best policy would be to screen
the refugees before they came. She asked me, Madam Secretary
Harris, she said, ``Well, how long will it take for you to get
people over there?'' I said, ``Within 24 hours,'' and that's
when our staff members from CDC appeared in Southeast Asia to
do the screening.
But perhaps most significantly, Mr. Chairman, was the Three
Mile Island nuclear plant disaster when, as we know, near
Harrisburg, there was a great threat of a nuclear reactor plant
disaster. This was prior to any experience with Chernobyl.
Nobody knew what was going to happen. We needed instant
response. Our CDC officers were on the scene within a matter of
hours and stayed there, and I might say in a very courageous
way at great risk to themselves, because no one could predict
what would happen. Fortunately, that pressure chamber never
exploded. But the CDC staff gathered data, and to this day
collect epidemiologic data so that we can learn from that
experience.
I mention these events because these responses are not
fortuitous. They result from cultivating a corps of highly
competent professionals. I can't over-emphasize that, and Dr.
Koop has emphasized it as well as Dr. Carmona. But the
competence of these professionals is engendered in the agencies
in which, to use the modern parlance, they are embedded, the
NIH, the CDC, HRSA, the FDA. This is where their professional
work and their professional competence is developed.
Now, what is combined with this high degree of professional
competence is the matter of flexibility. Effective responses
develop out of flexibility. No set of regulations, however well
intended, including those for the proposed transformation, can
replace the need for a high degree of flexibility.
So Mr. Chairman, my concerns over what I know about the
proposed transformation are the following. The Surgeon General
and the agency heads should constitute a governing council, as
they now functionally do, for the deployment of officers. They
would act in concert with the Surgeon General. The current
proposals do not take into account the concerns of the
leadership of the Public Health Service agencies and the need
to maintain our public health infrastructure, particularly at
the Federal level.
I think it's extremely important that we recognize that
there has been an erosion, as an Institute of Medicine report
not too long ago indicated, of our public health infrastructure
at the State and local level. But it also can be eroded at the
Federal level if we don't take cognizance of the importance of
maintaining the important functions of those agencies. And Dr.
Koop has said very eloquently how important that is.
Second, the Surgeon General should unequivocally be the
leader of the Corps, including, I would say, Mr. Chairman, its
planning, policy and management functions. The Corps is not so
large that one commanding officer can't incorporate the
direction of all of these functions. It violates any sound
principles of management to propose, for an example, an Office
of Commissioned Corps Force Management to assume functions that
the Surgeon General has had and has executed effectively
historically.
Last, I would say, Mr. Chairman, flexibility should prevail
in the evaluation and assignment of officers. This should
prevail as well in the physical fitness requirements. The
important issue is whether an officer can perform assigned
duties. Parenthetically, I would add that I served for 4 years
in World War II as a flight surgeon. Had we held to arbitrary
standards, we would have lost much very valuable person power.
And I could illustrate with many examples.
So in summary, Mr. Chairman, it's not that I am opposed to
change. We can always do better. And in Dr. Koop's day, I would
recall for you that we engaged in a revitalization of the
Corps. But we didn't have to reorganize the Corps to revitalize
it and enhance its functions. So our past performance is due to
the sound organizational structure and, in my view, the
leadership which the Corps has had. We should enhance its
efforts and not engage in changes which might well impair its
efforts by creating new problems. In other words, we must be
aware of, particularly, unintended consequences.
Thank you very much, Mr. Chairman.
[The prepared statement of Dr. Richmond follows:]
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Chairman Tom Davis. Thank you very much.
We have 7 minutes left on our vote on the floor. Here's
what I think I'd like to do if it's all right with you. Recess
it now, we just have two quick votes, we'll get there for the
end of one, the beginning of another. Then Mr. Waxman and I at
a minimum will be back here to hear from you, Captain Farrell,
and then we'll go to questions. Is that all right? Then I will
recess the meeting and we will reconvene within the next 15
minutes. Thank you.
[Recess.]
Chairman Tom Davis. The committee will come back to order.
Thanks for being with us and thanks for being patient.
Captain Farrell. Mr. Chairman, the Commissioned Officers
Association of the U.S. Public Health Service appreciates your
interest in the important contributions to the health of the
Nation by the Commissioned Corps of the U.S. Public Health
Service. In the Corps' long and distinguished history to the
service of the Nation, its role in defending and advancing the
public health has never been more important than today, given
the evolving and emerging new threats we face to public health.
