September 19, 2005
Miami Beach, Fla.

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I’m glad to be here to talk with all of you.
 
All of us at the Department of Health and Human Services have been thrown into the response to the public health disaster caused by Hurricane Katrina, so I want to spend most of my time today telling you about that, about the damage the storm did to the health center network, and about the role health centers have played in helping evacuees.
 
Then I’ll discuss health center issues we normally talk about and tell you about some agency initiatives.
 
When Hurricane Katrina hit the Gulf Coast, HRSA and the Department launched a full-scale push to get essential health care services to the suffering residents of Louisiana, Mississippi, and Alabama as quickly as possible.
 
But the immense evacuation caused by the hurricane quickly forced us to expand our focus from delivering services in these hardest-hit areas to also include the “ring States” where evacuees ended up.
 
All of us dropped whatever else we were doing to enlist in the response.  My deputy administrator, Dennis Williams, other top staff and I left HRSA’s headquarters in Rockville to help formulate the overall Department effort from the Humphrey building downtown.
 
The crush of the catastrophe forced all of us to work on several fronts at once:
 

• We worked as fast as we could to take stock of which HRSA assets in the disaster area were destroyed or off-line and which were still operating;
  
  
• For HRSA grantees still operating, we made provisions to tap their assets to deliver care to the injured and evacuees;
  
  
• We identified available HRSA’s Commissioned Corps personnel and sent them where they were most urgently needed; and
  
  
• We examined changes we could make to programs or policies to get help to the region faster.

The news is good in many areas.   Although many grantee sites were destroyed or inoperable, many other sites are up and running, and serving more patients than ever before. 
 
HRSA’s program staff did an incredible job of contacting and monitoring the condition of our grantees.  We continue to do that, trying to help grantees in any way that we can, and asking those that managed to remain open to help in the recovery.  They have done incredible, incredible work under very difficult conditions.
 
First, let me update you on the status of health centers along the affected Gulf Coast. As many of you know, health centers were hit very hard in Louisiana and Mississippi.
 
In Louisiana, 9 of the State’s 60 health center sites are closed -- considered destroyed -- and not expected to reopen.  All of the destroyed sites are in New Orleans.   Another 4 sites remain closed but are expected to reopen: that total includes 3 sites in Greensburg, northwest of Lake Pontchartrain, and 1 in River Ridge, just west of New Orleans. 
 
In Mississippi, 2 of the State’s 149 health center sites are destroyed: one in Gulfport and one in Bay St. Louis.  The storm also destroyed two mobile health care delivery units that served Biloxi.  Another 6 health center sites – two in Moss Point and one each in Biloxi, Gulfport, Columbia and Hattiesburg -- remain closed but are expected to reopen.
 
In Alabama, none of the State’s 155 health center sites was destroyed.
 
I promise you that HRSA will do everything possible to support the health centers that need to rebuild and reopen.
 
In that vein, I urge damaged centers to get included in claims for funds that state and local governments will submit to FEMA’s Public Assistance Program.  The program will reimburses 75% of the cost to rehab and restore public and private not-for-profit hospitals, clinics, and rehabilitation and long-term care facilities damaged by disasters.
 
The response to the evacuee emergency by health centers in the region covered by the  public emergency declaration – which includes the States where the hurricane went through and the “ring States” that accepted evacuees – has been very impressive.
 
As of Sept. 14, health centers in those areas had enrolled 41,760 people to receive services since Katrina hit.
 
This whole experience led us to acknowledge that health centers would benefit from knowing more about what is expected of them in responding to emergencies like the one caused by Katrina.  So I directed Primary Health Care staff to work with grantees on this issue.  We hope to have some guidelines ready in the next few months.
 
Other HRSA assets also were deeply involved in providing care.  Our Healthy Start and Maternal and Child Health grantees increased services to almost 45,000 women and children.
 
Let me tell you what two Healthy Start grantees in Texas have done.  A medical mobile unit from the Healthy Start grantee in Laredo was driven to Baton Rouge at the request of the Red Cross and deployed to help evacuees there.
 
And a second mobile Healthy Start unit from San Antonio went to Biloxi to serve as a central location for medical services and counseling.  Those two sites serve more than 1,000 individuals daily, and are in operation 18 hours a day.
 
Another 126 patients have received services outside of their hometown from other Ryan White CARE Act grantees.  This assistance is especially crucial, since strict maintenance of the drug regimen they receive though local ADAPs is literally the difference between life and death for them.
 
As I said, one of our most important efforts was to identify HRSA staff scattered across the nation who could help.  To date, we have sent about 10 percent of HRSA’s total staff – 200 Commissioned Corps officers out of a total agency workforce of just under 2,000 – to deliver direct health care to hurricane victims.
 
We began to deploy our Commissioned Corps to the Gulf area even before the hurricane hit early Aug. 29.  The 200 have come from the following HRSA entities:
 

• 81 from Health Professions, including 47 Ready Responders, the cadre of first responders we formed after 9-11;
  
  
• 48 from Primary Health Care, including 25 from the Division of Immigration Health Services and 2 from the Hansen’s Disease Center in Louisiana;
  
  
• 20 from our Office of Performance Review;
  
  
• 19 from the HIV/AIDS program;
  
  
• 12 each from the Office of the Administrator and Healthcare Systems; and
  
  
• 8 from the Maternal and Child Health.

