October 17, 2005
Washington, D.C.

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I am very happy to be here today because the Title V directors are so vital to so much of the work that HRSA and other federal agencies fund.
 
Your responsibilities for public health in your States go far beyond administration of the Title V program – which is a huge enough responsibility by itself.  I know that many of you also administer WIC, school health initiatives, programs for children with special health care needs, family planning programs, and even health centers in some States.
 
You play a crucial role in your State’s public health protections and the services you oversee for women and their children truly do benefit them “across their lifespan,” as the slogan of this meeting says.
 
We know, too, that many of you played enormously important roles during the disastrous hurricanes that ravaged Louisiana and her neighbors.  You sent Title V grantees into shelters to help evacuees, and then you and your own staffs filled the empty spots that those responders left in the clinics where they normally worked.
 
And I thank all of you for funneling to us so quickly the information we asked for on how your States were responding to the public health emergency caused by the hurricanes.
 
And after seeing how the stunning double disasters that hit Louisiana affected the delivery of services there, many of you now are re-examining your own preparedness and rethinking actions you might need to take to evacuate newborn nurseries or neonatal intensive care units.
 
It’s an exercise that officials at all levels of government must undertake.
 
Perhaps the most important lesson Katrina and then Rita taught us is that we have to more honestly and starkly contemplate unthinkable events.  And then we must think more deeply than we have up to now about what planning to respond to those events really entails.
 
It’s one thing to plan how to deliver services when hospitals and clinics are put out of service.  It’s another thing entirely to develop the layers of planning needed to respond to a disaster that also wipes out transportation and communications systems. 
 
And now we know that we must reconsider our assumptions about how first-responders and hospital and clinic staff can be expected to respond when they themselves are left homeless or evacuated to distant areas.
 
Our imaginations were not equal to nature’s awesome fury.  And September 11 proved that they were not equal to the worst designs of our fellow man.
 
So we all have a great deal of work ahead of us…
 
Let me now turn to updates on progress in some of HRSA’s regular programs and initiatives.
 
In this year’s National Child Health Day proclamation, President Bush reaffirmed his commitment to help schools and communities create “safe and nurturing environments” for all children and “promote a culture of responsibility.”   His commitment supports HRSA’s own efforts to prevent the harmful effects of bullying by changing the culture that allows it to persist, particularly in our schools.
 
The Journal of the American Medical Association reports that nearly 30 percent of all youth ages 11 to 15 have been a victim or perpetrator of bullying, and we’ve all seen the tragic consequences of bullying at school over the past several years.
 
We continue to build on the momentum of last year, when HRSA, with the help of Surgeon General Carmona, launched the “Take a Stand. Lend a Hand. Stop Bullying Now!” campaign.  The campaign’s website at www.stopbullyingnow.hrsa.gov recently added Spanish content for adults, along with 12 new fact sheets.  We are proud to say that 21 states now have anti-bullying laws, and HRSA is still working with our 72 partners -- from the American Academy of Pediatrics to the Departments of Justice and Education – to bring bullying to a halt.
 
Later this week HRSA will sponsor another important public meeting of the Advisory Committee on Heritable Disorders and Genetic Diseases in Newborns and Children.  Earlier this year, the American College of Medical Genetics delivered to the committee its report, which we commissioned, on the issue of Federal guidelines to help standardize screening practices among states.  The report gathered information on newborn screening, reviewed the scientific evidence, and presented options for model policies and procedures.
 
This past spring we received formal public comments on the report, which gave parents and others interested a chance to weigh in on its conclusions. The report has since been sent to HHS Secretary Mike Leavitt for his review and consideration.
 
Many of you know that HRSA is now more than halfway through our implementation of  President Bush’s health center expansion initiative.  That initiative, of course, will create or expand 1,200 health center sites and serve an additional 6 million patients annually by the end of 2006.
 
The expansion remains a priority for the President because he knows that health centers work for America.  According to the latest statistics, in 2004 health centers served an estimated 13.1 million people – close to 3 million more patients than were served in 2001 – at about 3,700 comprehensive primary care delivery sites.
 
The growth of the Health Center network not only expands access to care, it also helps reduce health disparities.  As you know, almost two-thirds of Health Center patients come from minority groups; they are the ones who will benefit most from the increased access to care and the expansion of available health care services.   And about 40% all patients treated at health centers have either no health insurance at all.
 
Through the years, health centers have built an solid record of success.  Evaluations from patients tell us that health centers offer care that rivals, and sometimes surpasses, health care found on the open market.  Health centers have improved health outcomes, increased preventive services, improved management of chronic disease, and reduced hospitalizations.
 
This underscores our belief -- that HRSA-supported health centers on the front lines of American health care are providing the best primary and preventive services to some of  our neediest friends and neighbors.

Many of you also know that HRSA administers the National Bioterrorism Hospital Preparedness Program, which has awarded close to $2 billion in grants to States since the program was established following the Sept. 11 terrorist attacks in 2001.
 