COA represents the interests, as you know, of some 7,000
active duty, retired and reserve officers of the Commissioned
Corps. Seventy percent of active duty officers are COA members.
Our constituents are the officers who will be charged with
implementing the changes to the Corps. We believe, therefore,
that they also have a role to play in developing what those
changes will be.
COA supports what is best for the Nation's public health, a
most fundamental component of our national security. The threat
of biological weapons in the war against terrorism demands an
army of public health warriors to provide leadership in the
Nation's public health defense. Leadership for the Corps and
the Nation's public health community is and ought to be
provided by the U.S. Surgeon General.
Along with improvements in emergency response, we must not
forsake more traditional public health roles, however:
research, laboratory and regulatory work. The Commissioned
Corps has many strengths. Among those are its adaptability, its
diversity, its cross-cutting relationships in public health,
the dedication, commitment, and professionalism of its officer
corps. But there is always room for improvement.
We therefore fully support the Department of Health and
Human Services' strategic plan which calls for an expanded,
enhanced and fully deployable Commissioned Corps, and we
applaud Secretary Thompson's initiative to transform the Corps.
Specifically, our association supports the restoration of
authority over and responsibility for the Corps to the Office
of the Surgeon General. This includes full budgetary and
manpower authority. We support the implementation of a force
requirements and management system, which is billet-based and
resourced similar to the other uniformed services. We support
an overall recruitment and assignment strategy, based on the
validated requirements. These will lead to a fully deployable
Corps, consistent with the needs and requirements of the
operating divisions, agencies and departments in which officers
are assigned. It will also lead to a robust, ready reserve. We
support initiatives to expand the size of the Corps and enhance
its readiness capability, consistent with the Corps' mission
and the goal of increased professionalism. Finally, we support
improvements in ongoing education, including the establishment
of a public health service academy designed to increase the
Corps' professionalism.
We were very interested to hear Admiral Carmona's testimony
earlier, because much of what the Admiral has discussed today
is new. But our specific concerns with the organizational
structure and planning process as we have understood them up to
this point lead us to believe that they were not designed to,
perhaps, but might undermine, the ability of the Corps to
attain the goals that we all agree upon. As we understood the
plan to be conceived, and according to its written record, it
would effectively sideline the Office of the Surgeon General
and marginalize any relationship between that office and the
Corps it is supposed to lead. It further fragments the Corps
when just the opposite is needed.
The Department's approach applied new roles and missions
for the Corps, but does not specifically address them. Nor does
the plan address existing roles and missions for the Corps,
which seem to be devalued. Force-shaping policies have been
introduced with no attempt to define the requirement to which
the force is being shaped. The new policies, since they were
decided without input from the operating divisions and
agencies, including the non-HHS agencies where officers are
assigned, have created a situation where officers are less
likely to be employed in these vital public health institutions
in the future.
The proposal to recruit 2 year degree nurses as warrant
officers, as has already been discussed, has raised significant
concerns in the public health community. Adequate funding for
the transformation and its effective implementation does not
appear to have been considered.
Corps officers look to the Surgeon General for leadership,
just as members of the other uniformed services look to their
respective service chiefs. In the present environment and under
the proposed plans to transform the Corps, the Surgeon General
is being prevented from exercising any meaningful leadership
authority over the Corps. This situation contravenes the intent
of the President in nominating him and the Senate in confirming
him.
The unfortunate result of a poorly planned and communicated
transformation is an alarming degradation of morale in the
Commissioned Corps. We have received hundreds of comments from
our members expressing their alarm and concern over the process
and direction of transformation. One Corps officer, an
eminently qualified medical epidemiologist assigned to CDC
wrote, ``In general, the leadership of CDC's disease
recognition and response teams has been staffed through the
Commissioned Corps. The transformation of the Corps would
appear to systematically disassemble such expert teams.''
Our recommendations are simple and straightforward. We
would like to see this committee, in collaboration with the
committees of jurisdiction in the House and Senate, take
appropriate action to ensure that the planning process used by
the Department is similar to that in use at the Centers for
Disease Control and Prevention, where they have a futures
initiative in place. Specifically, we urge a planning process
which includes, at a minimum, input and participation of all
Health and Human Services operating divisions and non-
departmental agencies, a process that is open and transparent
throughout.
