[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
EXAMINING PUBLIC HEALTH LEGISLATION TO HELP LOCAL COMMUNITIES
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 20, 2013
__________
Serial No. 113-101
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
______
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COMMITTEE ON ENERGY AND COMMERCE
FRED UPTON, Michigan
Chairman
RALPH M. HALL, Texas HENRY A. WAXMAN, California
JOE BARTON, Texas Ranking Member
Chairman Emeritus JOHN D. DINGELL, Michigan
ED WHITFIELD, Kentucky FRANK PALLONE, Jr., New Jersey
JOHN SHIMKUS, Illinois BOBBY L. RUSH, Illinois
JOSEPH R. PITTS, Pennsylvania ANNA G. ESHOO, California
GREG WALDEN, Oregon ELIOT L. ENGEL, New York
LEE TERRY, Nebraska GENE GREEN, Texas
MIKE ROGERS, Michigan DIANA DeGETTE, Colorado
TIM MURPHY, Pennsylvania LOIS CAPPS, California
MICHAEL C. BURGESS, Texas MICHAEL F. DOYLE, Pennsylvania
MARSHA BLACKBURN, Tennessee JANICE D. SCHAKOWSKY, Illinois
Vice Chairman JIM MATHESON, Utah
PHIL GINGREY, Georgia G.K. BUTTERFIELD, North Carolina
STEVE SCALISE, Louisiana JOHN BARROW, Georgia
ROBERT E. LATTA, Ohio DORIS O. MATSUI, California
CATHY McMORRIS RODGERS, Washington DONNA M. CHRISTENSEN, Virgin
GREGG HARPER, Mississippi Islands
LEONARD LANCE, New Jersey KATHY CASTOR, Florida
BILL CASSIDY, Louisiana JOHN P. SARBANES, Maryland
BRETT GUTHRIE, Kentucky JERRY McNERNEY, California
PETE OLSON, Texas BRUCE L. BRALEY, Iowa
DAVID B. McKINLEY, West Virginia PETER WELCH, Vermont
CORY GARDNER, Colorado BEN RAY LUJAN, New Mexico
MIKE POMPEO, Kansas PAUL TONKO, New York
ADAM KINZINGER, Illinois JOHN A. YARMUTH, Kentucky
H. MORGAN GRIFFITH, Virginia
GUS M. BILIRAKIS, Florida
BILL JOHNSON, Ohio
BILLY LONG, Missouri
RENEE L. ELLMERS, North Carolina
7_____
Subcommittee on Health
JOSEPH R. PITTS, Pennsylvania
Chairman
MICHAEL C. BURGESS, Texas FRANK PALLONE, Jr., New Jersey
Vice Chairman Ranking Member
ED WHITFIELD, Kentucky JOHN D. DINGELL, Michigan
JOHN SHIMKUS, Illinois ELIOT L. ENGEL, New York
MIKE ROGERS, Michigan LOIS CAPPS, California
TIM MURPHY, Pennsylvania JANICE D. SCHAKOWSKY, Illinois
MARSHA BLACKBURN, Tennessee JIM MATHESON, Utah
PHIL GINGREY, Georgia GENE GREEN, Texas
CATHY McMORRIS RODGERS, Washington G.K. BUTTERFIELD, North Carolina
LEONARD LANCE, New Jersey JOHN BARROW, Georgia
BILL CASSIDY, Louisiana DONNA M. CHRISTENSEN, Virgin
BRETT GUTHRIE, Kentucky Islands
H. MORGAN GRIFFITH, Virginia KATHY CASTOR, Florida
GUS M. BILIRAKIS, Florida JOHN P. SARBANES, Maryland
RENEE L. ELLMERS, North Carolina HENRY A. WAXMAN, California (ex
JOE BARTON, Texas officio)
FRED UPTON, Michigan (ex officio)
(ii)
C O N T E N T S
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Page
Hon. Joseph R. Pitts, a Representative in Congress from the
Commonwealth of Pennsylvania, opening statement................ 1
Prepared statement........................................... 2
Hon. Tim Murphy, a Representative in Congress from the
Commonwealth of Pennsylvania, opening statement................ 66
Hon. Kathy Castor, a Representative in Congress from the State of
Florida, opening statement..................................... 67
Hon. John Shimkus, a Representative in Congress from the State of
Illinois, opening statement.................................... 67
Hon. Marsha Blackburn, a Representative in Congress from the
State of Tennessee, opening statement.......................... 67
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 68
Prepared statement........................................... 68
Hon. Ed Whitfield, a Representative in Congress from the
Commonwealth of Kentucky, opening statement.................... 69
Hon. Henry A. Waxman, a Representative in Congress from the State
of California, opening statement............................... 69
Prepared statement........................................... 70
Hon. Fred Upton, a Representative in Congress from the State of
Michigan, prepared statement................................... 194
Witnesses
Marsha Ford, President, American Association of Poison Control
Centers........................................................ 90
Prepared statement........................................... 93
Answers to submitted questions............................... 196
Steven J. Stack, Immediate Past Chair, Board of Trustees,
American Medical Association................................... 100
Prepared statement........................................... 102
Answers to submitted questions............................... 200
Drew Nagele, Board of Directors, Brain Injury Association of
America........................................................ 107
Prepared statement........................................... 109
Edward R.B. McCabe, Senior Vice President and Chief Medical
Officer, March of Dimes Foundation............................. 112
Prepared statement........................................... 114
Patricia V. Smith, President, Lyme Disease Association, Inc...... 120
Prepared statement........................................... 122
Laura Crandall, Program Director, Sudden Unexplained Death in
Childhood Program.............................................. 130
Prepared statement........................................... 132
Robert MtJoy, Chief Executive Officer, Cornerstone Care, Inc..... 145
Prepared statement........................................... 147
Answers to submitted questions............................... 210
Submitted Material
H.R. 1098, the Traumatic Brian Injury Reauthorization Act of
2013, submitted by Mr. Pitts................................... 3
H.R. 1281, the Newborn Screening Saves Lives Reauthorization Act
of 2013, submitted by Mr. Pitts................................ 6
H.R. 610, A Bill to provide for the establishment of the Tick-
Borne Diseases Advisory Committee, submitted by Mr. Pitts...... 19
H.R. 669, the Sudden Unexpected Death Data Enhancement and
Awareness Act, submitted by Mr. Pitts.......................... 25
H.R. 2703, the Family Health Care Accessibility Act of 2013,
submitted by Mr. Pitts......................................... 47
H.R. --------, the Poison Center Network Act, submitted by Mr.
Pitts.......................................................... 53
H.R. --------, the National All Schedules Prescription Electronic
Reporting Reauthorization Act of 2013, submitted by Mr. Pitts.. 58
Letter of November 20, 2013, from Carmen A. Catizone, Executive
Director Secretary, National Association of Boards of Pharmacy,
to Mr. Pitts and Mr. Pallone, submitted by Mr. Pitts........... 72
Statement, dated November 20, 2013, of the National Association
of Chain Drug Stores, submitted by Mr. Pitts................... 75
Letter of November 19, 2013, from the National Organization for
Injury and Violence Prevention to Mr. Upton and Mr. Waxman,
submitted by Mr. Pitts......................................... 82
Letter of November 19, 2013, from Barbara E. Murray, President,
Infectious Diseases Society of America, to Mr. Upton, et al.,
submitted by Mr. Pitts......................................... 84
Letter of November 19, 2013, from Martha A. Roherty, Executive
Director, National Association of States United for Aging and
Disabilities, to Mr. Upton and Mr. Waxman, submitted by Mr.
Pitts.......................................................... 86
Letter of November 20, 2013, from the Alliance to Prevent the
Abuse of Medicines to Mr. Whitfield, submitted by Mr. Pitts.... 88
Letters of endorsement, dated February 28 through November 20,
2013, submitted by Mr. Pallone................................. 156
Statement of Hon. Bill Pascrell, Jr., a Representative in
Congress from the State of New Jersey, dated November 20, 2013,
submitted by Mr. Pallone....................................... 184
EXAMINING PUBLIC HEALTH LEGISLATION TO HELP LOCAL COMMUNITIES
----------
WEDNESDAY, NOVEMBER 20, 2013
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 3:00 p.m., in
room 2123, Rayburn House Office Building, Hon. Joseph R. Pitts
(chairman of the subcommittee) presiding.
Members present: Representatives Pitts, Burgess, Whitfield,
Shimkus, Murphy, Blackburn, Lance, Griffith, Bilirakis,
Pallone, Green, Barrow, Castor, and Waxman (ex officio).
Staff present: Noelle Clemente, Press Secretary; Brenda
Destro, Professional Staff Member, Health; Brad Grantz, Policy
Coordinator, Oversight and Investigations; Sydne Harwick,
Legislative Clerk; Katie Novaria, Legislative Clerk; Andrew
Powaleny, Deputy Press Secretary; Chris Sarley, Policy
Coordinator, Environment and the Economy; Heidi Stirrup, Policy
Coordinator, Health; Ziky Ababiya, Democratic Staff Assistant;
Elizabeth Letter, Democratic Assistant Press Secretary; and
Anne Morris Reid, Democratic Professional Staff Member.
Mr. Pitts. Thank you for your patience. I ask all guests
please take their seats. The subcommittee will come to order.
The Chair will recognize himself for an opening statement.
OPENING STATEMENT OF HON. JOSEPH R. PITTS, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA
Today's legislative hearing examines seven important
bipartisan public health bills aimed at improving the health of
our families and communities. They are H.R. 1098, the Traumatic
Brain Injury Reauthorization Act of 2013 introduced by
Representative Bill Pascrell, which reauthorizes programs at
the Centers for Disease Control and Prevention, CDC, to reduce
the incidents of traumatic brain injury, TBI, and TBI
surveillance systems and registries; H.R. 1281, the Newborn
Screening Saves Lives Reauthorization Act of 2013 introduced by
Representative Lucille Roybal-Allard, which reauthorizes
Federal programs that provide assistance to States to improve
and expand their newborn screening programs; H.R. 610, a bill
to provide for the establishment of the Tick-Borne Diseases
Advisory Committee introduced by Representative Chris Smith to
ensure interagency coordination and communications on these
diseases; H.R. 669, the Sudden Unexpected Death Data
Enhancement and Awareness Act, introduced by Ranking Member
Pallone which provides for grants to help improve the
understanding of sudden unexpected death; H.R. 2703, the Family
Healthcare Accessibility Act of 2013 introduced by
Representative Tim Murphy, which would provide Federal Tort
Claims Act protection for health care professionals who
volunteer their time at community health centers; H.R. 3527,
the Poison Control Centers Reauthorization Act, a very well-
crafted bill introduced by Representative Lee Terry and will
reauthorize important activities related to poison control
centers; and H.R. 3528, National All Schedules Prescription
Electronic Reporting, NASPER, Reauthorization Act introduced by
Representative Ed Whitfield, which will reauthorize the NASPER
program to support State prescription drug monitoring programs.