HRSA’s folks made up a fifth of the 1,000 U.S. Public Health Service officers that HHS ordered into the region.  The Department’s response to Katrina, which also included tons of supplies, has been the largest public health relief operation in U.S. history.
 
We took a number of steps to get resources more quickly to the area.
 
On September 9, HHS Secretary Mike Leavitt acted on a recommendation we had forwarded to him, and announced that the Department would speed up the delivery of 26 New Access Point grants in areas impacted by the hurricane.  The advanced funds, which were scheduled to be awarded in December, will go to 9 grantees in Texas, 5 in Louisiana, 4 each in Florida and Oklahoma, 2 in Georgia and 1 each in Mississippi and Tennessee.  Organizations receiving the advanced funds already had won the grants – we announced those in an April 11 press release – but the initial distribution of funds was to occur in December.  Thanks to the Secretary’s quick action in response to our recommendation, those funds are out today.
 
We advised States covered by the emergency that they may use program funds from HRSA’s National Bioterrorism Hospital Preparedness Program to address immediate emergency health care needs.
 
We also made it easier for safety-net health care entities enrolled in the 340B drug pricing program to fill low-cost prescriptions for evacuees.  According to the law, only “patients” of health care entities can qualify.  So we determined that health care providers can quickly evaluate evacuees and make them “patients” by filling out an abbreviated health record.  In cases where patients have no identification or insurance cards, self-reporting is adequate.
 
We’re working to expedite processing of National Health Service Corps (NHSC) Loan Repayment applications for clinicians who want to serve in high-need sites in states under the Public Health Emergency.  This means that clinicians serving in these high-need sites could receive their first payments from NHSC up to 6 months earlier than without expedited processing.  Expedited processing is available in all states for sites with HPSA scores of 14 or higher.  High-need sites in States covered by the Emergency Declaration will be defined as those with a HPSA score of 12 or higher.
 
We’re also getting set this week to expedite the process for designating HPSAs to help states covered by the Emergency Declaration recruit clinicians more quickly.  A conference call with State Primary Care Offices and State Primary Care Associations will be held later this week to review the new procedures and help States address new areas of need.  A written notice will be developed following the conference call.   A minimum amount of data collection will be required if new HPSA areas are requested, and there will be no more than a 48-hour turnaround once the required information is submitted to HRSA.  And if States not included in the Emergency Declaration can identify areas affected by the hurricane and provide a justification, they also may be eligible for the accelerated designation process.
 
Finally, we’re using our Internet resources to try to get technical assistance and guidance out to grantees as quickly as possible.  As of last week, the “Frequently Asked Questions and Answers” page on HRSA’s Hurricane Katrina site (www.hrsa.gov/katrina) had responded to 51 questions we received from grantees about emergency services in the wake of the disaster.
 
Now let me turn to some non-Katrina issues I know you’re interested in.  First, the issue of performance reviews of health center grantees.
 
Our Office of Performance Review has completed 450 performance reviews of HRSA grantees.  A little more than 250 of those reviews – about 55% – were of health centers.
 
So far, we have received very positive feedback from grantees, especially with respect to the focus on performance outcomes.  This focus is consistent with Federal government and industry trends placing more attention on performance and the need to demonstrate the impact of programs on populations served.
 
In addition, grantees have raised many other issues that we are beginning to address.  One issue asked us to figure out a way to answer questions that could be shared with all grantees.  We took this suggestion to heart and decided to set up a Q&A page on the Web to get information to grantees following the hurricane.  Other topics we’re working on include:
 

• CMS reimbursement issues;
• technical assistance resources available to grantees;
• streamlined and improved data requirements, including performance measures for grantees that focus more on outcomes and less on process; and
• improved coordination with the Indian Health Service.   

Support of the Health Disparities Collaboratives is a vital element in HRSA’s status as a model for primary care in quality and chronic care management. 
 
Health centers and their patients increasingly see the value of participating in the Collaboratives, especially in the last two years. 
 
After starting with 1,685 patients in March of 1999, Collaboratives have enrolled over 400,000 (401,212) patients as of July 2005.
 
In the diabetes registry, health center patients are seeing improved clinical outcomes.  The results are dramatic.  Contrary to national trends, health centers are seeing decreases in our diabetes rates!  Patients’ average HbA1c is currently at 7.87, down from 7.96 last year at the same time.
 
We see these results even as the total diabetes registry has increased from 15,045 in July 2000 to 249,032 patients by July of this year.
 
I have a little bit more information on implementation of Medicare’s Prescription Drug Coverage than I shared with you at the all-grantee meeting in June.
 
As you know, HRSA’s sister agency, the Centers for Medicare and Medicaid Services – CMS – has the lead on the implementing the new program, which will extend prescription drug coverage for the first time to all 43 million Medicare beneficiaries, giving them substantial help in paying for their drugs.
 