We would recommend a process which begins with the
validation of the mission of the Corps and a set of core values
to guide the way. The validated mission becomes the basis for
and drives end strength requirements, recruiting plans and
policies, training requirements, assignment, including
deployability policies, promotion plans,and policies. In short,
mission requirements shape the force. Requirements for Corps
officers at the Federal, State and local levels of public
health infrastructure must also be included.
We recommend establishing a billet-based system of
requirements identification with the active participation of
all affected operating divisions, departments, and agencies
where Corps officers are assigned. This should include
establishing requirements for a ready reserve component.
We recommend delaying implementation of the force shaping
policies, including new promotion policies, until the profile
of the future Corps can be defined by the requirements-based
force management system previously discussed. We believe that
it is important to confirm the role of the Office of the
Surgeon General in providing direct leadership, policy
administration, management, and operational control, including
budgetary and personnel management for the Commissioned Corps.
We recommend identification by the Department and appropriation
by the Congress of funding to implement the key provisions of a
transformed Corps, including its expansion where needed, a
ready reserve component, and a training academy with
scholarship opportunities.
Finally, we recommend clarification of the Surgeon
General's role in regard to emergency preparedness within the
Department. This is consistent with the Surgeon General's role
in public health, especially as envisioned by the Department in
the transformation process thus far.
Once again, sir, the Commissioned Officers Association very
much appreciates this opportunity to submit our views, and we
look forward to addressing further details of these and other
issues with you and the committee staff, and in the future, to
working with the Department on these important issues. Thank
you, Mr. Chairman.
[The prepared statement of Mr. Farrell follows:]
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Chairman Tom Davis. Thank you very much.
Captain Farrell, do you feel you've been involved in the
process to date? Have you shared these views with the people
that are putting this reorganization together?
Captain Farrell. We've done our best to do that, sir. I
have had, as Admiral Carmona mentioned, two meetings, one
several months ago with the then-Department Chief of Staff
where we discussed very specifically the organizational issue.
Unfortunately, that gentleman left office a week later, and
we're not aware of any follow-through.
About 2 months ago, I was able to meet with the Acting
Assistant Secretary for Health, Cristina Beato. But we
discussed mostly issues relative to the Association and not
anything substantive relative to the issues regarding
transformation. Subsequent to that meeting, I have offered on
three occasions my services or the services of our association
to the Department and we have been rebuffed on all three of
those occasions, sir.
Chairman Tom Davis. Rebuffed meaning?
Captain Farrell. No answer at all.
Chairman Tom Davis. ``Don't call us, we'll call you,'' that
kind of thing?
Captain Farrell. Yes, sir.
Chairman Tom Davis. So what's the morale of the men and
women that you represent at this point?
Captain Farrell. Pretty poor, sir. The one survey that was
referred to earlier, they were able to use some metrics to
define a 50 percent degradation in morale at their particular
agency. I would say from the tenor of the input that I get from
our members there is considerable concern about not so much
that the Corps is being transformed, but that they may be asked
in the transformation to take on additional requirements and
obligations without the support structures being put in place
to enable them to do that, both in terms of fulfilling their
jobs in the agencies in which they work and in their ability to
take care of their families if they're going to be deployed
more often.
Chairman Tom Davis. Thank you.
Dr. Koop, thank you for your testimony as well. Ordinarily,
you noted, the mission drives the requirements, tempered by
resources. Are you concerned that in this case, maybe the
process is going to drive the mission?
Dr. Koop. I think it might be that way. Certainly, I think
that the direction that we usually take when we undertake
something like a transformation that's contemplated here, the
cart now seems to be before the horse.
Chairman Tom Davis. One of the concerns that this committee
constantly has is that Government becomes too bureaucratic and
process-driven instead of mission-driven. One of our goals is
to try to get out there and be able to be more mission-driven.
I think the jury is still out on what the ultimate plan is
going to be here. But I think I hear loud and clear your
concerns and the concerns of Dr. Richmond in terms of the way
this has unfolded to date.
Dr. Koop. Well, this 100 year-old organization has been
evolving for a long time. I think the two functioning words
that make it possible are flexibility, as Dr. Richmond said,
but also appropriateness. I think proper leadership of the
Corps, using those two guidelines, can accomplish a lot of
things without having a tremendous reorganization, which is
causing a lot of the disruption of morale and planning of many
of the members of the Corps.