[The prepared statement of Mr. Pitts follows:]
Prepared statement of Hon. Joseph R. Pitts
The subcommittee will come to order.
The Chair will recognize himself for an opening statement.
Today's legislative hearing examines seven important,
bipartisan public health bills aimed at improving the health of
our families and communities. They are:
H.R. 1098--the Traumatic Brain Injury
Reauthorization Act of 2013, introduced by Rep. Bill Pascrell,
which reauthorizes programs at the Centers for Disease Control
and Prevention (CDC) to reduce the incidence of traumatic brain
injury (TBI), and TBI surveillance systems and registries.
H.R. 1281--the Newborn Screening Saves Lives
Reauthorization Act of 2013, introduced by Rep. Lucille Roybal-
Allard, which reauthorizes Federal programs that provide
assistance to States to improve and expand their newborn
screening programs.
H.R. 610--a bill to provide for the establishment
of the Tick-Borne Diseases Advisory Committee, introduced by
Rep. Chris Smith to ensure interagency coordination and
communication on these diseases.
H.R. 669--the Sudden Unexpected Death Data
Enhancement and Awareness Act, introduced by Ranking Member
Pallone, which provides for grants to help improve the
understanding of sudden unexpected death.
H.R. 2703--the Family Health Care Accessibility
Act of 2013, introduced by Rep. Tim Murphy, which would provide
Federal Torts Claim Act protection for health care
professionals who volunteer their time at community health
centers.
H.R. ----, the Poison Control Centers
Reauthorization, will be introduced by Rep. Lee Terry, and will
reauthorize important activities related to poison control
centers.
And H.R. ----, National All Schedules Prescription
Electronic Reporting (NASPER) Reauthorization Act, will be
introduced by Rep. Ed Whitfield, will reauthorize the NASPER
program to support State prescription drug monitoring programs.
I look forward to hearing from our witnesses, and I'd like
to yield time to some of the sponsors of these bills.
[The information follows:]
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Mr. Pitts. I look forward to hearing from all of our
witnesses, and I would like to yield the balance of my time to
Dr. Murphy from Pennsylvania.
OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA
Mr. Murphy. Thank you, Mr. Chairman. Health centers are
quality low cost medical homes for millions, but they are more
than just doctor's offices. They are a place where a child sees
a pediatrician and an adult gets a checkup from their
internist, someone can see the dentist or receive mental health
care or prenatal care. Together, medical professionals at
health centers coordinate care and work as a team saving nearly
$25 billion each year, money that would otherwise be spent on
caring for sicker patients in emergency rooms. That is the good
news. But the sad news is there is a serious shortage of
providers, and no matter how great the center, families can
experience long delays because of the shortage.
Health centers located in medically underserved urban or
rural areas report a 27 percent shortage of dentists, a 26
percent shortage of OB/GYNs, a 13 percent shortage of family
physicians, and there are also shortages of psychiatrists and
psychologists. The centers simply do not have enough money to
hire additional staff required to cover the growing patient
needs, but there is an answer.
Part-time and semi-retired health professionals want to
help out but are unable to volunteer because of Federal
barriers. Oddly enough, at Federal free clinics, volunteer
providers receive medical malpractice coverage by the Federal
Torts Claim Act. On the other hand, doctors and professionals
employed by health centers are covered by the Federal Torts
Claim Act, but volunteers at health centers don't get that
liability protection, which then costs the centers thousands of
dollars, and in some cases, well over 100,000 per year for
these extra doctors. Clinics cannot afford that extra expense.
The Government Accountability Office has found that medical
liability insurance costs poses a significant barrier for
providers who otherwise would be eager to volunteer at health
centers. The Family Health Care Accessibility Act fixes this
disparity and opens the door for volunteer providers at clinics
all over the country.
I want thank Chairman Pitts and Chairman Upton for holding
this hearing, and my partner, a friend of this legislation,
Gene Green of Texas. I also want to thank Bob MtJoy of
Cornerstone Care in Washington, Greene County, for being here
today to testify about the potential for this legislation to
help millions of families. We have a chance to do something to
expand care to millions of Americans with this act without
raising the bills for families or taxpayers. This is an example
of real bipartisan reform that helps people get the health care
they need, when they need it close to home at an affordable
cost. Isn't that what we all want in health care? Thank you,
and I yield back.
Mr. Pitts. The Chair thanks the gentleman. Now yields 5
minutes to the lady from Florida, Ms. Castor, filling in for
Ranking Member Pallone.
OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF FLORIDA
Ms. Castor. Well, thank you very much, Mr. Chairman, for
calling this hearing today examining public health legislation
to help our local communities. We are grateful to the public
health experts, who we will hear from today, and I would also
like to commend many of my colleagues who have offered
legislation to combat some of the most serious public health
problems facing many of our families all across this country,
particularly when it comes to health centers, when it comes to
newborn screening, poison control, and the terrible problem I
am going to talk about a little bit later of pill mills and how
we monitor the prescription drug abuse. So, thank you again,
and at this time I am happy to yield to Mr. Waxman. Otherwise,
he could take a full 5 minutes if he would like.
Mr. Waxman. I am going to wait till my turn.
Ms. Castor. OK. Then I will yield back. Thank you.
Mr. Pitts. The Chair recognizes the gentleman from
Illinois, Mr. Shimkus, for 5 minutes.
OPENING STATEMENT OF HON. JOHN SHIMKUS, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF ILLINOIS
Mr. Shimkus. Thank you, Mr. Chairman. My job is really to
stall for Mr. Whitfield to get here, but since--that is a joke,
so. It is good to have you-all here. What I--we get a lot of
health care providers come to talk with us on public policy all
the time, and what I always ask them in the end when they leave
is to help us on the budgetary debate because we can authorize
all we want, but if we don't solve or major budgetary problem,
the discretionary budget keeps shrinking, which means less
appropriations for the authorized committee, so you-all could
help. I am not asking you to lobby, but I do ask you to get a
good understanding of our real budgetary problems here and help
us in that discourse.
Mr. Chairman, there is also another bill that I am not
trying to put pressure, but I just want you to put on your
record. It is H.R. 1252. We have got 90 cosponsors. It is
called, ``The Access to Care in Rural Communities,'' and it is
really about physical therapy being defined within the primary
health service for the purpose of the Health Services
Corporation, and if you would take a look at that, that is
bipartisan, and as we are talking about other bills that can be
very helpful, I think that would be helpful for rural America.
And with that, I would offer to the--Marsha Blackburn for
as much time as she may consume.
OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TENNESSEE
Mrs. Blackburn. I thank the gentleman from Illinois for
yielding, and I just want to welcome each of you and to commend
you for the work that you do and the role that you play, not
only in delivering health care services but in the education
component that is so vitally important to so many health care
consumers, especially young moms, those that have experienced
traumatic injury. It is something that many times we do not put
enough emphasis upon, and I appreciate that many of you are
dedicated to that as a part of your core mission. With that, I
yield back to the gentleman.
Mr. Shimkus. The gentlelady yields, and I yield back to
you, Mr. Pitts.
Mr. Pitts. Would you yield to Mr. Pallone, please?
Mr. Shimkus. I would be honored to yield to the ranking
member of the subcommittee.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you. I am not going to take up time
because I know that Ms. Castor spoke on behalf of the
Democrats, but I just wanted to thank--well, I should say a
very special welcome to Laura Crandall from New Jersey. She and
I have worked together for many years on the bill, my bill that
is before the subcommittee today, and I just want to say that
your strength and determination is commendable, so thank you.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Pallone follows:]
Prepared statement of Hon. Frank Pallone, Jr.
Thank you, Chairman Pitts, and thank you to our witnesses
for being here today; a very special welcome to Laura Crandall
from New Jersey. She and I have worked together for many years
on my bill that is before the subcommittee today. Your strength
and determination is commendable.
I am happy that the subcommittee is having this hearing and
moving forward with several public health bills. It is an
important function of this subcommittee to examine public
health priorities and to move legislation to promote and
protect the public health. I would like to say a few words
about each of the seven bills before us today.
Firstly, I am particularly pleased that we will be
examining a bill that I introduced, H.R. 669, the Sudden
Unexpected Death Data Enhancement and Awareness Act. Stillbirth
and sudden unexpected infant death affect tens of thousands of
families every year, according to data from CDC, and sudden
infant death syndrome is the leading cause of death for infants
up to 12months old. However, we currently lack the
comprehensive, high-quality data we need to help better
understand this problem.
My bill seeks to enhance CDC's activities in this area and
would expand and standardize surveillance and data collection
for stillbirth and sudden unexpected infant death and develop
protocols and training for medical examiners for investigating
these tragic deaths. I would like to submit for the record
endorsement letters from 24 organizations, including the CJ
Foundation, the American Academy of Pediatrics, and First
Candle.
I am proud to be a cosponsor of another bill we will
examine today. H.R. 1098, the Traumatic Brain Injury
Reauthorization Act of 2013, was authored by my friend and
colleague from New Jersey, Mr. Pascrell. Traumatic brain injury
(or ``TBI'') has been dubbed ``the silent epidemic,'' with at
least 1.7 million TBI's occurring every year in the United
States, manycausing death or permanent disability. This bill
would continue efforts to advance better surveillance,
prevention, and treatment of this serious public health
problem.
We will also cover today, the Newborn Screening Saves Lives
Reauthorization Act of 2013, which would update the 2008 law
that established national newborn screening guidelines by
expanding and improving State screening programs, parent and
provider education, and follow-up care. Newborn screening
allows thousands of infants every year the chance to recognize
and manage detectable conditions early on, and it improves
their chances of a more positive health outcome and better
quality of life.
We will also hear from our witnesses on H.R. 610, a bill
that would establish a Tick-Borne Diseases Advisory Committee
within the Office of the Secretary of Health and Human Services
to prioritize and coordinate efforts to address tick-borne
diseases like Lyme disease. CDC estimates there are 300,000
cased of Lyme disease every year, and it is my understanding
thatLyme disease is a growing threat in the United States, due
to ecological changes and changes in land use over the past few
decades that have increased the number and proximity to humans
of wild animal Lyme hosts and the ticks that can spread it to
humans.
The fifth bill we will look at today is H.R. 2703, the
Family Health Care Accessibility Act of 2013, which would
decrease barriers to healthcare professionals volunteering at
community health centers (or ``CHCs''). CHCs provide vital
access to care, especially for those underserved and vulnerable
populations who can benefit most from the comprehensive,
quality primarycare services these centers provide. For the
over 22 million patients currently served by CHCs, it is
important that these centers are adequately staffed.
Another bill we will consider today would reauthorize the
poison control center grant program. I understand that poison
exposure is a leading cause of unintentional injury in the
United States, and poison control centers help to reduce the
number of deaths and the severity of illness caused by
poisoning.
Finally, I am glad that we are considering the National All
Schedules Prescription Electronic Reporting (or ``NASPER'')
Reauthorization, which I coauthored with my colleague from
Kentucky, Mr. Whitfield. This legislation helps States set up
prescription drug monitoring programs in order to combat
prescription drug abuse, which is a growing epidemic in the
United States. It is critical that we continue support for this
program through Federal funding.