It’s now time for everyone with Medicare to start thinking about their options under the new plan.  Some important dates are arriving soon:
 
Later this week, I’m told, CMS will announce the list of all approved Medicare prescription drug plans.   On Oct. 1, the drug plans will begin marketing coverage options to beneficiaries.
 
October also will mark the beginning of CMS’ massive public education campaign to explain the new prescription drug coverage.  Specifically, a copy of the “Medicare & You 2006 Handbook” will be available on CMS’ website on Oct. 1.  And every Medicare beneficiary should have received a copy by mail by Oct. 15. 
 
In late October, CMS will mail auto-enrollment information to dual-eligible Medicare beneficiaries to inform them of the drug plan they will be enrolled in unless they select a different one. 
 
Medicare beneficiaries can begin to enroll in a specific plan on Nov. 15; coverage, of course, begins Jan. 1.
 
HRSA’s goal, of course, is to help CMS implement the new drug benefit as smoothly as possible.  As we receive additional information from CMS, HRSA will do our part to help our grantees and their patients understand their choices and make good decisions.
 
Let me gloat for a minute about the increases in organ donation that our Organ Donation Breakthrough Collaboratives have sparked over the last couple of years.
 

• Last month – August 2005 – set a new record for the most organ donors ever in a month.  There were 687 organ donors in the month of August, a full 53 donors more than August 2004.
• Each of the last 20 months has set a new high in organ donation for that month.
• In 2004, organ donation increased by a record 10.8 percent over 2003.  This translates into nearly 1,400 additional life-saving transplants.
• And with the August 2005 results now in, the first 8 months of 2005 are 8.3 percent higher than the 2004 numbers for the same time period!  Back-to-back increases of this level are absolutely unprecedented in an area that typically has registered increases of 1% to 3% annually. 

Our staff in the Division of Transplantation has done fantastic work and we are all very proud of the results.
 
The second annual Border Binational Health Week is scheduled for October 10-16.
 
The theme for the week’s activities is “Families in Action for Health.” Community organizations will sponsor events ranging from health fairs to diabetes seminars and other wellness conferences on both sides of the entire U.S.-Mexico border.
 
Planning for this event includes HRSA – which is again leading the Department’s efforts --  and partners at the U.S.-Mexico Border Health Commission, the U.S.-Mexico Border Health Association, Mexico’s Ministry of Health, and the Pan-American Health Organization.
 
I told you earlier that we sent nearly 200 of HRSA’s Commissioned Corps officers and staff to the disaster areas to deliver direct medical care.  All of them share incredible stories of dedication and service to their fellow citizens, believe me.  I’d like to share one with you now.
 
It’s about a nurse named Nettie Debisette, a commander in the Commissioned Corps.  In quiet times, Nettie is the senior advisor to Kerry Nesseler, the associate administrator for  Health Professions.
 
The day before the hurricane hit Nettie flew to Jackson, Miss., where she and 38 of her Corps colleagues spent the day of the hurricane, Monday, Aug. 29, watching Katrina pass through after slamming into the Gulf Coast.  The next day, Nettie and her team organized themselves and their medical supplies into a convoy of 18 minivans, and took off for Baton Rouge. Their destination was the Pete Maravich Athletic Center, the Louisiana State University’s basketball arena – maybe you saw it shown on TV coverage.
 
They arrived about 9 p.m. Tuesday and immediately began installing a huge field hospital in the arena, opening up beds and setting up a pharmacy, labs and treatment areas. 
 
Soon after, helicopters began to arrive from New Orleans, landing three abreast on a nearby track and field facility.
 
Doctors and nurses assessed the condition of arriving patients outside and then transferred those needing immediate care inside the arena for treatment.   Nettie was in charge of the facility’s Intensive Care Unit and oversaw the work of 10 other nurses who joined her on the night shift, from 6 p.m. to 6 a.m.
 
After patients from the Superdome began arriving by bus at the field hospital later in the week, the facility had grown to 800 beds.  At that point, Nettie told me, there wasn’t a bed available anywhere.   Most of the injuries she treated were for dehydration, diabetes, or hypertension. 
 
By the time the hospital closed Sept. 7, 6,000 people had been treated there, with all of those who passed through either transferred to other hospitals in the area, sent to shelters, or reunited with family members.
 
Nettie and her group slept at first in buses with 12 berths and a bathroom.  Later they transferred into a large dormitory set up in the basement of the arena.
 
I think what stuck with me most in Nettie’s recollection was that she remembered her patients, all 6,000 of them, as “the nicest and most appreciative people.”
 
That’s the kind of people we have working at HRSA.  It’s a big part of the reason I’m proud to lead the agency.
 
Let me close by saying that it was great to see many of you in June during the BPHC all-grantee meeting.  Your evaluations told us that 78% of the people who attended were very satisfied with the conference.  We are still making it a priority for project officers to travel to visit your sites.
 
And I want to express my personal gratitude to the Primary Health Care leadership at HRSA.  Michelle, Don, Neil and their staff are doing a great job implementing President’s expansion initiative, supporting those of you affected by the hurricane, and tending to ongoing business to help you do the best job possible for the people you serve.
 
Thank you for listening.  And thank you for all the work you do in service to the people of America.