Chairman Tom Davis. Unlike a lot of organizations, this
organization is driven by its membership, by its employees,
because they are technical and they are professional.
Recruiting and retaining them is critical. That's not true
everywhere. But it's certainly true in this particular case. I
know Mr. Waxman shares my concern here that this is an area
where you talk about larger reserves and continuing to track
top-quality people who are service-driven people. But we cannot
allow a diminution in the morale at this point. I think that
could have ramifications down the road. It's tough to get good
people.
Dr. Koop. It's comforting to hear you say that.
Chairman Tom Davis. It's always tough to get good people.
And I'm not just saying that we can't move ahead with
transformation, but I think, at this point, we don't have,
we're not sure exactly, from my perspective, we don't even have
all the information we've requested, I think. And I'm still
trying to get comfortable with it, and if the workers are still
getting comfortable with it, that gives us some concern.
I am going to turn the gavel over to Mr. Shays, but I'm
going to recognize Mr. Waxman. And let me just say to all of
you, thank you very much for being here. This has been very
useful to us.
Mr. Waxman. Thank you very much, Mr. Chairman. Well, what
we seem to see here is a reorganization where all the people
who should have been consulted weren't consulted. And from what
I hear from you, Captain Farrell, you don't feel that your
members of the Corps were really brought into the development
of this reorganization plan. That's one reason they don't feel
comfortable with it. And second, they don't feel comfortable
with it because they feel that their careers are going to be
jeopardized, all the service may be lost in terms of their
pension if they're forced to do things that were never expected
of them in the past. Is that right?
Captain Farrell. That's true, sir. One of the issues is
that many of these officers joined the Corps under a different
set of circumstances and a different set of rules. And there is
no provision, at least as we understand it, for grandfathering
the new rules. We don't really object to changing the rules as
long as the people who joined the Corps under a different set
of circumstances and understandings are somehow protected,
don't lose their retirement benefits and their ability to
continue to serve with the distinction that they have already
exhibited.
As far as our participation in the planning process, it's
not just the fact that we have been, I'll use the words shut
out, but even those elements within the Corps itself that have
been asked to provide input seem to have been ignored. For
example, the Department convened a distinguished panel of Corps
officers to look at promotion policies and make
recommendations. Yet when the revised promotion policies were
published at the end of August, the officers who served on that
panel were not able to discern any of their input having any
effect on the proposed new policies.
Mr. Waxman. One of the cries from members of the Corps is
that they're going to have to go through this physical fitness
standard that many of them won't be able to meet. Even though
that's not required of them in their day-to-day activities,
they feel they'll have to leave the Corps. Dr. Carmona gave us
some assurance today, and we'll look forward to some written
assurance as well, that the interpretation of the proposal that
all of us have seen is not going to be quite as we have read
it.
Have you been told that those physical fitness standards
are going to be revised, and have you seen any of the
revisions?
Captain Farrell. No, sir. Most of what Admiral Carmona was
reporting on this morning was news to me, and represents a
completely different plan from the one that I've had the
ability to examine thus far.
Mr. Waxman. Well, it's critically important for HHS to
followup today's testimony with a clear and detailed policy
that provides the assurances to people that they're not going
to be put through some mindless set of tests on how many
pushups they can do when that has nothing to do with their
expertise. We wouldn't want to lose their expertise.
Captain Farrell. No, sir.
Mr. Waxman. And have people who do good physical routines
but don't have the expertise that's going to be required, as we
heard from Dr. LeBaron, to deal with bioterrorism or at the FDA
to deal with drugs, or CDC with other public health matters.
Dr. Koop, in the 1980's you were the representation to
everybody of public health, and you spoke the truth whether it
was tobacco or AIDS. You represented the service and dedication
of the Commissioned Corps. You've raised a couple issues about
this transformation plan. One is that the Surgeon General
should be the leader. Do you feel that the changes that are
being talked about to either take away the powers of the
Surgeon General, give them to the Assistant Secretary of
Health, or to split the authority makes any sense?