Thank you to the many Members who have led these important
efforts by introducing these bills. I look forward to hearing
from our witnesses on these important public health issues.
Thank you.
Mr. Pitts. The Chair----
Mr. Shimkus. I am reclaiming my time. Now I would like to
recognize Mr. Whitfield from the great State of Kentucky for
the remainder of the time.
Mr. Pitts. All right. Two minutes.
OPENING STATEMENT OF HON. ED WHITFIELD, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF KENTUCKY
Mr. Whitfield. Thank you very much. I appreciate it so
much. And Chairman Pitts, I want to thank you for holding this
hearing on this important topic, including H.R. 3528, the
NASPER reauthorization as part of the discussion today. I would
like to thank our witnesses for being here, particularly Dr.
Steven Stack, a fellow Kentuckian from Lexington who will be
testifying about the importance of prescription drug monitoring
programs.
As you know, NASPER was authorized some years ago, we have
always had a battle like a lot of other programs in obtaining
sufficient money to make NASPER be what it should be. There is
a companion program over at the Department of Justice,
prescription drug monitoring, but it is more focused on law
enforcement. So, I want to thank the chairman very much for
working with us on this reauthorization and look forward to the
testimony of the witnesses today.
And Mr. Shimkus, thank you so much for yielding me the
time.
Mr. Shimkus. And I yield back, Mr. Chairman.
Mr. Pitts. The Chair thanks the gentleman. I now recognize
the ranking member of the full committee, Mr. Waxman, 5 minutes
for opening statement.
OPENING STATEMENT OF HON. HENRY A. WAXMAN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mr. Waxman. Thank you very much, Mr. Chairman. I appreciate
you holding this hearing. These bipartisan bills strengthen
Department of Health and Human Services programs on addressing
new public health challenges. It is critical that this
committee continues its focus on public health issues since our
actions in the public health arena have such a far-reaching
effect on the Nation's health.
We have a number of bills. H.R. 610 deals with the Lyme and
other tick-borne diseases. There is the Sudden Unexpected Death
Data Enhancement and Awareness Act. We have the H.R. 1098,
Traumatic Brain Injury Reauthorization, and we have, also
considering H.R. 1281, the Newborn Screening Saving Lives
Reauthorization Act, the Family Health Care Accessibility Act
of 2013 allowing community health centers to offer malpractice
insurance coverage to their employees, contractors, and
officers with the--under the Federal Tort Claim Act; H.R. 3527,
the Poison Center Network Act, which reauthorizes the Poison
Control Program; and then H.R. 3528, the National All Schedules
Prescription Electronic Reporting Act--Reauthorization Act of
2013.
I have longer statements about each of these, which I will
put into the record, but I want to commend a Democratic and
Republican Energy and Commerce Committee members and their
staffs who have authorized a number of the bills before us, Mr.
Pallone, Mr. Engel, Green, Whitfield, Terry, and Murphy, and
acknowledge the sponsors of the other measures, Congresswoman
Roybal-Allard, Congressman Pascrell, Congressman Smith.
We have a panel of stakeholders to share their views on
these bills, and I want to thank each of you for--in advance
for your testimony. I don't want to be parochial, but Dr.
McCabe was from California, but wherever you are from, we have
a national perspective to protect the public health, and so I
want to welcome all of you here today.
Mr. Chairman, I also hope we can work together on getting
the administration's input on each of these measures as they
move forward. With those comments, I will yield back the
balance of my time.
[The prepared statement of Mr. Waxman follows:]
Prepared statement of Hon. Henry A. Waxman
Mr. Chairman, thank you for convening this afternoon's
hearing on bipartisan bills that strengthen existing Department
of Health and Human Services programs or address new public
health challenges. It is critical that this committee continues
its focus on public health issues, since our actions in the
public health arena have such a far-reaching effect on the
Nation's health.
H.R. 610 would establish a committee to advise the
Secretary of HHS on the Department's Lyme and other tick-borne
disease activities. The Centers for Disease Control and
Prevention reports there has been a reemergence of tick-borne
disease--with hundreds of thousands of estimated annual Lyme
disease cases alone.
The Sudden Unexpected Death Data Enhancement and Awareness
Act or H.R. 669 addresses three, devastating health events--
stillbirth, the unexpected loss of an infant, and the
unexpected death of a child.
Thousands of expectant mothers and parents experience a
later-stage pregnancy loss or death of an infant due to causes
that are not immediately apparent. Less is known about the
unexplained deaths of young kids, like the daughter of one of
today's witnesses--Ms. Crandall. H.R. 669 seeks to improve our
understanding of the causes of these tragic events--and, in
turn, help us to better prevent them.
H.R. 1098 or the Traumatic Brain Injury Reauthorization Act
of 2013 extends TBI surveillance and research activities, and
programs for services and supports administered across the
Department. Millions of Americans experience a traumatic brain
injury each year. One goal of H.R. 1098 is to allow the
Department to better coordinate TBI activities with other HHS
programs focused on increased access to community supports.
We are also considering H.R. 1281, the Newborn Screening
Saves Lives Reauthorization Act of 2013. This legislation
extends newborn screening services and related activities
forconditions like sickle cell anemia--that are not otherwise
apparent at birth and, if left untreated, can cause severe
disability or even death.
The Family Health Care Accessibility Act of 2013, H.R.
2073, would allow community health centers to offer malpractice
coverage available to their employees, contractors, and
officers under the Federal Tort Claims Act to health
practitioner volunteers. In doing so, H.R. 2073 seeks to
eliminate possible disincentives for health practitioners to
volunteer. The House passed similar legislation during the
111th Congress.
H.R. 3527 or the Poison Center Network Act reauthorizes the
Poison Control Program. Federal funding for the Nation's poison
control centers supports the provision of treatment advice on
poisonings to health professionals and the public; educational
activities; and poison exposure surveillance efforts. The
poison control network plays an important role in reducing the
number of injuries and deaths resulting from poisoning and
overdose
The final bill is H.R. 3528, the National All Schedules
Prescription Electronic Reporting Reauthorization Act of 2013,
a second measure related to overdose. The NASPER
Reauthorization Act would extend the Department's prescription
drug monitoring program first authorized in 2005 and strengthen
the interoperability of State NASPER programs.
During a June subcommittee hearing, witnesses described how
programs like this one help respond to the prescription drug
overdose epidemic. Congress also passed legislation nearly
identical to H.R. 3528 during the 111th Congress. I want to
commend the Democratic and Republican Energy and Commerce
Members who authored a number of the bills before us--Ranking
Member Pallone and Congressmen Engel, Green, Whitfield, Terry,
and Murphy. I'd also like to acknowledge the sponsors of the
other measures--Congresswoman Roybal-Allard, Congressman
Pascrell, and Congressman Smith.
We have a panel of stakeholders to share their views on
these bills, and I want to thank each of the witnesses in
advance for their testimony. Mr. Chairman, I also hope that we
can work together on getting the administration's input on each
of these measures as they move forward.
Mr. Pitts. The Chair thanks the gentleman. We will work
with you, and I would like to seek unanimous consent at this
time to enter six documents into the record. First, a letter
from the National Association of Boards of Pharmacy; second,
statement from the National Association of Chain Drug Stores;
thirdly, a letter from the National Organization for Injury and
Violence Prevention; fourthly, letter from the Infectious
Diseases Society of America; fifth, letter from National
Association for States United for Aging and Disabilities; and
sixth, a letter from the Alliance to Prevent Abuse of
Medicines. Without objection, so ordered. They will be entered
into the record.
[The information follows:]
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Mr. Pitts. On our panel today we have introduce them at
this time. Dr. Marsha Ford, president of the American
Association of Poison Control Centers; Dr. Steven Stack,
immediate past chair, Board of Trustees, American Medical
Association; Dr. Drew Nagele, Board of Directors, Brain Injury
Association of America; Dr. Edward McCabe, senior vice
president, Chief Medical Officer of the Office of Medicine and
Health Promotion, March of Dimes Foundation; Ms. Patricia
Smith, president of the Lyme Disease Association; Ms. Laura
Crandall, cofounder of Sudden Unexplained Death in Childhood
Program; and finally, Mr. Robert MtJoy, CEO of Cornerstone
Care.
I thank each of you for coming. Your prepared testimonies,
written testimony will be placed in the record. You will each
have 5 minutes to summarize your testimony, and so at this
time, the Chair recognizes Dr. Ford for 5 minutes for a summary
of her opening statement.
STATEMENTS OF MARSHA FORD, PRESIDENT, AMERICAN ASSOCIATION OF
POISON CONTROL CENTERS; STEVEN J. STACK, IMMEDIATE PAST CHAIR,
BOARD OF TRUSTEES, AMERICAN MEDICAL ASSOCIATION; DREW NAGELE,
BOARD OF DIRECTORS, BRAIN INJURY ASSOCIATION OF AMERICA; EDWARD
R.B. MCCABE, SENIOR VICE PRESIDENT AND CHIEF MEDICAL OFFICER,
MARCH OF DIMES FOUNDATION; PATRICIA V. SMITH, PRESIDENT, LYME
DISEASE ASSOCIATION, INC.; LAURA CRANDALL, PROGRAM DIRECTOR,
SUDDEN UNEXPLAINED DEATH IN CHILDHOOD PROGRAM; AND ROBERT
MTJOY, CHIEF EXECUTIVE OFFICER, CORNERSTONE CARE, INC.
STATEMENT OF MARSHA FORD
Ms. Ford. Thank you. Chairman Pitts, Ranking Member
Pallone, and members of the subcommittee, I appreciate the
opportunity to testify today in support of the reauthorization
of the National Poison Center Program entitled ``America's
Poison Center Network Act.'' I am Dr. Marsha Ford, director of
the Carolina's Poison Center In Charlotte, North Carolina and
president of the American Association of Poison Control
Centers, otherwise known as the AAPCC. The AAPCC is comprised
of 56 regional poison centers that serve 100 percent of the
population of the United States providing 24/7 real-time case
triage and management advice for diverse multitude of poisoning
problems.
I am pleased to have join me today Kathy Jacobitz, who is
director of the Nebraska Regional Poison Center in Omaha,
Nebraska, and John Fiegel, the interim executive director of
the AAPCC. And on behalf of all AAPCC member centers, I wish to
express our appreciation to Mr. Terry and Mr. Engel and to the
very talented health staff, including respectably, Nick
Magallenes and Heidi Ross for their leadership in helping craft
this bipartisan reauthorization legislation.
The National Poison Center network legislation was first
passed in Congress in 2000 and has been reauthorized twice. It
is a highly successful truly public-private Federal, State,
local partnership. It reduces unnecessary hospital visits,
hospitalizations, and health care cost in our country by 1.8
billion annually, according to the 2012 Lewin Group cost-
benefit study and as restated in HRSA's annual report to
Congress earlier this year.