States use these funds to develop and implement regional plans to improve the ability of hospitals, emergency departments, EMS systems, and other health care organizations to respond to possible bioterror attacks and other public health emergencies.
 
Hurricane Katrina gave us a valuable glimpse into how States have invested these funds to improve their response capabilities.
 
In North Carolina, for example, State officials used beds, medical equipment and training paid for by HRSA Hospital Preparedness grants to set up a 120-bed mobile hospital in the parking lot of a K-Mart in Waveland, Miss., soon after Hurricane Katrina ravaged the area.  As of early October, the 450 medical personnel who staffed the unit on a rotating basis had treated 7,000 local residents.
 
The mobile unit was the only hospital operating in hard-hit Hancock County – considered the epicenter of Katrina’s fury – after the local hospital was flooded to its second floor during the storm.
 
The North Carolina health department put CDC and Department of Homeland Security funds together with those from HRSA to staff and outfit the State Medical Assistance Team – called the SMAT -- that operated the mobile hospital.  The SMAT operates something like a medical State National Guard.  The 900 health care professionals and trauma experts who make up the ranks of the SMAT are committed to report to duty when their team is called to service.
 
The North Carolina SMAT also got substantial private-sector support for its mission in Mississippi.  Hendrick Motorsports, a NASCAR racing company based in North Carolina, provided weekly flight between North Carolina and the Mississippi Coast that allowed the SMAT to rotate staff in and out of the area.
 
North Carolina responded to Mississippi’s request for help under guidelines established by the Emergency Management Assistance Compact, which the U.S. Congress ratified in 1996.  The compact allows States asking for aid during disasters or emergencies to honor licenses, certificates and other permits awarded by the responding State.
 
The mobile hospital is scheduled to demobilize and return to North Carolina at the end of October, by which time local hospital facilities hope to reopen.
 
Let me now talk a little bit about an effort that we started at the beginning of this year inside HRSA to take a look at how we interact with State governments and how we can improve those relationships.  And in so doing, of course, improve the delivery of services to the needy populations HRSA and the States serve.
 
MCHB’s Cassie Lauver heads up the effort, which we call the HRSA/State Partnership Committee.  Cassie and her colleagues started with an internal review of how each of HRSA’s bureaus and offices work with State officials.  They examined mechanisms for collaboration, points of contact, what worked in the past, and barriers to working well together.
 
They also sought comments from outside groups and they looked at earlier studies the recommended ways to improve collaboration inside HRSA and with our State partners.
 
We’ve learned several things.
 

• We need to communicate and collaborate internally, within HRSA, before we can honestly expect to communicate and collaborate better with our State and local partners.
  
  
• We do some things very well at HRSA, and the lessons from those successes could  be adapted to other programs.
  
  
• Our relationships with States contain both gaps and overlaps.  In both cases, we miss out on opportunities to collaborate more successfully.

Recommendations from the committee have been shared with HRSA’s leadership, and we are currently examining them and considering their merits.
 
I can tell you that improving the way HRSA shares useful information with you will be one of areas we focus on.  And in that vein, I can tell that our staff in the Office of Information Technology is working hard, right now, to improve the user-friendliness of the HRSA Geospatial Data Warehouse.
 
For those who may not know about it, the Data Warehouse gives the public access to an incredible range of HRSA information on grants and grantees, and health and demographic statistics.  And the software allows you to plot these investment on a map you build on your computer.
 
Earlier this month the Data Warehouse was honored with one of 10 awards for innovative technology by the magazine Government Computer News.  It’s amazing technology and we’re very proud that we developed it.
 
But many of you have said you want to see us improve the data we offer and make it easier for you to access and use.
 
My OIT people tell me that, in response, they updated the Warehouse to give you easier access to reports of HRSA grants in your States.  They also say that new and improve State and County profiles were included in the update, with plenty of charts and graphs.
 
And we’re not done yet.  OIT staff will continue working to make the Data Warehouse easier to use, with the right data at the right time in the right format, so that you can use the information you find there to improve the programs you operate.
 
Finally, I guess you all now that the Fiscal Year 2006 budget remains in discussion in Congress and that the government is operating under a continuing resolution.
 
Reauthorization of the Ryan White CARE Act, whose current authorization ended with the Sept. 30 end of Fiscal Year 2005, also remains in debate at Congress.
 
Last year President Bush stated his commitment to reauthorize CARE Act based on these principles:
 

• focusing Federal resources on life-extending care;
• ensuring flexibility to target resources to address areas of greatest need;
• and ensuring results.

The President’s FY 2006 budget asks for $2.1 billion in CARE Act activities, a slight increase over FY 2005, with the extra funds going to provide additional funding for the State AIDS Drug Assistance Program. The FY 2006 request is more than $275 million more than the appropriation in FY 2001, when President Bush came into office.
 
Finally, let me tell you that the grantee performance review schedule for Calendar Year 2006 is now available on the web at http://www.hrsa.gov/performancereview.   That site also contains a copy of the Performance Review Protocol, the protocol guide, and other relevant review documents you might find useful.
 
Thank you for listening.  It has been a pleasure to be with you today.