Dr. Koop. I've never been asked to testify, Mr. Waxman,
with so little real knowledge. A lot of the things that I have
behind me are hearsay. And I have to say what Mr. Farrell has
just said, and that is, what I heard from Dr. Carmona is not
what I knew up until yesterday. So there seem to have been some
major changes. But the way I saw it, I would say that the
Surgeon General's powers had been emasculated. To have him co-
equal with a Department that knows nothing about what he is
supposed to be doing and reporting to somebody who is in a
different division of HHS seems to me ridiculous.
Mr. Waxman. Well, I didn't get assurances from his
testimony this morning that was changed. I thought he gave a
good face to it by saying how the Surgeon General would deal
with the day-to-day activities. But it sounded like the
policies were no longer going to be the Surgeon General's
policies, they were going to come from elsewhere.
Dr. Koop. As I heard Dr. Carmona, I thought he was
separating policy from day-to-day activity, but you can't.
Mr. Waxman. And Dr. Richmond, do you also agree with that
position? You were Surgeon General and Assistant Secretary of
Health.
Dr. Richmond. Yes. In my testimony I focused particularly
on the importance of the Surgeon General having responsibility
for the policy and management of the Corps. Now, that of course
is under the rubric of the Secretary of the Department's
overall responsibility. But having said that, all of the policy
development and the management of the Corps, and particularly I
would emphasize, Mr. Waxman, the extremely important functions
of relating to the agencies where the professional expertise of
the officers keeps being renewed. This is why we're the envy of
all of the countries of the world and that's why we're often
drawn upon, particularly our capacities in CDC, by countries
all over the world, because of this matrix that we have of
professional competence in the agencies and the Commissioned
Corps and the Surgeon General as its commanding officer. That
delicate balance, I think, should not be impaired. The minute
one goes down the path of separating policy from management in
an organization of that size, I think, is an invitation to
disaster.
Mr. Waxman. Just one last question, I'll ask Dr. Koop, and
Dr. Richmond, I want you to respond. You can look at the Corps
as having to respond to a medical emergency, and that's
important. But also what's important is the idea of having
Commissioned Corps officers serve in agencies like FDA, NIH and
CDC. These are science-based agencies and they're critical to
the overall mission of the Corps. Is that your view, and do you
feel that there's some suggestion people ought to be only in a
medical response team and not the other side?
Dr. Koop. That's where I stress flexibility and
appropriateness, because the individual officer is sometimes
caught between the demands of a medical emergency which require
a Corps response and his day-to-day activities as well as
responsibility to the agency where hi serves.
I'd like to call attention to one other thing I think Mr.
Tierney mentioned: the difference between the civil service
response to an emergency and the Commissioned Corps. It's
another anecdote that was mentioned in part by Dr. Richmond
just a minute ago. That is, when Castro did dump a lot of
people on our shores from his prisons and his insane asylums
and so forth, the Governor of Florida called Secretary Harris
for help. She issued an immediate request to the civil servants
in HHS to respond to that emergency, and not one person
volunteered. When she inquired why, they said, ``It's not my
job description.'' In desperation, she turned to the Surgeon
General, who said, ``Go,'' and 268 people went and served
between 2 weeks and 2 years at that very onerous job of sorting
out those people which, you'll remember, ended in separating
6,000 criminally insane people from other refugees.
Mr. Waxman. All three of you made excellent points, and I'm
persuaded by the testimony today that everybody we've heard
from, and the Secretary himself, has the same goal in mind,
making sure that we have a Commissioned Corps that serves the
best interests of the public health and needs of the American
people. I just wish the Department had gone through a process
where everybody's views might have been sorted through and
digested and there could have been a greater consensus for the
proposal. But it's not too late. And I hope this hearing will
produce that kind of dynamic that I think is essential to
getting a win-win for everybody, not something where people
fear a plan and may find themselves with no other choice but to
leave. Because, as Congressman Van Hollen pointed out, in that
survey, if we have 70 or 80 percent of people leaving the
Corps, leaving the Centers for Disease Control and Prevention,
it's not in their interest and it's certainly not in our
interest to have that happen.
I thank the three of you for coming and I appreciate your
contribution today. I hope as a result of this hearing we can
get to a good result for everybody.
Mr. Shays [assuming Chair]. I thank the gentleman.
In my previous life chairing--I chair now the National
Security Subcommittee--I used to oversee the Departments of
Health, HHS, CDC, and so on, in the 4-years that I chaired that
subcommittee. I developed a tremendous appreciation for our
health care institutions and all the folks associated with it.