The Poison Center Program is currently authorized through
Public Law 110-377, the Poison Center Support, Enhancement, and
Awareness Act of 2008. This program is legislatively mandated
to do three things: Supply funding to support operations of
poison centers, establish and maintain a single national toll-
free number, and implement a nationwide media campaign to
educate the public and health care providers about poison
prevention, poison center services, and the toll-free number.
These three essential components comprise what is being
requested for funding in this reauthorization bill.
What key services do poison centers provide? I will briefly
describe four: First, we provide assistance in triaging,
diagnosing, and managing victims of a multitude of toxic
exposures and public health emergency situations. We do this
for the public, for health care providers, for emergency
response personnel, and others. We do this for all people,
including underserved and vulnerable populations. We do this
for all ages and all types of problems. We do this for
physicians and other health care providers who increasingly
utilize poison centers for toxicological expertise. Emergency
911 dispatchers refer poison-related calls to poison centers,
often avoiding unnecessary EMS transports.
Altogether, in 2012, the Nation's poison centers handled
nearly 3.4 million cases and made 2.7 million follow-up calls
to ascertain the status of the caller or the patient. And we do
this at no cost to the caller.
Poisoning is a major public health problem and is now the
leading cause of injury death in the United States, having
surpassed motor vehicular deaths. Poisonings are expensive. In
2009, an estimated 4.4 billion was spent on health care for
poisoned patients. Poison centers are an antidote for some of
the spending. In 2011, use of the Nation's poison centers
avoided an estimated 1.7 million unnecessary health care visits
and decreased hospital lengths of stay for some patients.
A second function of poison centers is the collection of
poison exposure and disease surveillance data. Multiple Federal
agencies use this data for surveillance to identify,
characterize, and track public health threats. One example,
early recognition of the toxicity of unit dose, laundry
detergent packets in small children. In a great sense of
timing, The Wall Street Journal had a front page article about
this in yesterday's paper.
Poison centers also provide case triage and management
advice in specific public health events. Something I am very
excited about, the AAPCC and its member centers are working
with the CDC to design a coordinated national network that will
provide telemedicine services during a severe influenza
pandemic to triage cases and selectively provide anti-virile
medications, thus reducing medical surge on health care
facilities and allowing more appropriate use of these medical
resources.
Once created, this network may be capable of providing
services during other public health emergencies.
A third function, poison centers provide poisoning
prevention education to the public and clinical education to
health care providers.
And finally, a fourth function, participation in emergency
preparedness. The surveillance system that I mentioned earlier
enables detection and monitoring of public health and
environmental emergencies involving toxic exposures and
pandemics. The value of poison centers has been demonstrated in
national emergencies such as the Gulf Oil spill, the H1N1
outbreak, and the Fukushima Nuclear Accident. Medical
toxicologists from poison centers assist the Department of
Homeland Security with risk assessment of chemical threats.
Tens of millions of American families and tens of thousands
of health care professionals have used poison centers services,
experiencing firsthand the value of the Nation's poison center
network.
Thank you again for this opportunity to highlight the value
and importance of the National Poison Center Program. The
Nation's poison centers, your poison centers strongly support
the proposed Terry-Engel reauthorization legislation of the
poison center program that is before the subcommittee today.
Thank you.
Mr. Pitts. The Chair thanks the gentlelady.
[The prepared statement of Ms. Ford follows:]
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Mr. Pitts. I now recognize Dr. Stack, 5 minutes for an
opening statement summary.
STATEMENT OF STEVEN J. STACK
Mr. Stack. Thank you, Mr. Chairman. My name is Steven
Stack, an emergency physician from Lexington, Kentucky, and the
immediate past chairman of the board of trustees of the
American Medical Association. To begin, thank you, Chairman
Pitts, Ranking Member Pallone, and members for convening to
examine public health legislation to help local communities.
The AMA appreciates the opportunity to provide our views on
H.R. 3528, the National All Schedules Prescription Electronic
Reporting Reauthorization Act of 2013. Reauthorization and full
appropriations for NASPER are urgently needed to ensure that
physicians across our Nation have this critical tool to combat
the scourge of prescription drug abuse while ensuring that
patients in pain are relieved of their suffering.
The personal and economic costs of prescription drug abuse
far outweigh the annual appropriations of H.R. 3528. One study
puts the potential overall cost of prescription drug abuse at
more than $70 billion a year. The escalating cost of diverted
prescription drugs to the overall health care system and the
financial impact to the rest of the economy are enormous. The
human cost and personal tragedies that could be averted with
the help of NASPER are no less profound.
Since 2005, the AMA, along with many other health care
stakeholders, have supported NASPER as an essential resource to
combat prescription drug abuse and diversion. Unfortunately,
the appropriations to fully fund, modernize, and optimize
NASPER prescription drug monitoring programs, or PDMPs have not
kept pace with the escalation in abuse and diversion.
Physicians struggle firsthand with this epidemic and fully
understand the human cost and toll it takes on families and
entire communities. It is a formidable challenge. We have an
ethical obligation to treat patients with pain, and also to
identify inappropriate drug seekers in order to prevent abuse,
overdose, and death. This is not easy. In fact, it is often
downright difficult. Physicians face many barriers in their
efforts to maintain a balance.
The AMA agrees with other impacted stakeholders that this
problem requires a multi-pronged coordinated strategy. We
support robust implementation of a combination of Federal and
State policies to address both the supply and demand side of
this epidemic. Modernized and fully interoperable PDMPs are a
key component of these efforts. Though nearly a decade has
passed since NASPER was enacted, the full promise has not been
achieved.
In theory, PDMPs were to provide reliable and actionable
clinical information to physicians in State public health
agencies. In reality, although $60 million was authorized over
a 5-year period, it was not until 2009 that Federal funds were
appropriated under NASPER to support the State adoption of
PDMPs.
H.R. 3528 is urgently needed now. The vast majority of
physicians still don't have access to reliable real-time
information about controlled substance prescriptions patients
have obtained and filled from other prescribers. In fact, it is
only in the past couple of years that most States have finally
passed legislation establishing PDMPs. Even now, the majority
of PDMPs still are not real-time, interoperable, or available
at the point of care as a regular part of physician workflow.
In far too many States, PDMPs remain underfunded, understaffed,
and technologically inadequate. Recent years, a financial belt
tightening within States has led to anemic funding, and in some
cases, defunding of PDMPs, even as this public health scourge
ravages our communities. We must do better.
To be helpful, it is essential that PDMPs are easy to use
and provide reliable information to guide sound clinical
decisions. When prescription drug monitoring programs support
clinical decision making, the efficacy is remarkable. As a
pilot, Ohio placed PDMPs in emergency departments and found
that 41 percent of prescribers, given reliable PDMP data,
altered their prescribing decisions. Accurate PDMP data can
directly inform sound clinical decisions, thereby reducing
diversion and abuse, while still ensuring that patients receive
the care they need.
The AMA is committed to combating prescription drug abuse
and diversion. Further, we believe a public health focus is
essential to achieve to successful and sustainable solutions.
By working together, we can and will resolve this crisis. The
AMA appreciates the opportunity to provide our views on the
essential role of modernized PDMPs. Action is needed now. I
implore you to urgently reauthorize and fully fund NASPER.
Thank you.
[The prepared statement of Mr. Stack follows:]
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Mr. Pitts. The Chair thanks the gentleman. Now recognizes
Dr. Nagele for 5 minutes for an opening statement.
STATEMENT OF DREW NAGELE
Mr. Nagele. Chairman Pitts, Ranking Member Pallone, and
members----
Mr. Pitts. Is your light on?
Mr. Nagele. Yes.
Mr. Pitts. Just make sure. OK. Pull it up.
Mr. Nagele. And members of the Health Subcommittee, thank
you for inviting me to testify on reauthorization of the
Traumatic Brain Injury Act, H.R. 1098.
My name is Dr. Drew Nagele. I am the executive director of
Beechwood NeuroRehab, which serves clients from Pennsylvania,
New Jersey, and Delaware. For over 30 years, I have worked with
individuals who have brain injury and their families as a
licensed psychologist. I serve on the board of the Brain Injury
Association of America, and I am also testifying on behalf of
the National Association of State Head Injury Administrators
and the National Disability Rights Network.
2.4 million Americans of all ages, races, and income levels
sustain TBIs each year. The injury can change the way a person
can think, move, talk, feel, and act, and can increase the risk
for other brain-related diseases and disorders. The TBI Act is
a comprehensive law combining research, data collection,
prevention, public awareness, consumer advocacy, and service
system coordination for this vulnerable and growing population.
The law authorizes NIH to conduct basic and applied research,
and for CDC to conduct surveillance, prevention, and public
education programs. The Health Resources and Services
Administration makes grants to States and territories to
develop or expand service system capacity based on the specific
needs in each State. Currently, 20 States and territories are
receiving these grant funds.
Many States work to strengthen screening and identification
methods among unserved or underserved persons with brain
injury. In Pennsylvania, we are screening prison inmates and
connecting them to services and supports when they are released
from prison. Minnesota has instituted a similar program, and
Virginia is screening its juvenile justice inmates.
Several States use grant funds for TBI-specific training
and professional development. In New Jersey, State grant funds
were used to train members of the clergy. Grants allow States
to coordinate and streamline TBI service systems. In
Pennsylvania and Tennessee, we have linked hospitals and
schools, and in Alabama we have improved Federal mechanisms for
accessing existing services.
Additional State grants have helped leverage resources in
other Federal and State programs and nonprofit organizations.
Michigan and West Virginia evaluated Medicaid utilization and
then applied for home and community-based waivers that are
tailored to the needs of individuals with brain injury and are
more cost-effective for the State. By far, the most common use
of State grants is assisting persons with brain injury and
their families through outreach, information, education,
service coordination, and resource facilitation.
Arizona, Colorado, Idaho, Iowa, Indiana, Massachusetts,
Michigan, Missouri, Nebraska, New York, Virginia, West
Virginia, and Texas have all used TBI Act grants to outreach to
children and youth, active duty military and veterans, Native
Americans, older adults, multi-cultural families, and the
thousands of civilians who fall through the cracks each year.
The TBI Act also authorizes formula-funded grants to protection
and advocacy organizations to ensure that people with TBI live
full and independent lives. Known as PATBI, this programs helps
people navigate complex service systems and investigates
instances of abuse and neglect.
Recently, the Disability Rights Network of Pennsylvania
represented a client who has a TBI as a result of domestic
violence and was being denied appropriate services by her
service coordinator. Our P&A helped her change to a new service
coordinator, and now she is getting the services she needs.
In this reauthorization, BIAA, NASHIA, and NRDN all
recommend the State grant program and the PATBI program be
elevated within the Department of Health and Human Services,
preferably the Administration for Community Living, to better
integrate individuals with brain injury into HHS' aging and
disability initiatives.
Now, more than ever, it is imperative that we foster
collaboration and maximize the limited resources at both the
State and Federal levels. This can only be achieved if we work
hand-in-hand with other aging and disability populations. The
TBI stakeholders believe elevating the program to ACL is the
best way to increase effectiveness and cost efficiency. Thank
you.