I'm struck with this basic belief, that I think the
administration has a lot of very intelligent people working for
it, and I sense there are probably a lot of good ideas in this
reorganization. But the one criticism that seems to be not just
unique to HHS and so on has been the desire sometimes to just
mandate without involving the employees. So what could
potentially be really good ideas aren't bought into by the
employees. And frankly, the administration's desire just
sometimes not to disclose stuff to Congress and so on, it's an
Achilles heel in my judgment. It's a view that I have that goes
not just in health care but in a lot of others.
So I take that general bias, so it's very easy for me to
accept, Captain, your criticism of this process, because we've
heard it before in so many different ways. But having said
that, it doesn't mean the ideas are wrong or the effort is
wrong. And I'd like to ask you first, Dr. Koop, in your
testimony, you stated that the Corps, to reach its full
potential, the Surgeon General must have complete and direct
control over all aspects of the day-to-day administration,
management, and operation of the Corps. I'd like you to tell me
what this means. Every manager wants to have as much control,
but are you saying that it needs to be more complete and more
direct over everything as opposed to some other type of
management of individuals? And if so, why?
Dr. Koop. The essential thing has been mentioned in several
ways, and that is that every officer has two obligations: that
to the agency which employs him for his day job, where he has
many obligations, and when emergencies arise, he has the
obligation to respond as a member of the Corps. And that's why
I said that, at the present time, the flexibility and the
appropriateness which guide the council that makes these
decisions makes it more than just a one-man decision. It isn't
that the Surgeon General is a dictator, but he is the
orchestrator of a very highly-tuned group of experts, all of
whom have a very definite understanding of their
responsibilities, both to emergencies and to the day-by-day
situations that occur; they vary from agency to agency.
In my day, high on the table of organization, I reported
directly to the Assistant Secretary of Health. But that did not
mean that I didn't consult almost every day with the agency
heads, and it didn't mean that I bypassed the Assistant
Secretary and spent a lot of time with Otis Bowen on the
discussion of policy. So it was a collegial atmosphere, which
is one of the things that always was attractive about the
Corps. Nevertheless, the Corps itself and the agency heads
looked for direction to the Surgeon General.
Mr. Shays. Dr. Richmond, would you amplify on anything?
Would you disagree with anything?
Dr. Richmond. No, I think Dr. Koop has put this very well.
But I would also emphasize, just in terms of management
principles, one cannot have a Corps which brings together
professional expertise as well as preparedness issues without
having clear lines of command and authority. I think anything
that creates any degree of ambiguity about the Surgeon
General's capacity to be the commanding officer would be a step
backward.
Mr. Shays. So when I intuitively look at people in uniform
and see ranks, the analogy is much closer to the military than
it would be to so-called civilian life?
Dr. Richmond. Yes, and I think the uniformed service
component sort of exemplifies that. And I think that the
differentiation in part from the military is this professional
expertise that exists in the Corps. That can't be constantly
renewed and reinvigorated without these officers being in the
operating agencies where the professional skills and
developments are, as I indicated earlier, bringing the
resources of NIH, FDA, CDC, and all of the others, HRSA, to
bear on the problems. If we don't have that constant
refreshing, professionally, of these officers by virtue of
their placement there, they won't have the competence really to
do the job in emergency preparedness that we hope they have.
Mr. Shays. So putting in my words, qualification to the
pure military model is that a lot of those in the Corps are
highly educated, part of a profession of doctors who basically
you then say somehow modifies this concept of pure military.
Dr. Richmond. That's correct.
Mr. Shays. It implies to me there has to be more
consultation and so on. But you still want lines of authority
and so on. Is that what you're saying?
Dr. Richmond. That's exactly right.
Mr. Shays. Dr. Koop.
Dr. Koop. That's correct, because the command and control
aspect that the military uses so well is what separates us from
a civilian organization.
Mr. Shays. Otherwise, you might as well not exist.
Captain Farrell, anything you would disagree with, or how
would you amplify it or where would you put your emphasis?
Captain Farrell. No, sir, I think that both Dr. Koop and
Dr. Richmond both can say it far more eloquently than I can.
The model that the Corps likes to look at is the military
model. And that is in terms of organization and operation. But
they don't execute it the way the military does, because
they'll never be able to, because their mission is different.