[The prepared statement of Mr. Nagele follows:]
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Mr. Pitts. The Chair thanks the gentleman. Now recognizes
Dr. McCabe, 5 minutes for an opening statement.
STATEMENT OF EDWARD R.B. MCCABE
Mr. McCabe. Good afternoon, Chairman Pitts, Ranking Member
Pallone, and members----
Mr. Pitts. Is your mic on? There you go.
Mr. McCabe. Good afternoon. And thank you. My name is Dr.
Edward McCabe, and I am senior vice president and chief medical
officer for the March of Dimes Foundation, a unique partnership
of scientists, clinicians, parents, and volunteers working to
prevent birth detects, preterm birth, and infant mortality. I
appreciate this opportunity to testify today on newborn
screening, one of the great public health victories of the 20th
Century and one which continues to save infants lives every
day. Newborn screening is a critically important and highly
effective public health program for testing every newborn for
certain genetic, metabolic, hormonal, and functional conditions
not authorize apparent at birth.
Approximately one in every 300 newborns has a condition
that can be detected through screening. Newborn screening
detects conditions that, if left untreated, can cause
disability, developmental delay, illness, and even death. If
diagnosed early, many of these disorders can be managed
successfully, which not only reduces the physical burden of
disease but can also help to reduce the associated economic
burden on families, communities, and the government.
This year, our Nation is celebrating the 50th Anniversary
of newborn screening. The March of Dimes is deeply proud of our
decades' long history of funding research that has led or
contributed to the development of numerous newborn screening
tests. Together, these tests have allowed us to preserve the
health and wellbeing of thousands of children.
The remarkable progress of newborn screening over the past
2 decades persuaded Congress to pass a Newborn Screening Saves
Lives Act in 2008. The law renewed and updated various programs
that underpin States' newborn screening efforts as well as the
Secretary's Advisory Committee on Heritable Disorders. That law
expired at the end of fiscal year 2013 and is due for a 5-year
renewal. Passage of the Newborn Screening Saves Lives
Reauthorization Act is essential to the continued success of
newborn screening programs across our Nation.
Most importantly, reauthorization will ensure the
uninterrupted continuation of the Secretary's Advisory
Committee on Heritable Disorders and its work. Maintaining and
updating the recommended uniform screening panel that States
use to adopt and implement new conditions is vital and ongoing
and planned evidence review should not be delayed. The Newborn
Screening Saves Lives Reauthorization Act also extends
important programs at HRSA, CDC, and NIH, including Seven
Genetics and Newborn Screening Regional Collaborative Groups
and the National Coordinating Center, which improves the
availability, accountability, and quality of genetic services
and resources for individuals with genetic conditions; the
Critical Congenital Heart Disease Newborn Screening
Demonstration product program, a program to support the
development, dissemination, and validation of screening
protocols and newborn screening infrastructure for point-of-
care screening specific to congenital heart defects; Babies
First Test, a national educational resource center for newborn
screening, the Newborn Screening Technical Assistance and
Evaluation Program, or NewSTEPs, which serves as a technical
assistant program for State newborn screening systems; the
Newborn Screening Quality Assurance Program, a comprehensive
CDC program devoted to ensuring the accuracy of newborn
screening; and the Hunter Kelly Research Program at the NIH,
which supports grants and contracts to develop and improve
technologies related to newborn screening.
Today, 42 States and the District of Columbia require
screening for at least 29 of the 31 treatable core conditions.
Millions of babies have been screened for dozens of disorders,
and in thousands of cases, the health and well-being of those
children has been preserved. Newborn screening represents a
model Federal-State public health partnership that has produced
extraordinary improvements in child health.
We must not allow this vital public health effort to
falter. On behalf of over 3 million March of Dimes volunteers
and countless other organizations and families, I urge the
members of this subcommittee to cosponsor and support H.R.
1281, the Newborn Screening Saves Lives Act, and the committee
to report the legislation this fall. We look forward to working
closely with the committee and chamber leadership to ensure it
can be passed as soon as possible by both the House and the
Senate.
Thank you for your attention to this vitally important
child health issue. The March of Dimes stands ready to assist
you in ensuring that newborn screening programs will continue
to protect the health and well-being of newborns for many years
to come. Thank you.
Mr. Pitts. The Chair thanks the gentleman.
[The statement of Mr. McCabe follows:]
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Mr. Pitts. Now recognize Ms. Smith, 5 minutes for an
opening statement.
STATEMENT OF PATRICIA V. SMITH
Ms. Smith. Thank you, Mr. Chairman and committee members. I
appreciate the opportunity to testify on the establishment of
Lyme and Tick-Borne Diseases Advisory Committee. In 2009, the
CDC indicated that Lyme surpassed HIV in incidents, and that
was followed by a 2013 announcement confirming a 10-fold
underreporting of Lyme cases, estimating 300,000 Lyme cases
annually. A 2001 NIH-sponsored study found the impact of Lyme
on physical health status was at least equal to the disability
of patients with congestive heart failure or osteoarthritis
and, was greater than those with type II diabetes or recent
myocardial infarction. If you couple those facts with Lyme
spreading worldwide now to 80 countries and the discovery of
many new emerging tick-borne pathogens carried by many
different ticks, then the passage of H.R. 610 is long overdue.
Other tick-borne diseases in the U.S. include anaplasmosis,
babesiosis, bartonellosis, ehrlichiosis, Rocky Mountain Spotted
fever, Colorado tick fever, Q fever, tick paralysis, tularemia,
Powassan encephalitis, STARI, which is a Lyme-like disease
carried by a different tick, Rickettsia parkeri--parkeri,
excuse me, Ricketsiosis found increasingly along the Gulf Coast
and in the South, Borrelia miyamotoi, which was an organism
that produced disease in Russia, the first cases, and now it
has been found here, and Eschar-associated illness, Ricketsia
species 364D in the Pacific region, and a newly-discovered
tick-borne virus in Missouri called Heartland.
So, my education on Lyme began almost 30 years ago as a New
Jersey Board of Education member whose district had a large
number of students and staff out with the disease. At that
time, only a few ticks were recognized as major health threats
to humans. Now the list includes Ixodes scapularis, which is
the deer or black-legged tick you probably know, Amblyomma
americanum, the lone start tick, Dermacentor variabilis, the
American dog tick, Dermacentor andersoni, the Rocky Mountain
wood tick, Ixodes pacificus, which is the western black-legged
tick, Amblyomma maculatum, the Gulf Coast tick, and Dermacentor
occidentalis, the Pacific Coast tick.
Now, one tick bite can produce more that one disease at the
same time. My Lyme work, including 17-plus years as president
of the volunteer-run national nonprofit Lyme Disease
Association keeps me in close contact with patients nationwide.
Lyme's complexity and difficulty in diagnosis have exacerbated
the plight of patients and their families, many of which
contain more than one Lyme victim. Medical bills rise, jobs are
lost, education is interrupted. Children are at the highest
risk of acquiring Lyme, and based on CDC's Lyme reported case
numbers from 2001 to 2010 by age, the LDA estimates 37 percent
of reported cases were children. So, if you use 1990 through
2011 CDC reported numbers and you adjust that for the 10-fold
underreporting, we then found that 1,599,000--excuse me,
1,590,499 children have developed Lyme over that time period,
and unfortunately, there are probably more children that were
diagnosed, but they weren't included in that CDC surveillance
figure because that is a very narrow surveillance criteria not
meant for clinical diagnosis.
A 2001 Columbia study showed children with Lyme had
significantly more psychiatric disturbances and cognitive
deficits, even after they were controlled for anxiety,
depreciation, and fatigue. So Lyme in children may be
accompanied by long-term neuropsychiatric disturbances
resulting in psycho, social, and academic impairment. Parents
indicated 41 percent of children had suicidal thoughts. 11
percent had made a suicide gesture.
Early intervention and appropriate treatment are the
answers for Lyme patients to prevent development of chronic
disease, also known as Post Treatment Lyme Disease, late
disseminated Lyme disease, persistent Lyme, Post Lyme Disease
Syndrome, et cetera. The discussions continue on the
justification for various terms for chronic Lyme, but we can't
allow semantics to eclipse the need for research on chronic
Lyme, the area producing the most human suffering, but yet it
is receiving the least research funding.
According to a new Columbia study, based upon the 10-fold
underreporting and 10 percent of newly infected and treated
patients developing symptoms, which persist for more than 6
months, the actual incidents of new chronic Lyme cases, which
they call Post Treatment Lyme Syndrome, is 30,000 annually for
chronic Lyme development.
Many major health threats, including chronic fatigue, have
an advisory committee. Lyme doesn't, placing patients and
advocates at a great disadvantage. We have lobbied for a
research agenda, which includes more effective treatments that
are diagnostic, including detection of active infection.
Borellia Burgdorferi was recognized to cause Lyme almost 33
years ago, yet the two-tier testing system endorsed by CDC,
though it is very specific for Lyme, 99 percent and gives few
false positives, the tests have a uniform low sensitivity, 56
percent, meaning 88 out of 200 patients with Lyme are missed.
Mr. Pitts. Summarize, please.
Ms. Smith. Excuse me?
Mr. Pitts. Your time has expired. Could you summarize?
Ms. Smith. Oh, I am sorry. I was so busy, I didn't realize.
I am sorry, Mr. Chairman. Thank you.
Mr. Pitts. Thank you.
[The prepared statement of Ms. Smith follows:]
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Mr. Pitts. The Chair now recognizes Ms. Crandall for 5
minutes for opening statement.
STATEMENT OF LAURA CRANDALL
Ms. Crandall. Good afternoon. Thank you. I am very grateful
to have this opportunity to speak with you regarding the Sudden
Unexpected Death Data Enhancement and Awareness Act. The
problems that the bill seeks to address were first made known
to me through a very personal experience. I recall July 30th,
1997 as a beautiful, beautiful gorgeous summer day as I sat out
on our front steps waiting to awaken my daughter Maria from her
nap. She had her 15-month checkup scheduled for later that
morning, but I went to--when I went to wake her in her crib, I
found Maria not breathing and blue. I called 911 on speaker
phone, I started CPR, and even though the police arrived
immediately and care was intervened immediately, she was
transported to the hospital, heroic efforts. Maria could not be
revived. A thriving, happy, walking, talking, beautiful little
girl had died. We returned home from the hospital to find the
police waiting for us with lots of questions and needing to
investigate our home.
A medical investigator from the ME's office called and came
over the next morning to take pictures and ask many more
questions and asked me to replay the most horrific moment of my
life, how I found my daughter. Over the next few days, it was
all we could do to plan her funeral and try to keep ourselves
going on. I had no idea that during those same days that the
investigation of Maria's death was the most crucial. I did not
know that what was and what was not done at that time would
have such a lasting impact on myself and the rest of my family.
It is not like TV. Nothing happens quickly, and questions don't
get answered in an hour, if they ever do at all.
Two long years later, her investigation was concluded and a
cause for her death was never found. So I am left with the
understanding that her true cause of death was buried with her,
and that is a tragedy of missed opportunities that I live with.
I do not want to see this happen for other families in the
future.
Sadly, my story is not unique. There are many bereaved
families who could sit in this chair and tell you the same
story of tragedy, inexplicable loss, and missed chances. In
2010 alone, over 3,600 infants and nearly 200 toddlers died
suddenly and without explanation, and in over 26,000 babies
were lost to stillbirth. H.R. 669 efficiently addresses the
core problems present in our country today to allow us to
improve the collection of comprehensive and standardized
information to better understand these presently inexplicable
deaths.
Regarding stillbirths. Nearly half of the 26,000 are
unexplained. Its surveillance is very limited when utilizing
fetal death records, which are often incomplete and
insufficient. However, a CDC-funded effort to gather richer
data through some existing State birth defects surveillance
programs have shown success. Education of health care providers
and expectant families is also limited and needed to teach the
importance of known prenatal health initiatives.
In regards to infant and childhood deaths, coroner and
medical examiner offices have the authority in our country to
investigate all unexplained, unexpected, and suspicious deaths,
and therefore, the infant and child deaths that we discussed
today fall under their purview. In this regard, it is very
important to recognize that the death investigation systems in
our country vary immensely from State to State and often from
county to county. Therefore, the investigations that parents
encounter are directly tied to where they live and the
resources and the policies which their local medical examiner
or coroner officer utilizes.
The tracking of sudden unexpected infant death rates showed
a significant drop in the early 1990s with the initiation of
NICHD successful back-to-sleep campaign. Unfortunately, we have
not seen any additional progress in lowering those rates
further. As shown in the CDC graph I submitted in my written
testimony on page 8, I believe, our progress as a country has
seen a plateau for more than a decade, and if we are committed
to see a change and prevent more of these deaths in the future,
we must make a change in our process.
The medical legal death investigation of these cases needs
to be standardized, they need to be resourced, and the
resultant data centralized and specifically studied. The Sudden
Unexpected Death Data Enhancement and Awareness Act addresses
these critical limitations in order to provide answers to
families as well as our Nation overall.
Specifically, it would improve the effectiveness of current
activities of the CDC by removing the obstacles that impede
their success today. This will be achieved by improving the
surveillance of stillbirth by expanding on current programs,
improving the surveillance of infant and child deaths by
supporting comprehensive investigations, supporting evidence
based public awareness campaigns and providing relief to
families.
Thank you for allowing me to provide my views on this
important legislation, and on behalf of all the children gone
too soon, my Maria being one of very many, thank you forgiving
them a voice. I know they would want us to know what happened
to them and help create a future free of tragedies for others.
[The prepared statement of Ms. Crandall follows:]
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Mr. Pitts. Thank you. Thank you very much for your
testimony. Mr. MtJoy, you are recognized for 5 minutes for your
opening statement.
STATEMENT OF ROBERT MTJOY
Mr. MtJoy. Chairman Pitts, Ranking Member Pallone, and
distinguished members of the----
Mr. Pitts. Pull your mike a little closer if you could,
yes.
Mr. MtJoy. My name is Robert MtJoy, and I am chief
executive officer----
Mr. Pitts. Is it on? Is the red light on?
Mr. MtJoy. It is on now.
Mr. Pitts. OK. Good.
Mr. MtJoy. My name is Robert MtJoy. I am chief executive
officer of Cornerstone Care. On behalf of the 23,000 patients
that we serve, our 186 employees, the entire health center
community, including more than 22 million patients nationwide
served by health centers, I want to thank you for this
opportunity to testify today regarding the Family Health Care
Accessibility Act of 2013 and for this subcommittee's strong
support of health centers for many years.
In particular, I want to thank Congressman Murphy for
introducing this important legislation that would benefit
health centers and their patients across the country by
extending the Federal Tort Claims Act medical malpractice
coverage to licensed health care professionals who volunteer
their services at health centers.
Health centers are community-owned, nonprofit entities
providing primary medical, dental, and behavioral health care.
By statute and mission, health centers are located in medically
underserved areas or serve medically underserved populations.
Health centers are also directed by patient-majority boards,
ensuring care is locally controlled and responsive to each
individual community's needs. Health centers provide primary
care to all residents of their communities, regardless of their
ability to pay or insurance status and offer services on a
sliding fee scale.
To date, there are over 1,200 health centers located across
the Nation at more than 9,000 urban and rural health locations.
Without their local health center, these communities and
patients would often be without any access to primary care.
Health centers have a demonstrated track record of improving
the health and wellbeing of their patients, while at the same
time, reducing unnecessary avoidable and wasteful use of health
resources. Health centers reduce preventable hospitalizations,
emergency department use, as well as the need for more
expensive specialty care.
Cornerstone Care was formed as a direct result of citizens
who organized a board of directors and raised funds in 1978 to
provide health care where before none had existed. The first
doctors joined the organization in 1981. Dental care, soon
after, in a small church building in a neighboring community.
Thirty-five years later, Cornerstone Care provides a full range
of primary and preventive health care services in Greene,
Washington, and Fayette counties in southwestern Pennsylvania
through its eight facilities, a mobile unit, and a teaching
health center.
Regarding the bill of interest to the committee today, by
way of background, in 1993, Congress extended the Federal Tort
Claims Act coverage to health center grantees by deeming them
Federal employees for the purposes of medical malpractice
coverage. The extension of the FTCA to health centers have
resulted in significant savings for health centers, savings
that have been used to expand access to care for millions of
patients.
There are health care professionals who want to assist
health centers in serving their communities and addressing this
unmet need by volunteering their services. However, the high
cost of medical liability insurance often provides to be too
burdensome for the provider and the health center, preventing
these volunteers from doing so.
While health centers are engaged in many workforce
development initiatives, one immediate solution to alleviate
this workforce shortage is the use of volunteer providers. By
extending FTCA coverage to include volunteer providers, there
will be more providers available to meet the needs of millions
of patients who still lack care.
Recruitment and retention of health care providers is one
of the greatest challenges I have. And unfortunately, the
looming critical shortage of primary care physicians will be
more profoundly felt in rural areas like mine. We have got an
aging physician population getting ready to retire, and this
bill allows us to take advantage of this valuable resource.
Mr. Chairman, there is significant unmet needs in our
communities that health centers could address. The Family
Health Care Accessibility Act is vital to the effort of
addressing the Nation's primary care shortage. I would be
remiss if I also forgot to mention two other vital programs
that support the goal of creating medical homes for underserved
Americans: The National Service Corps and the Teaching Health
Centers Graduate Medical Education Program. These programs play
important roles in addressing primary care workforce shortages
and most--and both must be authorized soon if they are to
continue.
We look forward to working with you and other members of
this subcommittee to improve access to primary care and reduce
the overall health care costs in our community and across the
country.
[The prepared statement of Mr. MtJoy follows:]
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Mr. Pitts. The Chair thanks the gentleman. That concludes
the opening summaries of our witnesses. We will now begin
questioning by the members. I will recognize myself 5 minutes
for that purpose.
Dr. Nagele, since you are from Pennsylvania, can you
describe for us how the Federal TBI State Grant Program
impacted the State of Pennsylvania and its TBI population?
Mr. Nagele. Yes. In Pennsylvania, we have had a HRSA grant
for many years now, and one of the functions that we have used
it for is training and education. We have trained many
different types of people on what brain injury is and how to
help people with brain injury to access brain injury services
which are available. We had started training mental health
workers and prison personnel, and the work that we did with the
prison personnel have actually led us to another grant
opportunity with the Pennsylvania Commission on Crime and
Delinquency, and so the initial TBI Act funds helped us to
leverage and get another grant where we are actually in the
prisons now doing screening of inmates who are about to be
released, and for those who are determined to have a brain
injury, which is about 70 percent in our early----
Mr. Pitts. 70 percent?
Mr. Nagele. 7-0 percent, yes.
Mr. Pitts. What is the predominant reason for all the brain
injuries?
Mr. Nagele. Mostof them are mild repeated brain injuries
that have never been diagnosed. So these inmates are not
thinking of themselves as having had a brain injury. They are
just thinking they got in a fight or they were in a car wreck
or they were in a fall. They were never treated for these
injuries, and as we are learning from the NFL studies, repeated
mild brain injury can lead to much more serious problems in
later life, and so these prisoners have had brain injury, but
it has never been diagnosed, and our current work is to connect
them with brain injury services when they leave the prisons so
that they have every chance of success in the community and
they don't end up back in prison.
Mr. Pitts. Thank you.
Ms. Crandall, I found your testimony very moving. H.R. 669
calls for the improvement of death scene investigations in the
case of sudden unexplained death in childhood, including the
collection of medical information, description of the sleep
position, environmental factors. Would collecting this
information significantly lengthen the time it takes to
complete the current investigation?
Ms. Crandall. No. And the guidelines currently exist for
scene investigation through the CDC, were first created in the
mid 1990s and then revised in 2005, I believe. Those guidelines
are out there, but they are not universally utilized for
infants, and that information is very helpful to the
pathologist prior to them performing the autopsy, so they know
what may be a concern and whatnot. So those guidelines are out
there right now. Those are ideally captured within, on the day
of the death, when the death investigator goes to the place
where the infant or child died and interviews the caregivers
and collects that important data. So, it would not increase the
length of time.
Mr. Pitts. Do you know if local police or other law
enforcement authority support these changes?
Ms. Crandall. I believe in the last legislative session, I
know that the--there was a National Sheriffs Association, I
believe, that endorsed the bill. In general, again, death
investigations vary so greatly. In some areas, local law
enforcement are the deathinvestigators, and in other areas,
they are medical legal death investigators from the medical
examiner's office or coroner's office doing an investigation in
parallel, so it varies from jurisdiction to jurisdiction on how
these would be carried out, but the information from law
enforcement is very helpful to them in terms of giving them a
guidebook of what to follow.
As you can imagine, these are emotionally and very chaotic
scenes. It is very difficult. It is some of the most difficult
investigations that death investigators say they need to
respond to as well as law enforcement because the scene is
completely disturbed by the time they get there. So, their
ability to effectively interview a distraught parent, to get
that accurate information of what really happened really takes
an important skill set, and that is why the training for these
death investigators is so important. It is really a unique
highly skilled ability that they need to have to be able to
collect this information and do it in the most compassionate
way for the families.
Mr. Pitts. Thank you.
Ms. Smith, one of our colleagues, who does not serve on the
Energy and Commerce Committee, Chris Gibson from New York's
19th District, has been a tireless advocate for his
constituents on the issue of Lyme disease, and he has submitted
a question that he would like me to ask on his behalf.
Ms. Smith, you mentioned the concentration of existing
research dollars and the lack of diversity and coordination in
Lyme research, and this was a helpful analysis. Can you
identify any areas of progress first, and what has worked and
been helpful and what has not?