What the uniformed service brings to the Corps probably
more than anything else is the perception that very uniform
conveys. Because what that uniform conveys is a perception of
order, a sense of disciplined organization, it brings with it
identity, a sense of purpose, and a commitment and a
confidence, not so much a confidence in the people wearing the
uniform, but in the confidence of the general public and those
who adopt the uniform and wear it. There have been countless
surveys over the past number of years that ask the general
public, ``What is the institution in the country that you have
the most confidence in?'' They list them, they are judges or
clergy or whatever. Uniformed services consistently rank in the
top three. That is something that I think is essential in
health.
Mr. Shays. You put the emphasis slightly differently. I
don't mean to be splitting hairs, but I'd like the two Surgeons
General to respond. You said what made it different, I was
inferring that the difference was the education of the
individuals and the focus on the individuals. You put the focus
on the mission. Is this a difference without a meaning? Are
they one and the same, Dr. Richmond or Dr. Koop?
Dr. Koop. I don't think there's a gap in what we're
thinking. The mission of the military is much more focused.
That of the Public Health Service is very diffuse. And I think
there's another thing that may sound silly to bring up, but of
all the uniformed services in this country, we are the only one
that is unarmed, also the only one that doesn't go by the
principles of the Uniform Code of Military Justice. So we have
certain flexibility in our ranks that the Army, Navy and the
Air Force cannot exert.
Mr. Shays. Can an employee within the Corps be ordered to
go into harm's way like they can be in the military? If there's
an epidemic somewhere, can you basically, as the Surgeon
General, basically say, you need to go there, your life is
somewhat in danger but that goes with the uniform?
Dr. Koop. That goes with the uniform. The difference comes
where, if he says, ``I'm not going,'' the Surgeon General
doesn't have the right to court martial him.
Mr. Shays. No firing squads?
Dr. Koop. Not yet. [Laughter.]
Dr. Richmond. Mr. Chairman, I don't think there is a
difference between mission and the other issues we're talking
about. But our mission is to promote the public's health. And
the difference is that we have to have professional skills in
order to do that, not just military skills.
Mr. Shays. This may seem a little trite, but it does
interest me, because uniforms are worn. I'd love to know what
the policy of yours, Dr. Koop, and Dr. Richmond were, if
someone was, when would they be required to wear a uniform if
at all? If they worked for the CDC or NIH, would they be in
uniform? Tell me how you sorted that out. Was that up to each
individual to decide?
Dr. Koop. When I came, the rule was you had to wear your
uniform at least 1 day a week. I decided, we had several things
that happened to us that really lowered morale right after I
got here. One was that the administration closed all the public
health service hospitals. Morale was very low. We lost our
educational component. I announced to the troops that if they
wore their uniform, they'd see that they had a lot of friends
suffering the same way. And I tried to stress the wearing of
the uniform more and more.
Then when the day came for the revitalization, we had a
problem in the Corps that we inherited from the Vietnam war. As
you'll recall, if one volunteered for the Public Health Service
at the time of the draft, they were exempt from the draft. We
got a number of people who joined the Public Health Service for
reasons other than pursuing public health. And we were very
unhappy to have the military refer to these people as the
``Yellow Berets,'' and they were a relatively incorrigible
group that did not like the military discipline. They are the
first people that I was anxious to do something about.
Revitalization was geared in such a way that would make life
very uncomfortable for these people and we lost 400 of them
almost immediately. So one of the rules was----
Mr. Shays. And that didn't disappoint you?
Dr. Koop. Not one bit. After that, I would say that
gradually, the uniform became something that was worn more and
more, and we had very few officers at the time I left in 1989
that spurned the uniform for reasons that were never made
clear.
Mr. Shays. Interesting. Dr. Richmond, talk to me about the
uniform, and also Captain Farrell. I just want to know, what
role does the uniform play?
Dr. Richmond. I think Dr. Koop has spoken to this point. I
think it's an important morale issue. It gives the group a
sense of identity. I think it conveys important messages to the
public about the commitment. We haven't talked all that much
about what the Commissioned Corps means.
Mr. Shays. I'd be happy to have you tell me.
Dr. Richmond. When people enter the Corps, they really have
made a commitment. That really includes, as you suggested, Mr.
Chairman, being ordered into harm's way. That is part of the
oath that they take. So it does provide a sense of identity,
and to the public, it certainly communicates the sense of
commitment that people in the Corps have.