Ms. Smith. I am sorry. I have a little bit of hearing
impairment. Could you just repeat the last portion of that
question?
Mr. Pitts. Yes. What has worked and has been helpful and
what has not worked or been helpful?
Ms. Smith. I am sorry, in regards to?
Mr. Pitts. As far as areas of progress----
Ms. Smith. Oh, OK. I am sorry.
Mr. Pitts [continuing]. In your analysis.
Ms. Smith. OK. So as far as areas of progress, I think what
has been helpful is in recent times that I think there has been
more agency interest and more agency coordination in focusing
on the amount of disease across the country. And so I think
that because of that, the amount and the diversity of the
disease, I mentioned the number of tick-borne diseases that are
being transmitted, and so on and so forth, I think that that
has all come into play to begin to focus research, not just on
Lyme disease, but on other tick-borne diseases. How do patients
react if they have more than one disease? You know, how are
they able to diagnose? Because many of them don't have tests to
diagnose, unfortunately, with, they don't have particular
treatments for certain viral diseases.
And so I think the fact that now that the information is
being more freely shared about these tick-borne diseases and it
is coming in from a lot of university studies that are being
done, not just in the United States, but throughout the world,
I think that has been extremely useful.
Mr. Pitts. Thank you. My time has expired. I am sorry to go
over.
Mr. Pallone, you are recognized 5 minutes for questions.
Mr. Pallone. Mr. Chairman, I wanted to submit for the
record endorsement letters from 24 organizations. This is with
regard to the H.R. 669.
Mr. Pitts. Without objection, so ordered.
[The information follows:]
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Mr. Pallone. And I wanted to mention that--because you
mentioned law enforcement and, you know, their support for the
bill--and I just wanted to mention that 3 of those in the 24,
the National Association of Medical Examiners, the
International Association of Coroners and Medical Examiners,
and the Society of Medicolegal Death Investigators, are, you
know, enforcement, just for your information.
But before I get to questions, Mr. Chairman, I wanted to
address both you and the subcommittee for a moment. I just
wanted to be sure to express my disappointment that the
subcommittee didn't give the administration enough time to be
here today to have input on these seven public health bills. As
you know, many of the bills cross a number of agencies at HHS,
and it is critical that they are able to give us their
expertise on these proposals.
So I was going to ask if you could commit to me that we
will arrange for some way to have the administration's
technical views be heard by our staff and members.
Mr. Pitts. I am informed that we are in the process of
getting technical information from the administration.
Mr. Pallone. All right. And then, Mr. Chairman, I also
wanted to enter into the record a statement by Congressman Bill
Pascrell with regard to his bill, the Traumatic Brain Injury
Reauthorization Act.
Mr. Pitts. Without objection, so ordered.
[The information follows:]
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Mr. Pallone. Thank you, Mr. Chairman.
Let me see, I wanted to start with Ms. Crandall. I don't
know if I can get through all these, but I am going to try.
I wanted to thank you again for being here and, you know,
sharing the heartwrenching story about the loss of your
daughter Maria. And in your testimony, you also shared some
sobering statistics that over 3,600 infants and 200 toddlers
die suddenly each year. You noted that 26,000 women experience
stillbirth. Clearly we need to do something to address this.
The Sudden Unexpected Death Data Enhancement Awareness Act
that I sponsor contains provisions that will build upon the
current CDC activities and ultimately help prevent these deaths
from occurring. And I am sure I don't have to tell you that we
are in a difficult fiscal climate. As much as I would like to
advance all the provisions in H.R. 669, I recognize that that
may not be feasible. So I just wanted to ask you, in light of
these constraints, what do you believe are the most important
areas or provisions for us to address?
Ms. Crandall. I strongly feel that the most important areas
are the comprehensive investigations that would then allow for
effective surveillance and then public awareness and
intervention strategies. I think if we don't fix the issue of
these cases initially being investigated thoroughly, we will
never have the good data that will then later on help public
health and research, and as well as these families on an
individual basis. But there are many efforts going on right now
that have huge obstacles in front of them because they are
dealing with broken data. I think we need to go back and
prioritize the investigations.
Mr. Pallone. All right. Thank you so much really again for
your testimony and all your support in getting this moved.
Dr. Nagele, if I could ask you, in your testimony you
discussed movement of State TBI and protection and advocacy
programs currently administered by the Health Resources and
Service Administration to the Administration for Community
Living, and you noted this would help foster greater
collaboration between TBI and aging and disability programs.
You also cited some additional benefits of a potential
reorganization. For example, you mentioned greater
collaboration on TBIs among older adults resulting from falls.
Can you elaborate on how movement of TBI programs to ACL
will be beneficial for individuals with TBI and their families?
Mr. Nagele. Yes. We believe that elevation to the ACL will
help people across the age span to better recognize the effects
of brain injury and to coordinate with the many services that
sit within ACL, within intellectual disabilities and with
aging, and that this opportunity will actually give more
ability to leverage with other existing programs.
Mr. Pallone. All right. Thank you.
I think I am going to get in all three questions.
Mr. Stack. Dr. Stack, you know, I have been involved with
NASPER for a long time with Mr. Whitfield. It is clear from
your testimony that NASPER and other prescription drug
monitoring programs, or PDMPs, are an important tool in helping
to address the problem of nonmedical use of prescription drugs.
As you know, State PDMPs collect, monitor, and analyze
information on scheduled or controlled prescription drugs. You
noted PDMPs provide valuable info for physicians, pharmacists,
and other health providers to support appropriate prescribing
and treatment for pain management. And you also mentioned the
importance of NASPER's public health focus.
So if I could ask you, why do you believe the public health
focus of NASPER is so important, and how does that differ from
the emphasis of other monitoring programs?
Mr. Stack. Well, I would say there is a difficult balance
between two different issues here. One is treating patients who
have pain. And the Institute of Medicine estimates there are as
many as 100 million Americans who live with chronic daily pain
that is inadequately treated. And then the difficulty of an
epidemic, and I think we would all agree it is an epidemic, of
prescription drug abuse and the horrible damage and devastation
that causes.
So it is a public health magnitude kind of problem, because
we have to address competing needs in society, the treatment
for one, which has grave consequences when misapplied or
misused for other folks.
We would suggest that it is a public health as opposed to
principally a public justice issue or a legal issue, because
these are our fellow men and women and children who require
treatment and care for various problems and maladies. And we
believe very strongly that it is a health-related issue, that
if we attend to that particular concern and work together as a
society, we will get far further in helping our fellow men and
women than incarcerating them all and pursuing them through the
justice system. So we can't emphasize strongly enough that we
believe the health-based approach is the proper approach.
Mr. Pallone. And I appreciate that. That is very helpful.
Thank you very much.
Thank you, Mr. Chairman.
Mr. Pitts. The Chair thanks the gentleman.
Now recognize the gentleman from Kentucky, Mr. Whitfield, 5
minutes for questions.
Mr. Whitfield. Well, thank you, Mr. Chairman. And I would
like to thank all of the witnesses for joining us today and
giving your views on this important legislation.
Dr. Stack, I would like to follow up on the prescription
drug monitoring programs as well. As you know, the first
program came out of the Appropriations Committee and was placed
over at the Department of Justice and was primarily focused on
law enforcement issues, abuse. And then Mr. Pallone and I and
others, Mr. Pitts and others, authorized the national
Prescription Drug Monitoring Program. And as you have indicated
in your testimony, ever since we started the program we have
had difficulty getting the necessary appropriations, and we
still are having difficulty doing that. We tried to merge the
programs, and we have had some difficulty even doing that.
But I guess the good news is that it is my understanding
that now 47 States do have a prescription drug monitoring
program. Certainly they are not all the same. But in your
testimony, I think you referred to in Ohio in the emergency
rooms, that you said 40 percent of providers, based on
information they have received on the prescription drugs,
change their prescription orders.
Mr. Stack. Right. So in that particular study they found
that 43 percent of prescribers produced less or prescribed no
opioids at all based on the information they received.
There is a second side to that, though. When I and my
colleagues practice, there are quite a number of times when we
look in the database and find that a patient has received no
opioids ever. And in fact that helps to validate and help us to
feel more comfortable that a short course of treatment is
appropriate----
Mr. Whitfield. Right.
Mr. Stack [continuing]. In that patient. It helps both
ways.
Mr. Whitfield. Well, do you feel that the KASPER program in
Kentucky is doing well or do you have any suggestions of how we
could improve it or----
Mr. Stack. So the KASPER program in Kentucky has come a
long way. As recently as 2011, there were strong prohibitions
in who could see it, who could share it----
Mr. Whitfield. Right.
Mr. Stack [continuing]. Enter it into the medical record.
That has rapidly evolved, as you know, with House Bill 1 in the
State of Kentucky and then the legislation the following year,
in 2013, that made some corrective actions. So I would say that
the KASPER program in Kentucky is evolving well.
It did teach and show, I believe, something we feel
strongly about, which is these tools are so rapidly evolving
and are so uneven and heterogeneous across the country that
mandating the use of these programs is not the appropriate
approach; that, in fact, if we would work to standardize them,
make them interoperable, and have realtime data, meaning I ask
the database for an answer and I get it quickly, that the
clinicians will use these tools when they function well. And we
are only just beginning down that path.
Mr. Whitfield. So you don't think mandating is necessary
then?
Mr. Stack. I don't think so. I think with countless other
things, physicians have shown when the technology works and
helps patients, we adopt it----
Mr. Whitfield. Yes.
Mr. Stack [continuing]. And when it is broken and doesn't
work, we generally don't find it useful.
Mr. Whitfield. Yes.
Mr. Stack. We are getting to a better place. But NASPER is
essential, because the States are so all over the map for the
immaturity of their programs and the fact that they don't
communicate with each other yet----
Mr. Whitfield. Right.
Mr. Stack [continuing]. That the relatively small
investment on the Federal Government could help to jump start a
profound evolution in advancement in these programs.
Mr. Whitfield. Yes. Well, I really appreciate your taking
time to come up and talk about it. As I said, we appreciate the
issues that all of you have discussed. And as we move forward,
Dr. Stack, maybe we could get together sometime and get some
additional ideas from you on ways that we can try to merge
these programs so that they can be as efficient and
technologically advanced as possible.
Mr. Stack. The AMA is definitely committed to working on
this issue, and we would be happy to do that.
Mr. Whitfield. Thank you so much.
Oh, I yield to Dr. Burgess.
Mr. Burgess. Oh, I am sorry. I have to leave.
Mr. Whitfield. Oh. OK. Got to leave.
Mr. Pitts. The Chair thanks the gentleman.
Now recognize the gentleman from Texas, Mr. Green, for 5
minutes for questions.
Mr. Green. Thank you, Mr. Chairman.
And I want to thank our panelists and thank the Chair and
the ranking member for listing this number of bills on our
schedule for today, because each of them address a certain
part. And some of us who have been on the Health Subcommittee
for years have dealt with these before, and, again, we
appreciate your time this afternoon.
And I would like to thank Mr. MtJoy for taking time to
testify for the Family Health Care Accessibility Act, which
would greatly benefit health centers and their patients. That
just happens to be the one that Congressman Murphy and I have
been working on. It seems like this is our third Congress. We
passed it out of the House twice, and the Senate hasn't taken
it up.
In your testimony, you mention issues facing community
health centers regarding recruitment and retention of
healthcare providers. There are programs like the National
Service Health Corps, but even the current number of National
Health Service Corps scholarships and awards, there is a
primary care shortage. Can you give us some examples of why
health centers have difficulty retaining or recruiting
providers?
Mr. MtJoy. Well, even with the recent investments in
expanding the National Health Service Corps, the demand still
outpaces the supply of healthcare providers. And this is
particularly true in rural areas, such as where I am from.
Healthcare providers generally aren't from rural areas, whereas
we try a number of initiatives to what I will call grow your
own. Certainly recruitment and retention is one of the largest
or most challenging areas of providing healthcare, certainly
for us.
Mr. Green. And I know there are a lot of programs over the
years have tried to encourage, you know, loan forgiveness and
things like that to have physicians go to rural areas. How will
the Family Health Care Accessibility Act help health centers
meet that growing demand for primary health care?
Mr. MtJoy. Well, again, it will expand our provider base.
And as we struggle to meet the demands of our patients,
recruitment and retention of providers, expanding our primary
provider base is one more method of helping us do that.
Mr. Green. And I know, I represent a very urban area in
Houston, Texas, and our federally qualified health centers have
some of the same challenges, even though we have three medical
schools within 50 miles, of attracting primary care physicians.
You stated that one untapped resource for meeting the demand
for primary care is volunteers, and especially retiring or
retired health practitioners. If Congress were to pass the
Family Health Care Accessibility Act, what type of
practitioners would you hope and expect to volunteer their time
in your health centers?
Mr. MtJoy. Well, I have spent or focused most of my
attention on physicians, but in addition to physicians, for
instance at Cornerstone Care and other community health centers
across the country, this also includes nurse practitioners,
physician assistants, dentists, licensed social workers, et
cetera. So, again, it crosses the gamut of provider types.
Mr. Green. And I have always said if I can get a primary
care or a person, not even a volunteer, into community health
centers, they would know they can actually practice medicine
and maybe make a decent living for their families.
Can you explain to the members of the subcommittee how
training in health centers increase the likelihood that an
individual would be more likely to stay in the community where
they complete their training?
Mr. MtJoy. Well, absolutely. We try to expand our provider
base by providing training opportunities for a variety of
disciplines that I have just mentioned, from PAs to nurse
practitioners, et cetera. Recently Cornerstone Care became one
of the new teaching health centers, and we have got our first
class of residents now in the program and recruiting our
second.
We have found that when healthcare providers, particularly
physicians, do their training or part of their training at
community health centers, they are two-thirds more likely to
return to that type of practice following their training.
Mr. Green. OK. Thank you, Mr. Chairman. I will yield back a
few seconds. But again, thank you for scheduling this bill
today.
Mr. Pitts. The Chair thanks the gentleman.
Now recognize the gentleman from Virginia, Mr. Griffith, 5
minutes for questions.
Mr. Griffith. Thank you very much, Mr. Chairman. I, too, am
very appreciative of the fact that we have all of these
witnesses here, and the testimony that you gave on each of the
various issues was very important and enlightening.
Mr. Chairman, I will take a minute to talk about Lyme
disease and ask a question of our witness on that, Ms. Smith.
But Lyme disease is a growing problem throughout our State, but
it is endemic in northern Virginia. Our representatives from
the local, State, and Federal levels are working aggressively
to raise awareness about this issue for our citizens and
medical providers to encourage prevention, quick diagnosis, and
treatment. My colleagues and I in the Virginia delegation,
particularly Congressmen Frank Wolf and Rob Wittman, appreciate
you having this hearing. I should also mention that Barbara
Comstock is working on this in the Virginia House of Delegates,
as well.
Ms. Smith, H.R. 610 requires that Tick-Borne Diseases
Advisory group include members that represent State and local
healthcare professionals, individuals who have firsthand
experience with tick-borne disease, and representatives of a
tick-borne voluntary organization. How do you think this will
help to enhance communication amongst the Federal agencies?
Ms. Smith. Well, I think, unfortunately, what has happened
right now is oftentimes what I see is that the agencies--now,
they are trying to do a good job in their area, but it is not
always communicated into other areas as to what kinds of
projects they are doing. Plus, there is really not a national
strategy to attack tick-borne diseases. And so over the 30
years what I have seen, the numbers have grown, you know,
greatly, the numbers of ticks, the numbers of diseases.
And so if you put people on there who have perspectives--
for example, we have no clinical treating physicians have a
perspective right now, are able to give their perspective to
the Federal Government about what research projects they feel
are important. They are seeing a lot of people with very
serious chronic Lyme disease, which is different than just
getting a tick bite and getting, you know, a few weeks and
getting better.
So they are seeing people with these debilitating symptoms.
They have all this knowledge that they have gleaned from many
years of treatment, and they are able, for example, to look at
the results of Lyme disease testing, and sometimes, even though
the test may come back and it says it is negative, they are
able to read the bands from their clinical experience and
determine, yes, these people really do have Lyme disease and
they require extensive treatment.
And so they would be able to take this kind of knowledge,
because one of the biggest factors, and I think everybody
agrees on this, we need testing that is, you know, a gold
standard. We don't have that now. We are missing so many
patients, and they go on to develop these intense symptoms that
are not only causing them a lot of health disability, but are
also causing obviously great, tremendous costs to their
families, to the government, et cetera.
So if the clinicians could provide their input, it would be
a better chance that we could get diagnostic tests. Also, tests
need to be found that will determine whether someone has active
infection.
Mr. Griffith. And you believe that this bill will help
that. And I do appreciate it and appreciate your testimony. I
am going to move on to another subject, because, unfortunately,
while I would like to talk to each one of you, I only have a
few minutes.
That being said, I will move to the NASPER bill and pick up
where Congressman Whitfield left off. It is a very serious
issue in lots of the country. It is particularly a serious
problem in my district in southwest Virginia. A study done
there by the United States Attorney's Office for the Western
District of Virginia found serious problems, that this was a
major impact on our region.
And the study also cited that just four counties, which
have 1 percent of Virginia's population, accounted for the
Virginia State Police spending 25 percent of their statewide
undercover purchase funds buying prescription medications in
those four counties. Likewise, the chief medical examiner's
office in Roanoke says that deaths are up by 40 percent as a
result of the activities with prescription drugs.
Doctor shopping contributes to this spread. I think we need
to do more to prevent this practice, which is why I support the
lock-in mechanism that many private insurers are utilizing, and
I think that would be helpful.
Dr. Stack, is there anything you would like to in 23
seconds tell us what you didn't touch on when you were
answering Mr. Whitfield?
Mr. Stack. No. We share that this is critical, but you just
touched in your own testimony how it is a variable problem that
affects different communities more intensively, which is why we
don't believe a one-size-fits-all for some of the other
strategies is appropriate, because it will misapply strategies
in some areas and under-apply them in different places. So we
believe NASPER, everyone agrees, all the stakeholders agree
these PDMPs are an essential tool. The other strategies, we
could have a longer discussion another day about where they may
be best applied.
Mr. Griffith. I appreciate it very much. And with that, Mr.
Chairman, I yield back.
Mr. Pitts. The Chair thanks the gentleman.
Now recognize the gentleman from New Jersey, Mr. Lance, 5
minutes for questions.
Mr. Lance. Thank you very much, Mr. Chairman. Good
afternoon to the panel.
To Dr. McCabe, the Senate bill, the companion bill,
contains a priority review process for nominating new diseases
that meet certain criteria. Would you please discuss with us
this provision and its impact on the screening process and the
health of children.
Mr. McCabe. Yes. That is a difference between the two
bills. We feel that it is important as the March of Dimes that
there be timely, swift consideration of new entities, and these
were submitted from the Secretary's Advisory Committee. So
there needs to be rigorous scientific integrity around that,
but we do feel that there needs to be swift movement once
action is taken by the Secretary's Advisory Committee.
Mr. Lance. Thank you.
We are hearing increasingly that in the not-too-distant
future, next generation DNA-based sequencing may allow the
rapid analysis of a newborn's genome, possibly replacing some
or even all of the current newborn screening techniques that
rely on biochemical changes in the blood. Do you see that is
happening in the near term and do you have any thoughts on the
advantages or disadvantages of genome sequencing compared to
current techniques?
Mr. McCabe. That is something I have watched very closely,
because my lab was the first to show that you could get DNA----
Mr. Lance. Yes.
Mr. McCabe [continuing]. From the newborn screening spots.
The NIH has funded, both NHGRI and NICHD, have funded four
institutions to look at this problem, not only to look at the
technology and can you sequence in a reliable fashion from the
DNA in the newborn screening, but all of the ethical, legal,
social implications, and policy issues around that. So I think
this is important work that you bring attention to, and it is
being funded now by two institutes that are heavily invested in
this, and we are all looking forward to the results.
Mr. Lance. Do you think that H.R. 1281 should be altered in
any fashion to take into account what we were just discussing?
Mr. McCabe. I think that the research has just begun. Those
are 5-year research projects that were just established. I
think there would be opportunities in the future. Certainly I
think it is important to recognize that there may be other
technologies, such as DNA sequencing, that will come along.
I think it is also important to recognize that there is
NICHD authorization for funding for the project to continue to
develop new technologies in the future. But, yes, it should
encompass new technologies, but I think that is one of the
things that the Secretary's Advisory Committee would allow. It
allows the community to be nimble if new technologies do come
along.
Mr. Lance. Thank you very much.
To Dr. Ford, can you point to a specific example of a
situation where a poison center's being located within a
community or geographic area has benefited public health
surveillance?
Ms. Ford. Yes. Well, first of all, I think that in many
ways with regard to emergency preparedness planning, working
with EMS, the public health outreach, the education of the
healthcare providers in a region that are done through the
regional poison center are very, very important. It was one
study done that showed that as the distance between a poison
center and the caller increases, it is less likely that that
caller is going to call that poison center.
Mr. Lance. Yes.
Ms. Ford. And I believe that that probably needs to be
studied further, but I believe that it is true that you are
more likely to use a service that you are more intimately
associated and familiar with.
Mr. Lance. Thank you to this very distinguished panel. And
I yield back the 30 seconds I have.
Mr. Pitts. The Chair thanks the gentleman.
That concludes the questions of the members present. Other
members will have questions, and we will have some follow-up
questions. We will submit those to you in writing. We ask the
witnesses to please respond promptly.
Thank you very much. This has been very important
information, very important issues. We thank you for coming
today.
I remind members that they have 10 business days to submit
questions for the record, and that would be by the close of
business on Friday, December 6th.
Thank you very much for your attendance.
Without objection, the subcommittee is adjourned.
[Whereupon, at 4:28 p.m., the subcommittee was adjourned.]
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