Captain Farrell. I would agree with all that, Mr. Chairman.
The uniform brings a sense of identity, a sense of shared
common purpose, unity of purpose. It brings tremendous
visibility.
To go back to your earlier question, the decision about
uniform policy is essentially today left to the individual
agencies in which Corps officers are assigned. For instance, in
the Bureau of Prisons, officers that are assigned there are
required to wear their uniforms. It is a matter of being able
to sort out who are the good guys and who are the bad in the
prison. In Indian Health Service, you will find that most of
the officers wear their uniform most of the time. Just
recently, within the past month, Commissioner McClellan at FDA
issued an edict that from, I guess it was the beginning of
October, henceforth, all FDA commissioned officers will wear
their uniform every day. That is something that we support,
because we think the uniform adds a tremendous amount to this
shared sense of purpose.
Mr. Shays. Thank you. It looks like your oath is the same
as the oath of Congress for the most part?
Captain Farrell. That may be true. The oath is the same,
exactly the same as the other uniformed services.
Mr. Shays. Right. It also says, ``I will support and defend
the Constitution against all enemies, foreign and domestic,
that I will bear true faith and allegiance to the same, that I
take this obligation freely, without any mental reservation or
purpose of evasion, that I will well and faithfully discharge
the duties of the office for which I am about to enter, so help
me God.'' And then an affidavit as to service: ``I am willing
to serve in any area or position wherever the exigencies of the
service may recall.'' And another affidavit as to striking
against the Federal Government: ``I am not participating in any
strike against the Government of the United States or any
agency thereof, and I will not so participate while an employee
of the Government of the United States or any agency thereof.''
It's a fairly clear statement.
Before we adjourn this hearing, what would you like to put
on the record? Whatever you'd like, I'd like you to put it on
the record, however long you'd like to take to do that. Dr.
Koop, is there anything that you would like to put on the
record?
Dr. Koop. No, as I've said, when you've been chairman of
the committees before, sir, there are a lot of things you can
do that we can't do. And I think that the guidance from your
committee as to how this particular transformation should have
been done is not too late to correct. I think corrected, and
following the things you've heard from all of the witnesses
here, it can be done in such a way that we get the kind of a
Corps we want that doesn't change its character, but does put
responsibility and leadership where it belongs.
Mr. Shays. I know that Mr. Davis tends to followup on this,
with the very good staff that we have. So that will be done.
Dr. Koop. Good.
Mr. Shays. Dr. Richmond.
Dr. Richmond. I would just reinforce that notion that this
have continuity, and certainly, we admire the interest that the
committee members have demonstrated.
But I think the central message that I would like to leave
is that the Surgeon General needs to be the commanding officer
of the Corps, and that needs to be very clear.
Mr. Shays. Free from politics.
Dr. Richmond. Including policy, yes. With the oversight of
the Secretary.
Mr. Shays. Right, but I'm saying free from politics, the
ability to say what needs to be said when it needs to be said.
The irony is that when you have a Surgeon General that does
that, he or she is a credit to the administration, besides
protecting the health and welfare of all Americans. They also
in a very real way give credibility to the administration when
they do that, whatever administration.
It's a comfort to those of us who aren't in the health
field to know that if something needs to be said, we know one
person will do that, and that's the Surgeon General, that they
will say whatever needs to be said. That's essential. I was
under the reign of Dr. Koop, and I just appreciated it so much,
Dr. Koop. I never felt that you would be reluctant to say what
needed to be said. You found a gentle way to say it in most
cases, but you said it.
Captain Farrell, is there anything you would like to put on
the record?
Captain Farrell. Sir, I'd just like to add that our
association I think is encouraged and heartened by what we've
heard here today, and we certainly appreciate the committee's
interest. I would agree with Dr. Koop and Dr. Richmond that the
important thing here now is to follow through and to make sure
that the changes that are apparently taking place and the
details of the transformation plan are actually carried out,
put in writing for us all to see so we can evaluate and make
sure that the plan is moving in the direction that the Corps
officers will be able to fully support.
Mr. Shays. Thank you all very much. With that, we'll
adjourn this hearing. Thank you.
[Whereupon, at 1:05 p.m., the committee was adjourned, to
reconvene at the call of the Chair.]
[The prepared statement of Hon. Carolyn B. Maloney and
additional information submitted for the hearing record
follow:]
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